December 2nd, 2021

To Our Valued Patients and The Residents of Huron and Perth Counties,

It is with great excitement that we are able to share the announcement that children aged 5-11 years are eligible to receive a vaccination against COVID-19. Like you, many of us are parents who have been eagerly waiting for Health Canada to approve a vaccine against COVID-19 for our children.

We recognize that many of you have questions about giving these vaccines to children. We want the best for our children, and it is completely normal to want as much information as possible prior to making a decision on whether or not to have your child or children immunized against COVID-19. We hope that the information and resources below will help you make that decision based on up-to-date, scientifically-based information.

A few things to remember:

  • COVID-19 is still circulating in our community and currently Ontario’s case counts are increasing steadily.
  • In Ontario, throughout the month of November, children aged 5-11 had a higher rate of new COVID-19 cases per 100,000 than any other age group. 1
  • Since September 2021, within the communities of Huron and Perth, there have been:
    • 64 school-based exposures
    • 5 school outbreaks (meaning transmission occurred in the school setting)
    • 4 school closures (schools may be closed due to uncontrolled transmission and/or lack of school capacity)

Some quick facts:

  • The dose of the Pfizer-BioNTech vaccine for children aged 5-11 is one third the dose given to teens and adults, as part of a different formulation. This is because younger children have stronger immune systems than adults so they don’t need as high a dose to mount a solid immune response.
  • Currently, a full series of this vaccine consists of 2 doses. This may change as evidence evolves. The National Advisory Committee on Immunization (NACI) has recommended that these doses be given 8 weeks apart in order to achieve the best long-term immune response possible, and to decrease the risk of potential myocarditis/pericarditis (see Common Question #1 below for more information).
  • Common side-effects for this vaccine are similar to those for other vaccines and may include discomfort at the injection site, headache, or fatigue. These symptoms usually resolve within a few days and can easily be treated with acetaminophen.

1 Public Health Ontario: https://www.publichealthontario.ca/en/data-and-analysis/infectious-disease/covid-19-data- surveillance/covid-19-data-tool?tab=ageSex ;

Reasons to have your child immunized against COVID-19:

  • While most children experience only mild symptoms with COVID-19, a small number do go on to develop severe disease requiring hospitalization and, unfortunately, a very few die. Over the course of the pandemic, in Canada, 10 children under the age of 12 have died2.
  • Multisystem inflammatory syndrome in children (MIS-C) is a severe complication of COVID-19 that most frequently occurs among children aged 5-11. Although this is a rare outcome in Canada, it is severe: nearly all cases require hospitalization and one third have required admission to the ICU. Currently, the estimated risk of MIS-C hospitalization for children aged 5- 11 in Ontario is roughly 1 in 2000 COVID-19 cases.3 A large international trial has shown that up to 3% of children with COVID-19 may go on to develop MIS-C4. As of early October 2021, 269 cases of MIS-C have been reported in Canada5.
  • Both children and adults can go on to develop “long-COVID”, a condition where symptoms last for several months. Studies have shown that prior to the emergence of the delta variant, 1-4% of children who tested positive for COVID-19 might go on to develop long-COVID. The true incidence and severity of long COVID in children is still unclear and studies are ongoing6.
  • Current data from children 5-11 vaccinated thus far show that The Pfizer-BioNTech vaccine is 90% effective at preventing symptomatic COVID-19 in kids7.
  • If kids don’t get COVID-19, they don’t pass it on to other family members who may be at higher risk for severe disease.
  • If your child contracts COVID-19, they will have to self-isolate for 10 days or more if unvaccinated, which can disrupt the entire household and beyond. That is 10+ missed days of school and other activities that likely could have been avoided by being immunized.
  • If your child is a close contact of someone diagnosed with COVID-19 (such as a classmate) and they are fully immunized, they currently do NOT have to self-isolate unless they develop symptoms. If they are not immunized, they must self-isolate for 10 days following their last exposure. If your child is not old enough to self-isolate alone from the rest of your family, then an adult will have to isolate with them.
  • If a household member develops ANY symptoms of COVID-19 and is awaiting results of a COVID- 19 swab, then all unvaccinated household members must stay home until a negative COVID-19 result is received. However, if your child is vaccinated, then they may continue to attend school despite a pending COVID swab in the home.
  • Children have experienced collateral harms from the pandemic. School disruptions, social isolation, and reduced access to academic and extra-curricular resources have had impacts on the mental and physical well-being of children and their families (source: NACI summary, Nov 19). Having your child immunized will help protect them from further such harms.

2COVID-19 Special Advisory Committee, 2021; Statistics Canada Leading causes of death, 2020; From https://www.ontariofamilyphysicians.ca/tools-resources/covid-19-resources/covid-19-vaccines/covid-19-vaccination-children-2021-11-26- session-slides.pdf

3https://www.ontariofamilyphysicians.ca/tools-resources/covid-19-resources/covid-19-vaccines/covid-19-vaccination-children-2021-11-26- session-slides.pdf
4 NACI Statement: Recommendation on the use of the Pfizer-BioNTech Vaccine in Children 5-11 years of age

5 Laverty et al, 2021; From https://www.ontariofamilyphysicians.ca/tools-resources/covid-19-resources/covid-19-vaccines/covid-19-vaccination- children-2021-11-26-session-slides.pdf

6 https://www.ontariofamilyphysicians.ca/tools-resources/covid-19-resources/covid-19-vaccines/covid-19-vaccination-children-2021-11-26- session-slides.pdf
7 NACI Statement: Recommendation on the use of the Pfizer-BioNTech Vaccine in Children 5-11 years of age

Below, you will find a few of the most common questions we have been receiving about COVID-19 vaccinations in kids and the answers to them. You will also find a list of reliable and up-to-date resources for any further questions you may have.

We understand that some of you may still not be sure whether immunizing your child or children is the right decision for you. As parents, physicians, and primary care providers we will be vaccinating our children because research has shown that it is safe and effective. We strongly encourage you to do the same. We are very happy to discuss this in more detail with any of our patients. If you have further questions or concerns, our doors are open and we look forward to discussing them with you.

Sincerely,

Dr. Rob Annis
Dr. Danielle Anstett
Dr. Greg Antoniadis
Dr. S. Appavoo
Dr. Kyle Armstrong
Dr. Jason Bandey
Dr. Kirsten Blaine
Dr. Rachael Berta
Dr. Peter Brooks
Dr. Alex Chun
Dr. M. Dawson
Dr. Jeff Dietrich
Dr. Sarah Donaldson
Dr. Gillian Edmonds
Dr. Farahnaz Farzadfar
Dr. Candi Flynn
Dr. Tamara Foster
Dr. Derek Gateman
Dr. Chuck Gatfield
Dr. Paul Gill
Dr. Kim Gilmour

Dr. Erin Glass
Dr. Ram Gobburu
Dr. Lauren Hayward
Dr. Sean Henderson
Dr. Jeff Hepburn
Dr. Deborah Josephson
Dr. Miriam Klassen
Dr. Agnieska Kluz
Dr. Laurie Komorowski
Dr. Victor Kulczycki
Dr. Veronika Kurtz
Dr. Vanessa Kustec
Dr. Ming Lam
Dr. Grace Langford
Dr. Sergio Lappano
Dr. Russell Latuskie
Dr. Shaun Marshall
Dr. Bonnie Marshall
Dr. Carolina Montiveros
Dr. Laurel Moore
Dr. Mark Moores

Dr. Mahrous Mousa
Dr. Shannon Natuik
Dr. Dan Noel
Dr. Michaela Ondrejicka
Dr. Neeraj Patel
Dr. J. Peel
Dr. Leanne Peters
Dr. Tina Pittman
Dr. Nadine Potvin
Dr. Andrew Prout
Dr. Justin Puntillo
Dr. Hema Purushotham
Dr. Sam Reaume
Dr. N. Rittenhouse
Dr. Sean Ryan
Dr. Peter Salsbury
Dr. Jon Schiedel
Dr. Phil Schieldrop
Dr. Elizabeth Seary
Dr. Loretta Seevaratnam
Dr. Raji Sextus

Dr. Megan Sherman
Dr. Stacey Snider
Dr. K. Spacek
Dr. S. Spacek
Dr. Liora Steele
Dr. T. Steinmann
Dr. Terry Suggitt
Dr. Jeremy Thimm
Dr. David Thompson
Dr. Tanya Thornton
Dr. William Thorpe
Dr. Jocelyn Traher
Dr. K. Treasurywala
Dr. Mike Trevail
Dr. Tamar Tsafnat
Dr. Patricia Uniac
Dr. Stephen Vander Klippe
Dr. Rex Warren
Dr. Evelyn Westen
Dr. Tania Wilson


Common Questions About COVID-19 Vaccinations in Kids 5-11 Years Old

  1. What are the SERIOUS side effects of COVID mRNA vaccines in children? In the Pfizer trials with kids aged 5-11 years no new serious side effects were noted. In people aged 12 and older, the rate of anaphylaxis (a serious allergy) to the Pfizer vaccine is 2-8 for every one million people. It has been noted in older children and young adults that there is a very small risk of developing myocarditis (inflammation of the heart) or pericarditis (inflammation of the sac around the heart) following vaccination with an mRNA vaccine for COVID-19. These adverse effects were most common in young males between the ages of 18 and 24, and the vast majority were mild cases treated with medications. NACI recommendations indicate that extending the interval between doses to 8 weeks may protect against the development of myocarditis/pericarditis. In contrast, myocarditis from COVID infection is far more common, more severe and more difficult to treat. In the nearly 2500 children who participated in the Pfizer trial, NO CASES of myocarditis or pericarditis were noted. It is expected that cases of myocarditis and pericarditis will be even lower in this age group, but our experts will be monitoring this carefully. It should be noted that in a trial this size, it is possible that VERY RARE side effects might not be identified initially. However, given the very real risks associated with COVID-19 we believe that the benefits of vaccination outweigh the risks.
  2. What are the LONG-TERM side effects of COVID-19 mRNA vaccines in children? We do not expect any long-term side effects to these vaccines in kids. The mRNA in the vaccine is disintegrated within 2 days, and the spike protein for which it codes is cleared within 2 to 3 weeks. All that remains are the antibodies that your body has learned to produce. We know that side effects tend to happen within 6 weeks of receiving the vaccine. Temporary disruptions in menstrual cycles have been noted, but these are short-lived and fertility is not affected. Additionally, mRNA vaccines have been used in humans for many years and no long-term effects have been noted.
  3. My child is terrified of needles. What can I do to help them get through this vaccination? Many children are afraid of needles. Some can be comforted with a mere hug and kiss from a caregiver or parent, but others have intense fears that need a bit more attention. You can prepare your child for their vaccination using the CARD system (comfort, ask, relax, distract). A medicated patch that numbs the skin can be purchased from your pharmacy, and may help your child feel less worried about the pain associated with injection. For children with more intense fears, there are several resources listed below that parents can use to help overcome those fears. Your primary care provider is also available to discuss these concerns with you. The Children’s Hospital at LHSC has a COVID-19 Vaccine Clinic that is available for children with severe anxiety, sensory needs that require low stimulus environments, and behavioural needs that require extra time. For more information: email: childrencovidvaccine@lhsc.on.ca or book an appointment at Children’s Hospital by going to http://www.covidvaccinelm.ca
  4. Is it safe to receive the COVID-19 vaccination at the same time as other vaccines, like the flu shot? Currently, the National Advisory Committee on Immunization (NACI) is recommending that in children aged 5-11, no other immunizations, including the flu shot, be administered 14 days prior to or after receiving a COVID-19 vaccine. This is a precaution that is suggested to avoid confusion about any potential side-effects a child may have following immunization. It is not a safety concern.
  5. When and how can I get a COVID-19 vaccine for my child? Huron Perth Public Health (HPPH) is ready to go! Appointments are currently open for booking. Family-friendly clinics will be running in Stratford and Goderich throughout the month of December, and are bookable at http://www.hpph.ca/vaccinebooking. Further clinics are planned for the new year, so stay tuned. Additionally, some primary care offices, family physicians and pharmacies will be offering COVID-19 vaccines. Please check their clinic websites or contact their offices for details.
  6. I want to vaccinate my child, but can’t afford to get to where there are clinics and the related costs, what can I do? Call the HPPH COVID Intake Line at 1-888-221-2133 ext 3299 to discuss support options.

Resources for parents and caregivers:

“Max the Vax”: a GREAT resource for parents and kids, produced by the Canadian Medical Association and the Ontario Association of Children’s Aid Societies. Can be found at (http://www.oacas.org/what- we-do/communications-and-public-engagement/maxthevax/)

The University of Waterloo School of Pharmacy has some great Q&A’s on COVID-19 vaccination in kids:
https://uwaterloo.ca/pharmacy/sites/ca.pharmacy/files/uploads/files/faq_covid- 19_vaccines_for_children.pdf?fbclid=IwAR3ym6pRB46o1wovPWOn3q1UiItSC1bSeUb4BcI_i75VgfsUBWV5Vbp4sXw

https://uwaterloo.ca/pharmacy/sites/ca.pharmacy/files/uploads/files/myocarditis_and_pericarditis_aft er_covid-19_vaccines.pdf?fbclid=IwAR1BDcB71sEPhf00T_F8r3_I_Wzf-DSyuOjpVC7L9e9-2Dd4VDTzYO2v6bE

https://uwaterloo.ca/pharmacy/sites/ca.pharmacy/files/uploads/files/now_or_wait_covid- 19_mrna_vaccines_for_children_aged_5_to_11_years.pdf

From SickKids Hospital:

https://www.aboutkidshealth.ca/COVID-19

https://kidshealthfirst.ca/

https://www.sickkids.ca/vaccineconsult

For Kids who are afraid of Needles:

https://kidsinpain.ca/wp-content/uploads/2021/03/Vaccine-Pain-Needle-Fear-Resources-2.pdf

https://immunize.ca/card-kids-and-adolescents

CARD system:

https://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/vaccine/CARD_Vaccina tion_Handout.pdf


Click the link below to view/download the PDF of the original letter:

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