Girl in doctor's office receiving a vaccine from a healthcare professional Photographer: Heather Hazzan; Wardrobe: Ronald Burton; Props: Campbell Pearson; Hair: Hide Suzuki; Makeup: Deanna Melluso at See Management. Shot on location at One Medical.

What is the risk of severe disease from coronavirus in children and teens?

The risk for severe disease in children is relatively low. The rate of severe pediatric disease is roughly comparable to the risk of severe disease from flu, according to a recent report from NPR.

Health experts recommend parents and guardians continue to take precautions with unvaccinated children, including mask-wearing and social distancing.

At what age can kids or teens receive a COVID-19 vaccine?

The national Centers for Disease Control and Prevention recommends everyone 12 and older receive a vaccine.

Federal law permits the U.S. Food and Drug Administration commissioner to allow unapproved medical products to be used in emergencies when there are “no adequate, approved and available alternatives.” Because the pandemic is a global emergency, the FDA considers authorizations for COVID-19 vaccines. 

The Pfizer-BioNTech vaccine is the only vaccine currently approved under emergency use authorization for anyone 12 years of age. Moderna continues to test the vaccine in anticipation of possible approval later this year.

Clinical trials are currently underway for younger children, though there is no specific date when vaccines will be approved for them. Pfizer has stated it believes it will have enough data to apply for authorization by September, though that may not include the youngest children. 

Where can kids and teens get their shots? 

Shots are available at national retailers CVS and Walgreens as well as at local health departments for free. The N.C. Department of Health and Human Services’ website shows available vaccine sites. 

The state’s COVID-19 vaccine hotline (888-675-4567) is available Monday through Friday from 7 a.m.-7 p.m., and Saturday and Sunday from 8 a.m.-4 p.m.

There is no cost for the vaccine in North Carolina, and no proof of insurance is required.

How do these vaccines compare to adult vaccines?

The Pfizer vaccines approved for children 12-15 are exactly the same as the vaccines already approved for individuals 16 and older. They contain the same amount of vaccine, require two doses to confer full immunity and require the same time interval between the two doses. 

How effective is the Pfizer vaccine in kids?

Very effective. The clinical trials for 12- to 15-year-olds included 2,260 teens. At the end of the trial, 18 who received the placebo shot ended up contracting COVID-19 while none of those who received the vaccine became ill.

While no vaccine is 100% effective, the trial and subsequent follow-ups showed teens developed a robust immune response to vaccination. 

What is known about safety and side effects?

The safety and efficacy of these vaccines have been trialed in thousands of 12- to 15-year-olds to ensure that the dosage confers a strong and safe immune response.

Some short-term side effects should be expected, as it appears that children experience the same side effects at roughly similar frequencies as adults. Pfizer said 12- to 15-year-olds in its clinical trials showed side effects “generally consistent with those observed in young adults.

According to an FDA fact sheet that accompanied its emergency use authorization, “adverse reactions in adolescents 12 through 15 years of age included pain at the injection site (90.5%), fatigue (77.5%), headache (75.5%), chills (49.2%), muscle pain (42.2%), fever (24.3%), joint pain (20.2%), injection site swelling (9.2%), injection site redness (8.6%), lymphadenopathy (swollen lymph nodes) (0.8%) and nausea (0.4%). 

Any side effects should be short-lived and subside within 24-48 hours of injection.

On May 17, a CDC vaccine safety group announced an investigation into reports of myocarditis in some young adults and adolescents who received a COVID-19 vaccine. Myocarditis is an inflammation of the muscles of the heart, often caused by the immune system as it responds to disease. This inflammation can lead to some chest pain, trouble breathing and abnormal heartbeat. 

The CDC group said that, at the time, myocarditis rates did not exceed a background rate of what might be expected in any population, but that it was investigating out of an abundance of caution. 

The announcement also included some trends. The group said that symptoms occurred more often in males than females, and they are more common after the second vaccine dose than the first. The group also said that symptoms generally occur within four days of vaccination. In most cases, this inflammation subsides on its own and does not require treatment, but if symptoms do appear after vaccination, recipients should contact a doctor and input the event into the Vaccine Adverse Event Reporting System, or VAERS.

Will kids have to prove their age to get the shot? 

According to NCDHHS, “North Carolina does not require that people have a government-issued identification card … to be vaccinated.”

Does a parent need to provide consent for a child to be vaccinated?  

Under North Carolina law, “a physician or local health department may immunize a minor with the consent of a parent, guardian, or person standing in loco parentis to the minor.”

Alternatively, an adult who signs a statement that he or she has authorization to obtain the immunization for the minor from a parent, guardian, or person standing in loco parentis to the minor may take the child for vaccination.

Will vaccines be required for school or other activities? 

With few exemptions, students in North Carolina are required by law to be vaccinated against diphtheria, hepatitis B, Hib disease, measles, meningococcal, mumps, pertussis (whooping cough), pneumococcal, polio, rubella, tetanus and varicella (chickenpox).

The COVID-19 vaccine is not yet required statewide for school entry. Individual districts are debating the legality of requiring vaccines that are made available through emergency use authorization. 

Some summer camps and other activity organizations may require vaccinations but also offer a negative COVID test as an alternative for those who cannot be vaccinated or are not yet eligible. 

Is there evidence that the vaccine affects puberty or fertility in preteens and teens?

There is no evidence that COVID-19 vaccines have any effect on fertility, hormones or other bodily functions. The mRNA vaccines do not alter DNA, affect stem cells or alter hormones involved in puberty.

DNA is housed safely in the nucleus of each cell to protect it from damage. Messenger RNA is created within the nucleus and then transported out to the rest of the cell specifically to protect DNA. Once out of the nucleus, mRNA is read by ribosomes, which create proteins, and then degrades. In short, mRNA vaccine never enters the nucleus or alters DNA.

In clinical trials and in follow-ups after receiving the vaccines, numerous women have become pregnant and delivered healthy children after having been vaccinated. If antibodies to COVID-19 somehow caused infertility, public health experts would expect to see infertility difficulties in anyone who has developed a natural immunity to disease — an outcome not seen in the more than year of the pandemic.

Christian Green

Christian Green is the lead Carolina Public Press contributing writer reporting on healthcare and health policy in North Carolina. He obtained a master’s degree in neuroscience at Wake Forest University’s Graduate School for the Arts and Sciences, where he worked in the Laboratory for Complex Brain Networks. He is based in Raleigh. Contact him at cgreen@carolinapublicpress.org.