Vaccination for children
between the ages of 5 and 11

Studies show that the hospitalisation rate among children is between 0.3% and 1.3%, which means that, statistically, between 0.3% and 1.3% of children and adolescents who test positive for coronavirus are treated in hospitals. However, these figures do not make a distinction between whether a child is hospitalised for COVID-19, or whether it is a secondary diagnosis when a child is hospitalised for other reasons.

Since the vaccination rates for children between the ages of 5 and 11 are lower, infections are a more frequent occurrence in this age group. The Omicron variant is particularly contagious, even for children. However, there are currently no indications that children infected with Omicron are more likely to become seriously ill.

Paediatric Inflammatory Multisystem Syndrome (PIMS) is a multisystem inflammatory condition that can occur in children a few weeks after they get the virus. The Likelihood of getting PIMS does not depend on the severity of the infection; in other words, it may occur even after a mild case of COVID-19. The main symptoms are fever, abdominal pain, tiredness and weakness. Recent data from the US indicates that paediatric COVID vaccination not only provides protection against COVID-19 itself, but also against the occurrence of PIMS subsequent to a COVID infection.

We currently have relatively little data, and there is still no generally accepted definition of long COVID in children. There is no definite evidence that children are at higher risk of long COVID. Longer-term physical health effects have rarely been observed in children, and are most likely to be recorded after cases of PIMS. The primary focus is on the psychosocial consequences of COVID-19, which are complex and difficult to assess. The significance of the studies available so far is limited, because there are no studies with control groups and it is unclear to what extent the consequences described are due to the disease itself or are a more general result of the pandemic, of the restrictions associated with the pandemic, or of hospitalisation.

The Standing Committee on Vaccination (STIKO) recommends COVID-19 vaccination in this age group for children with pre-existing conditions and for children who have relatives or other contacts who are at high risk of severe disease and who cannot be adequately protected by vaccination. However, STIKO also recommends that it should be possible to vaccinate children who do not have pre-existing conditions if they wish to receive the vaccine and consent to do so following a medical consultation. These cases are not examples of ‘off-label use’ but are simply a standard use of the vaccine, since the vaccine is approved for all children in this age group.

At present, only BioNTech/Pfizer’s specially dosed vaccine is approved within the EU for vaccinating children between the ages of 5 and 11; the safety of this vaccine for children aged 5 to 11 has been tested and proven as part of the approval process.

No. The vaccine dose for children between the ages of 5 and 11 is lower (one third of the amount of active ingredient compared to the adult vaccine).

Pre-existing conditions or risk factors include: tumour, severe or uncontrolled asthma, obesity, cardiovascular disease, diabetes, hypertension, Down syndrome, heart defect with pulmonary hypertension and various other rare diseases.
An overview can be found on page 7 of the Epidemiological Bulletin dated 17 February 2022

In its recommendations, the Standing Committee on Vaccination (STIKO) takes into account how long it takes, based on experience, for more comprehensive data that can be used to reliably detect even very rare side effects to become available and how great the risk is if an unvaccinated person becomes infected in the meantime. Since the risk of children becoming severely ill with COVID-19 is very low, the Standing Committee on Vaccination decided to wait until more data on the vaccination of children aged between 5 and 11 years old was available. The volunteer members of STIKO thoroughly analyse the data that the studies are based on in each case, so that recommendations are not revised simply on the basis of press releases or articles in journals, but only when the data from the underlying studies is available and has been examined in detail by STIKO.

Even if there is no general STIKO recommendation, the vaccine is approved throughout Europe for all children aged between 5 and 11 years old. The Standing Committee on Vaccination does not advise against vaccination even for children between the ages of 5 and 11 for whom it does not specifically recommend vaccination; rather, it explicitly states that all children can be vaccinated if the parents or guardians wish to have them vaccinated, following informed consent.

The situation of children is different to that of adults. Children rarely become severely ill with COVID-19. Even if many children were to fall ill with COVID-19 at the same time, this does not mean that hospitals would end up being overwhelmed. Potential reasons to get children vaccinated include the following:

• Even though cases of children falling severely ill are very rare, they are better protected against severe illness or the consequences of coronavirus through vaccination.
• If there are people in the child’s environment who cannot effectively protect themselves through vaccination (e.g. clinically vulnerable people who do not respond well to vaccination), vaccination can reduce the risk of the child infecting these people.
• Even if they come into contact with infected individuals, a fully vaccinated child is exempt from quarantine for the first three months following vaccination.

However, since severe cases of COVID-19 are very rare in children, and children and adolescents are currently being closely monitored through testing, it is quite understandable if people prefer to wait for the Standing Committee on Vaccination to run further tests on paediatric vaccines before deciding whether a child should be vaccinated.

Vaccinated children and adolescents may experience common reactions to vaccination, most of which resolve within one to three days with no long-lasting effects. These include pain at the injection site, fever, chills and headache. Such reactions to vaccination are also commonly observed in clinical studies on adults, though observations so far suggest they are usually less severe in children.

In the US, some 9 million children aged between 5 and 11 have already been vaccinated with the BioNTech/Pfizer paediatric vaccine. Reports so far show that severe side effects are very rare. The risk of myocarditis as a result of the COVID-19 vaccine is, again, significantly lower than among adolescents and, above all, much lower than in the case of COVID-19 infection: according to the Vaccine Adverse Event Reporting System (VAERS) used in the US to report side effects of vaccination, there were 12 confirmed cases of myocarditis in this age group out of approximately 9 million vaccinations, and all of those 12 cases were mild. Other severe side effects have been reported even less frequently. The vaccination was very well tolerated by children in the vast majority of cases.

Long-term or delayed effects are not to be expected due to the vaccine’s mode of action. The vaccine is completely broken down in the body after a few hours or days. If they do occur at all, adverse side effects occur shortly after vaccination. However, very rare side effects of vaccinations are sometimes only discovered later on because they only become apparent when a sufficient number of cases have been studied: if an adverse reaction occurs in only one in 50,000 cases, it will not be detected if only 5,000 cases are investigated (as in the study used to approve the paediatric vaccine, for example). The data that is now available on the approximately 9 million children that have been vaccinated in the US alone does not so far suggest any increase in the incidence of any particular side effects in children.

No. It has been proven that vaccination has no negative impact on the fertility of boys/men or the ability of girls/women to conceive. This also applies to boys and girls before and during puberty.

Yes, there is evidence that the Omicron variant in particular can evade vaccination protection. However, vaccination reduces the individual viral load in case of infection. A vaccinated person is less likely to infect others if they themselves are infected. Additionally, the vaccination protects against severe disease progression and complications.

No, it doesn’t make sense to wait for an adapted vaccine to be developed. Realistically, there won’t be one available for adults until spring 2022; it will probably be even longer before an adapted paediatric vaccine is available. The risk of a child becoming infected before an adapted vaccine is available is very high (especially given the spread of the Omicron variant).

New inactivated vaccines are initially approved for adults; they are only approved for younger children in a later step when appropriate studies are available. The protein-based vaccine Nuvaxovid (Novavax) is currently approved for people aged 18 and over. It is unlikely that approval for children will be granted in the short term and that we will have access to the same kind of comprehensive data on safety for children as we already have for the BioNTech/Pfizer paediatric vaccine that has already been approved. Based on the evidence available so far, it does not appear that inactivated vaccines offer any advantages in terms of efficacy or safety compared to the BioNTech/Pfizer paediatric vaccine that has already been approved. There is also a high risk of a child becoming infected with COVID-19 before the inactivated vaccine is approved for this age group. So there is no reason to wait for the approval of an inactivated paediatric vaccine if you have already decided in principle to get your child vaccinated. It is important to note that the approved mRNA vaccine is not a live vaccine either, since it uses a pathogen that cannot replicate. Instead, the vaccines that work on the basis of the mRNA principle combine the advantages of inactivated and live vaccines without any of the essential disadvantages.

Children aged 5 to 11 years old have robust vaccine protection following two vaccinations. The vaccine for children between the ages of 5 and 11 has only been approved for two vaccinations so far, not for a booster shot. Whether children under the age of 12 should also receive a third dose of the vaccine after a certain period of time in the future can only be decided when more data is available on how long the vaccination protection remains effective in this age group. According to the latest knowledge, children who have currently received their first and second shots will be well protected in the coming months, even without a booster shot.

It can be assumed they are immune if the infection was recent. It is not possible to assess with any certainty at present whether someone is also protected against infection with the Omicron variant once they have been infected with the Delta variant. Immunity may weaken if the infection was a longer time ago. Then, vaccination makes sense, especially for children with pre-existing conditions. The recommended interval between infection and vaccination is three months.

Children have a right to take part in decision-making, and should be involved in decisions that affect them, depending on their level of development. However, the responsibility for deciding whether to get a child vaccinated lies with the parents, not the child. Special materials that answer questions about vaccination in a way that’s easy even for children to understand can be found on the likes of the German Federal Ministry of Health website, on the logo! website and here in the Downloads section.

Paediatricians are the first point of contact if you want to get your child vaccinated. Many paediatricians will vaccinate children aged between 5 to 11 – as recommended by the Standing Committee on Vaccination (STIKO) – if parents wish to have their child vaccinated. There are also opportunities to get children vaccinated at vaccination support centres or as part of vaccination campaigns. To find out where vaccinations are available, check out the information on dranbleiben-bw.de; you can also search specifically for places where children can get vaccinated.

Yes. Children can only get vaccinated with the consent of their parents or guardians; once children reach adolescence (approx. 14 years old), there may be certain cases in which the child can make their own decision. If both parents have joint custody, both parents must give their consent. A second signature is not required for single parents or guardians.

A digital vaccination certificate is issued for each vaccination. Parents can download this onto their smartphone and view it in the Corona Warn app or the CovPass app, though the digital vaccination certificate with a QR code can also be used on paper. Vaccination cards also available, for example from pharmacies (for a fee). For children who do not have a mobile phone, this offers another option for them to carry their vaccination certificate with them.

People who have received two shots and have not tested positive themselves are exempt from the quarantine requirement for contacts of an infected person if their last vaccination was no more than three months ago. This also applies to children who have been double-jabbed. The current mandatory quarantine regulations can be found here, for example.

Fully vaccinated children are exempt from compulsory testing as long as they received their last vaccine shot no more than three months ago. However, they will still be offered two rapid COVID-19 tests a week on a voluntary basis.

Yes; the same regulations apply as for adults: the exemption from quarantine takes effect from such time that full vaccination status is proven to the authorities.

No. When it comes to getting children vaccinated, what matters most is what’s best for the child. The legal requirements ensure that children have access to facilities and events, for example, even if they are unvaccinated.