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These Southern states have fully vaccinated less than a third of eligible adolescents. That gap could widen with younger children, expert says

<i>Mario Tama/Getty Images</i><br/>Clinical pharmacist Laura Gaar administers a COVID-19 vaccination dose to a 14-year-old at Lake Charles Memorial Hospital on August 10 in Lake Charles
Getty Images
Mario Tama/Getty Images
Clinical pharmacist Laura Gaar administers a COVID-19 vaccination dose to a 14-year-old at Lake Charles Memorial Hospital on August 10 in Lake Charles

By Aya Elamroussi, Maggie Fox and Mallika Kallingal, CNN

With federal health officials set to consider Pfizer’s Covid-19 vaccine for children 5 years and older, most Americans are slated to qualify for a shot soon. But a widening gap between vaccination rates could slow the country’s progress in its fight against Covid-19, an expert warned Thursday.

For 12- to 17-year-olds, a key demographic that lags other age groups with just 47% fully vaccinated nationwide, many Southern states are trailing even further behind.

Alabama, Georgia, Louisiana, Mississippi, South Carolina and Tennessee all have less than a third of eligible adolescents fully vaccinated, according to a CNN analysis, as do North Dakota, West Virginia and Wyoming. And it could pose a greater challenge moving forward, experts warn.

“Once again you have this geographic divide where parents are holding back on vaccinating their adolescents, and I have to believe they will probably hold back on vaccinating the younger kids as well,” Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Texas, told CNN.

“So we may be looking at very low uptake of this pediatric vaccine in the South and also in the Mountain West, and that’s going to be a problem that’s going to slow us down.”

And as the Delta variant continues to be the most common form of the virus in the US, unvaccinated children are at significant risk because the strain is more transmissible.

Boosters and children on CDC’s agenda

Vaccine advisers to the US Centers for Disease Control and Prevention have planned two meetings in coming weeks to discuss more Covid-19 vaccine boosters, as well as Pfizer’s application for emergency use authorization of its vaccine for children 5-11, officials said Friday.

“CDC’s independent Advisory Committee on Immunization Practices (ACIP) plans to meet on Wednesday and Thursday, October 20-21 to discuss COVID-19 vaccine boosters for Moderna and Johnson & Johnson,” a CDC spokesperson told CNN in an email.

“Additionally, ACIP will meet on Tuesday and Wednesday, November 2-3 to discuss pediatric COVID-19 vaccination.”

That means it’s unlikely children 11 and younger in the US will be able to begin the vaccination process before Halloween. The US Food and Drug Administration has scheduled meetings of its advisers on October 14 and 15 to discuss boosters, and then on October 26 to discuss Pfizer’s application for children 5-11. After the FDA decides, the question goes to the CDC.

So far, about one-third of parents of 5- to 11-year-olds say they will vaccinate their child as soon as a vaccine becomes available for that age group, according to the Kaiser Family Foundation Vaccine Monitor survey published late last month.

But more Covid-19 vaccine mandates for children on the state level could be on the horizon once the shots are approved, US Surgeon General Dr. Vivek Murthy said Thursday.

“I think part of the reason you’re going to see more states likely move in that direction post-authorization is because we all want our kids to go back to school, to be able to stay in school and to be safe,” Murthy told CNN. “We’ve lost hundreds of children to Covid. … Thousands have been hospitalized, and we could prevent a lot of this with a safe and effective vaccine.”

More than 600 children have died from Covid-19, according to the CDC.

A “mix and match” approach to vaccines

Pfizer already has authorization for booster doses of its vaccine for certain people who had their first round of shots six months ago or longer. Moderna and Johnson & Johnson have both applied for booster doses for their vaccines.

And Dr. Leana Wen, former health commissioner for the City of Baltimore, said Friday some people may want to consider a “mix and match” approach when it comes to Covid-19 vaccine boosters.

“I hope that when the FDA and CDC review data around the Moderna and Johnson & Johnson, that they will allow a mix and match approach,” Wen told CNN’s Pamela Brown.

Wen added for those who initially received the Pfizer or Moderna vaccines, being able to take a booster dose of either vaccine may be more convenient. “The mRNA vaccines really should be interchangeable,” she said.

However, those who received the Johnson & Johnson vaccine may need to consider the risks associated with taking a booster dose, according to Wen.

“We know that there is an association between the Johnson & Johnson vaccine and a very rare but extremely serious blood clotting disorder in women under the age of 50,” Wen said. She added while she was fully vaccinated with the Johnson & Johnson vaccine, she’d rather get a different vaccine booster.

“I will want to get one of the mRNA vaccines as the booster, and I would hope that the FDA and CDC will look at the mix and match studies already being done here in the US, as well as the data available in other countries, that support this type of mix and match approach,” Wen said.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said late last month, “mix and match” studies are ongoing.

“The mix and match study in which you look at Moderna as the boost against the other three, those data are now available,” Fauci had said at a White House Covid-19 briefing. The data has not yet been published or submitted to the FDA.

Israel is already preparing for some of its citizens to mix and match vaccines. The country is purchasing doses of AstraZeneca’s vaccine to use as boosters for those who developed myocarditis or had other adverse reactions to Pfizer’s vaccine, according to a senior Israeli health official on Monday.

“The doses are either in the air or already arrived in Israel. It’s happening very imminently,” said Dr. Boaz Lev, head of the advisory committee for epidemic control and corona vaccines, a part of the Israeli Ministry of Health.

Study: Kids have same risk of infection as adults, but are more likely to be asymptomatic

The risk of coronavirus infection among children compared to adults appears to be similar, but kids are more likely to be asymptomatic, according to a new study.

The research, published Friday in the journal JAMA Pediatrics, found the incidence rates of infection among a sample of people living in New York City and Utah were similar across ages groups.

But half of the infections among children were asymptomatic, compared with “a much smaller fraction among adults,” researchers from the CDC and other institutions wrote in the study.

When the researchers analyzed how many people in each age group experienced no symptoms, they found asymptomatic infection among 52% of kids younger than 4; 50% of those ages 5 to 11; 45% of those ages 12 to 17; and 12% of adults.

The study, conducted from September 2020 through April 2021, included data on 1,236 people from 310 households with one or more children in New York City and certain counties throughout Utah.

The researchers noted in their study some symptoms among young children might have been missed since the data on symptoms were collected from the adult caregivers of the kids — not the kids themselves.

In general, “our findings suggest that children and adults have similar incidence rates of SARS-CoV-2 infection, underscoring the need for rapid evaluation of vaccine efficacy and safety in children to expand vaccine indications to younger age groups,” the researchers wrote.

In an editorial accompanying the study, a pediatrics professor wrote as more children return to school and other normal activities, the actual impact of coronavirus on young people has become more apparent.

“While relative to adults, children continue to be generally less affected from severe Covid-19, hospitalization, and death, the number of pediatric cases, hospitalizations, and complications such as multisystem inflammatory syndrome are not insignificant and continue to rise with the advent of the Delta variant in the United States,” Dr. Flor Munoz, associate professor of pediatrics at Baylor College of Medicine, wrote in the editorial.

Vaccine mandates are working, top health official says

The increase in mandates is working in terms of boosting vaccinations, according to officials.

Murthy, the US Surgeon General, told CNN Thursday health officials are seeing evidence of an uptick.

“On average, organizations that put vaccine requirements in place are seeing a 20%-plus increase in the percentage of people who are vaccinated,” Murthy said.

He added such vaccine requirements aren’t new in the US, and their goal is to keep the public safe.

Currently, 65.8% of people eligible to receive Covid-19 shots are fully vaccinated, CDC data shows.

On average, 276,539 people are initiating vaccination each day, according to the CDC, a 9.5% increase from last week and a 24.5% drop from a month earlier.

In New York City, Mayor Bill de Blasio said 2,000 additional public school employees received their Covid-19 vaccine after the city’s mandate went into effect September 27. In the two weeks before the deadline, there were 20,000 vaccinations, he said.

“This strategy is working,” de Blasio said, adding all 1,600 public schools are open.

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CNN’s Jacqueline Howard, Virginia Langmaid, Ben Tinker, Michael Nedelman, Lauren Mascarenhas, Jamie Gumbrecht, Elizabeth Cohen and Kristina Sgueglia contributed to this report.

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