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Teens urged to wait 56 days before second COVID-19 vaccine as rare side effects assessed

Incidence of side effects very rare, most common among teenage boys
June 25, 2021
Kim Zarzour

Youth ages 12 to 17 are advised by York Region Public Health to hold off on second doses of COVID-19 vaccines for at least eight weeks after the first dose, as more assessments are done on the risk of heart conditions among young males.

The recommended timeline, announced by the region June 24, is in based on provincial guidance following "safety signals" coming out of the United States and Israel that Pfizer and Moderna may be associated with inflammation of the heart and the tissues surrounding it.

There are reports of myocarditis, and pericarditis in adolescents after the second dose of these vaccines, Dr. Karim Kurji, the region’s medical officer of health, said in the June 24 regional council meeting.

No safety signals have been detected yet in Canada by the Public Health Agency of Canada, Public Health Ontario or SickKids Hospital, Kurji said.

But at the June 23 meeting in the United States of their Advisory Committee on Immunization Practices (ACIP), it was reported that there is an incidence in 15 to 18 year olds of about 1.8 per 100,000, and this incidence gradually goes down with age, Kurji said.

The symptoms of myocarditis and pericarditis can include chest pain or discomfort, shortness of breath, and palpitations. It is usually confirmed through doing electrocardiography, or echocardiogram, MRIs or blood tests, where they show elevated cardiac enzymes.

When this occurs, treatment consists of supportive care and hospitalization, if it necessary, for four to six days.

"Most, but not all, commonly occur in males, most often, under the age of 30 and most commonly, this occurs about four days after the second dose," Kurji said

However, Kurji added, adolescents in the U.S. have among the highest incidence rates of COVID-19, so the assessment of risks of COVID-19 versus the benefits of vaccination clearly show benefits of vaccination outweigh the risks.

In a statement released yesterday following the CDC ACIP meeting, the nation’s leading doctors, nurses and public health leaders emphasized the vaccines remain safe and effective ways to prevent COVID-19 for everyone ages 12 and older.

"The facts are clear: this is an extremely rare side effect, and only an exceedingly small number of people will experience it after vaccination. Importantly, for the young people who do, most cases are mild, and individuals recover often on their own or with minimal treatment. In addition, we know that myocarditis and pericarditis are much more common if you get COVID-19, and the risks to the heart from COVID-19 infection can be more severe.

"It is worthy for us to note that neither the United States nor Israel has changed its policy on vaccinating youth, and we have been advised by the province of no change, whilst the National Advisory Committee on Immunizations and others study these presentations and await statements from the United States."

As the region awaits this information and any recommendations that may follow, it advises adolescents wait eight to 16 weeks between doses. Some York Region residents aged 12 to 17 may be eligible for their second dose of Pfizer beginning Friday, June 25, particularly youth at higher risk due to health conditions or young adults who are unable to work from home.

The region's priority continues to be administering first doses -- for youth and for the remaining adults who have yet to be vaccinated.

Similar advice was released by the U.S. Department of Health and Human Services June 23.

"The risks of being unvaccinated are far greater than any rare side effects from the vaccines. If you get COVID-19, you could get severely ill and be hospitalized or even die. Even if your infection is mild, you or your child could face long-term symptoms following COVID-19 infection such as neurological problems or diminished lung function," the statement reads.

"We recommend getting vaccinated right away if you haven’t yet. It is the best way to protect yourself, your loved ones, your community, and to return to a more normal lifestyle safely and quickly."