Pediatric Covid-19 Infection and Adverse Events Profile in the Philippines.

Children are at low risk from Covid-19 infection and have an even lower risk of death than the general population. Severe and fatal vaccine AEs have been reported. Does benefit outweigh risk?

From all population demographics children are considered to be at low risk for hospitalization and death.

While we must be aware that deaths reported as “from Covid-19” can simply be deaths “with Covid-19” as an incidental finding where deaths were due to other primary causes, I shall take the available data at face value.

We should also bear in mind, when reviewing cases and covid-19 case fatality rates (CRF) that these have changed across the pandemic with the different variants presenting different degrees of pathogenicity (decreasing over time) and infectiousness (increasing over time). Increase in knowledge on how to effectively treat covid-19 over time may reduce CFR, while incentivized reporting of both cases and deaths may skew it either way.

From early in the pandemic it has been recognized that children, youth, and indeed healthy people of all ages had an overall lower risk of both infection and death.

On March 19, 2022 Reuters published an article presenting the US CDC Correction on Covid-19 Deaths, which included a correction on pediatric deaths. In the US a total of 1,341 children are reported to have died while testing positive for covid-19. According to the American Academy of pediatrics, infection incidence in children is about 19% of all cases, but less than 0.26% of these cases resulted in death.

In the Philippines, data from the Department of Health Covid-19 Tracker shows the breakdown of total cases (3,678,245), recoveries and deaths (59,249) by age group, using reported data at 31st March 2022. Pediatric cases represented about 12% of all cases (436,177), while deaths represented 2.1% of all deaths (1,245 deaths). Of those children who tested positive with covid-19, 0.29% were were reported as having died, similar to the US data. The Philippines pediatric CRF is 5.7x lower than the country’s overall case fatality rate of 1.63%.

In the Philippines C-19 Vaccination of adolescents (12-17) began on 15th October 2021 and children (5-11) began on 7th February 2022. The weekly pharmacovigilance reports (up to 20th March 2022) show 3,329 Adverse Events (AEs), including 208 tagged as serious and 21 deaths following vaccination from the adolescents, and 504 AEs including 20 serious and 2 deaths in the children. While the vaccine has not been admitted as the cause of these AEs and deaths, the report wouldn’t have been made if the children had not received a vaccine shortly before their death and if their caregivers did not believe there was a link.

Evaluation of this data is necessarily limited because:-

1. The total number of adolescents and children vaccinated is not provided, so we cannot calculate any preliminary AE risk.

2. We must not forget that there is likely a large under reporting factor, meaning that actual AEs are likely far higher than has been reported.

3. We do not know the lag time between reports being made, investigated and included in the weekly reports so we cannot make any comparison between the local historical risk of death from covid-19 infection and the risk of injury or death from the covid-19 vaccines.

Healthy children have a low risk of catching covid-19 at all (12% of all cases), and an even lower risk of a poor outcome (0.26%) if they even catch Covid-19 based on our available data. However, every person who receives a vaccine is at risk of an AE (unknown risk factor).

International pharmacovigilance reporting systems (US vaers, Europe’s Vigiaccess, UK’s Yellowcard, Australia’s TGA) all report pediatric adverse events and deaths. The current AEs and deaths are not limited to the Philippines.

We cannot conclude that benefits outweigh risk with the current information. These products must be considered dangerous until proven safe, and the data is currently moving in totally the opposite direction of safe! I recommend conservative approach, do not proceed until safety is proven, for our most precious children.