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CDC recommends Pfizer-BioNTech booster for 12-to-17-year-olds

Walensky says the dose will provide 'optimized protection’ against the omicron variant

The CDC now backs booster shots for people ages 12 to 17. (Frederic J. Brown/AFP/Getty Images)
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The Centers for Disease Control and Prevention recommended Wednesday that children ages 12 to 17 get a Pfizer-BioNTech coronavirus vaccine booster, expanding protection to adolescents and teens as surging omicron infections threaten to disrupt schools and workplaces across the country.

Director Rochelle Walensky endorsed a recommendation that came several hours earlier from the agency’s vaccine advisory panel that urged the boosters for 10 million young people. The advisers’ unequivocal message about the importance of boosters makes it simpler for federal health officials to send a strong and unambiguous message to parents and others.

“It is critical that we protect our children and teens from COVID-19 infection and the complications of severe disease,” Walensky said in a statement that echoed the strong language used by many panel members. “I encourage all parents to keep their children up to date with CDC’s COVID-19 vaccine recommendations.”

Walensky cited data showing that boosters “help broaden and strengthen protection against omicron and other variants” — reiterating the administration’s oft-repeated message that vaccines, as well as boosters, reduce severe disease against an explosively spreading variant that has hospitalized children as well as adults. The omicron variant is thought to be less virulent than delta but its high transmissibility has produced many infections, some of which have resulted in severe disease.

The CDC had previously said 16- and 17-year-olds were eligible for a booster but stopped short of saying they should get them. But it quickly embraced the advisory panel’s 13-to-1 vote to expand the recommendation to include older teens, as well as the 12-to-15-year-olds who were the primary focus of the meeting.

Health officials’ decision came as the United States continued to see quick spread of omicron, with the seven-day case average nearing 580,000 on Wednesday. Covid hospitalizations neared 109,000 on average, though the number of people in intensive care units is climbing more slowly. The number of pediatric inpatients with covid-19 is now well above the previous highs set over the summer during a delta surge.

The spike in cases among children has caused widespread concern about school closures. On Wednesday, Chicago Public Schools canceled classes after the Chicago Teachers Union voted to defy the city’s in-person learning order and return to remote work.

As cases have soared, the CDC has also faced criticism from doctors and public health experts frustrated by the agency’s recently updated quarantine and isolation recommendations. The American Medical Association on Wednesday said that the new guidelines — which allow asymptomatic people to return to work after five days of isolation without a negative test result — are “not only confusing, but are risking further spread of the virus.” The CDC has said that lab-done tests are often misleading when people have had an infection for several days, and that rapid test results may be ambiguous in other ways.

On Jan. 5, Dr. Rochelle Walensky defended the decision to omit testing, saying that rapid tests are “for qualitative purposes, not quantitative purposes.” (Video: Reuters)

Wednesday’s booster recommendation by the Advisory Committee on Immunization Practices and subsequent endorsement by the CDC are part of a broader effort by federal officials to expand protection for children as well as adults. It follows the action Monday by the Food and Drug Administration authorizing the Pfizer product for 12-to-15-year-olds.

About 5 million adolescents ages 12 to 15 are now eligible for booster shots for the first time because they are five months past their second shots. Of the 16.7 million adolescents in the United States, about half are fully vaccinated. The FDA and CDC have already shortened the window that people who received the Pfizer vaccine must wait to get a booster shot from six months to five months. An additional 4.7 million 16- and 17-year-olds are fully vaccinated with Pfizer shots.

Much of the debate Wednesday by CDC panel members centered on whether to give a full-throated endorsement to booster shots for adolescents by recommending that they should get them, as opposed to recommending they may get them.

Several panel members supported a strong recommendation for the shots because of the omicron surge.

“I believe in the vaccine, I believe that it has been safe, I believe that we can prevent serious infection,” said Pablo Sanchez, a pediatrics professor at Ohio State University.

“I think we need to highlight that children are not okay,” said Kathy Poehling, a professor of pediatrics at Wake Forest School of Medicine. “Covid is overwhelming our hospitals and our children’s hospitals.”

Another panel member, Oliver Brooks, chief medical officer for Watts Healthcare in Los Angeles, called boosters a powerful tool in the toolbox. “If it’s a hammer, we should hit that nail hard,” he said. “So, I am in favor of a ‘should’ recommendation.”

Panel members have also noted that complicated vaccine recommendations are confusing to the public and hard to put into practice. Simple recommendations that state people should get boosted “are much easier to understand, to communicate and implement,” said Matthew Zahn, medical director of the Orange County Health Care Agency, representing the National Association of County and City Health Officials.

The only member to vote no was Helen Keipp Talbot, an infectious-diseases professor at Vanderbilt University, who said she supported adolescents having access to boosters but felt the recommendation would detract from the more important goal of getting first shots to unvaccinated children.

“I just really want the U.S. to move forward with vaccinating all kids, so that all kids can go back to a normal life,” Talbot said. “I don’t think it’s fair for the 12-to-17-year-olds, who have been vaccinated, to risk myocarditis again for an unknown benefit,” she added, referring to the extremely rare cardiac side effect, mostly in boys and young men, linked to the mRNA vaccines.

Vaccine uptake among people ages 12 to 17 has slowed after an initial wave of eager parents got their teens vaccinated in the spring and summer, according to the Kaiser Family Foundation. About half of parents said their teen had gotten at least one dose as of November, before news of the omicron variant.

But as more information emerges on the potential impact of omicron in children, parents’ attitudes toward vaccinating their teenagers and younger children may change, CDC official Sara Oliver said.

The Food and Drug Administration on Jan. 3 authorized the use of a third dose of the Pfizer and BioNTech coronavirus vaccine for 12- to 15-year-olds. (Video: Reuters)

FDA officials have said the agency broadened access to boosters this week because real-world data and laboratory tests indicate the shots significantly strengthen protection, especially against the omicron variant, while posing minimal risk.

Officials cited data from Israel that found no new safety concerns when more than 6,000 youngsters ages 12 to 15 got a Pfizer booster five months after their second dose. There were no new cases of heart-related complications.

Both the FDA and CDC relied on data from Israel in shortening the interval between the second and third Pfizer shots for adolescents and adults from six months to five months.

In the United States, most incidents of post-vaccine myocarditis have occurred in adolescent boys and young men. Cases of myocarditis in adolescents appear to peak at ages 16 and 17. Most cases have been mild, with the average hospital stay lasting two days.

CDC officials also said data show covid-19 cases and hospitalizations are seven to 11 times higher in unvaccinated 12-to-17-year-olds, compared with vaccinated adolescents. But the estimates for vaccine effectiveness are primarily in the setting of the delta variant and may not represent the current situation with omicron.

Jacqueline Dupree contributed to this report.

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