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The coronavirus SARS-CoV-2 appeared around the end of December 2019 in a province of China, causing acute respiratory failure syndrome.

It spread with particular speed across the planet, forcing the World Health Organization to declare a pandemic.

Governments under conditions of panic began to take various measures to limit the spread, which we have experienced and continue to experience today and concern all sectors of our social and economic life.

The frenetic pace of transmission of the virus was followed by a marathon race of researchers around the world.

Quickly:

• the genome of the virus was mapped
• the immunological properties of its structural proteins were studied
• pioneering techniques were applied
• antiviral drugs and monoclonal antibodies were developed
• the production of safe and innovative vaccines was achieved.

Their efficacy and safety were studied in tens of thousands of controls and within a year, vaccination of vulnerable individuals began.

Since then, in my articles, I had supported the view that vaccination of children would be an important step in controlling the transmissibility of the disease in the community.

The reasons that led to vaccination from the age of 5 are based on the following findings:

1. Without a doubt, children also get sick with COVID-19 like adults and it is even possible to a) become seriously ill and even require hospitalization, b) present complications immediately or later (long COVID-19), c) become carriers of the disease in the close family, wider social and school environment. In the United States, with statistical data from 21.10.21 until the end of the year, it was estimated that COVID-19 is among the top 10 diseases in mortality for ages 5-11. In terms of serious complications, the main ones are multisystem inflammatory syndrome, analogous to Kawazaki vasculitis syndrome with manifestations in the heart, lungs, kidneys, brain, eyes, skin and gastrointestinal system, myopericarditis and, with recent observations, the development of type I or II diabetes (at ages <18 years)
2. Children vaccinated for COVID-19 protect children and adults who have a contraindication to vaccination or for whom vaccination, due to underlying diseases, does not offer the maximum possible prophylaxis
3. Vaccinated children, even if they eventually get sick, will be asymptomatic or only mildly symptomatic, will generally not require hospitalization and will not be at risk in intensive care units
4. The vaccinated children will continue their school and extracurricular activities.

It is worth noting that unvaccinated children aged 2-5 years should wear a mask when they are in closed spaces or with people who do not belong to the immediate family environment.

For information, however, research is underway for the full vaccination of children under 5 years of age with positive results in terms of effectiveness and safety.

A general principle for the administration of any vaccine is its safety. The COVID-19 vaccine in particular has been preceded by thorough studies with tens of thousands of controls and parallel monitoring of the behavior of the vaccinated by local and mainly international bodies, such as the World Health Organization, the Center for Disease Control in the USA, the Advisory Committee on Vaccination, etc. Furthermore, the enormous number of doses of the vaccine, measured in billions, that have been administered to children and adults around the world in a single year, speaks in favor of the vaccine’s excellent safety.

Regarding the general administration of the vaccine and for the specific age group of 5-11 years, the following observations can be made:

1. The vaccine approved for the age group of 5-11 years is only the Pfizer-BioNTech mRNA technology in lipoimmunoparticles and at a dose of 10μg and a volume of 0.2ml. It is administered intramuscularly in the deltoid muscle or the anterolateral position of the thighs, as a basic vaccination, in 2 doses with an interval of 3 weeks (21 days). At this time, no additional or supplementary (3rd) dose to the basic vaccination has been officially approved. Studies in progress seem to recommend the administration of an additional dose for the age group of 5-11 years. This is inferred from the fact that the immune response does not seem to differ significantly according to the sun groups. However, even if we accept that the geometric mean antibody titer achieved with the basic vaccination in childhood and adolescence is higher, the exponential decline follows the same behavior. Unless we rely on the clinical observation that COVID-19 disease in younger ages interact more mildly in order to justify its omission.
2. The approved vaccine administered for ages 5-11 is extremely rarely implicated in serious adverse reactions. In general, its safety is considered completely acceptable.
3. Cases of myocarditis and/or pericarditis are extremely rare and even unlikely. In a recent study in Israel that included 44,000 children aged 5-11, 2 cases of clinically mild myocarditis were found. The rare cases seem to concern adolescents aged 12-17 years and with an incidence of 5 cases per 100,000 vaccinated adolescents after the 2nd dose.
4. Serious allergic reactions, such as anaphylaxis, observed rarely, as with other vaccines in use, are even rarer with the Pfizer-BioNTech vaccine.
5. It is not biologically possible and no COVID-19 disease has been observed after administration of the homologous vaccine.
6. The vaccine is not biologically possible to affect fertility.
7. The administered dose of the vaccine is not related to the weight of the vaccinee but to the age group to which he belongs.
8. The ingredients of the Pfizer-BioNTech vaccine for ages 5-11 are the same as those of the vaccine adolescents/adults. However, the vaccine for these ages is not used in children aged 5-11 years.

Adverse reactions after vaccination are rare and are divided into local (pain, redness, swelling) at the injection site and general or systemic (fatigue, headache, myalgia, fever, nausea, chills).

Their duration is short and local reactions are treated with cold compresses and general reactions with the administration of antipyretics, excluding aspirin, which should be avoided until the age of 18.

Contraindications for vaccination include:

1. severe allergic reaction to a previous dose of the vaccine
2. a serious diagnosed reaction to any of the vaccine components.

Preventive measures for vaccination include:

• temporary suspension of vaccination during a severe acute illness
• equipment and readiness to treat an immediate acute allergic reaction that occurs within 4 hours
• remaining in the vaccination area for 30 minutes in a sitting or lying position for 15 minutes to avoid a vagotonic episode
• remaining in the vaccination area for 30 minutes in individuals with a history of anaphylaxis of any etiology.

It is important to emphasize that Vaccination is mandatory for every person over 5 years of age, regardless of the history of illness, symptomatic or asymptomatic, from the SARS-COV-2 virus. Previous testing for antibody titer determination is not recommended.

Data from many studies have shown that the vaccine can be safely administered to people with previous COVID-19 illness.

It should not be overlooked that reinfection, although small in probability, is possible due to a gradual decline in immune readiness attributed to a decrease in antibody titer over time. Also, individuals who have been ill show heterogeneity in their immune readiness, unlike vaccinated individuals who demonstrate antibody homogeneity.

Additionally, epidemiological observations support the view that vaccination after COVID-19 infection reduces the risk of reinfection even if various variants of the virus are circulating in the community and this is associated with an enhanced immune response after vaccination.

Of particular value is the observation that vaccines against the SARS-COV-2 virus do not offer post-exposure prophylaxis.

For this reason, a person who has come into direct contact with a patient should be vaccinated after the end of quarantine and a person who has been ill should be vaccinated after the clinical resolution of the disease.

It is emphasized that maximum protection from the vaccine occurs 2 weeks after the completion of the basic vaccination.

Given the fear that children face, it is advisable for vaccines to be prepared appropriately by parents:

1. about what is going to happen
2. the protection that the vaccines provide in order to maintain their activities, friendships, sports, celebrations, vacations
3. the momentary duration of the pain.

Finally, we advise parents not to administer antipyretic or painkillers before the vaccine.