The COVID-19 vaccine and teens: What parents should know

With California teenagers ages 16 years and older eligible to receive the COVID-19 vaccine beginning April 15, parents may have questions about the vaccine and what to expect afterward. Here, Dr. Angela Dangvu, a pediatrician in the CHOC Primary Care Network, answers some common questions about the vaccine and teens.

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Dr. Angela Dangvu, a CHOC pediatrician
What vaccine will my teen receive?

At this time, the Pfizer vaccine is the only vaccine authorized for use in people ages 16 years and older to prevent COVID-19. It is administered in two doses three weeks apart, injected into the arm muscle.

The Pfizer vaccine, as well as the Moderna vaccine, which is authorized for people ages 18 years and older, is an mRNA vaccine. When the vaccine is injected, mRNA – a strip of genetic material –enters a body’s cell and prompts the cell to build copies of spike proteins. These spike proteins are the bumps that protrude from the surface of coronavirus particles. The body’s immune system then learns to spot these spike proteins and produces antibodies that block the virus from entering healthy cells in the future.

Studies show that vaccine recipients achieve immunity about two weeks after receiving the vaccine’s second dose. Scientists are still learning about how long that immunity will last.

I have younger children. What is the status of vaccine research in children and adolescents?

To date, Pfizer and Moderna have enrolled children as young as 6 months in clinical trial studies. Janssen and Astra Zeneca also have plans to study their vaccines in younger age groups.

Is the vaccine safe for teens? Are there other risks for teenagers that might not be present for adults?

The Pfizer vaccine is absolutely safe for children ages 16 years and older. In clinical trials, enough teens participated to show that the vaccine is safe for people as young as 16 years. We have no reason to expect that children would tolerate the vaccine less favorably than adults would.

If teens are less likely to get sick from COVID-19, why do they need a vaccine?

Even though it is rare for children to get seriously ill from COVID-19, children who are 16 years and older have needed hospital care for COVID-19. This is especially true for teenagers with underlying health conditions such as weakened immune systems, obesity  or chronic lung conditions. Having the vaccine may also give parents and teens alike peace of mind to return to more typical activities like in-person instruction and participating in sports, which is great for mental health.

Are there any teens who shouldn’t get the vaccine? Should I talk to my pediatrician before scheduling the appointment?

There is no category of teenagers who shouldn’t get the vaccine, unless they have a known allergy to one of the vaccine’s components. Because it isn’t a live vaccine – a vaccine that uses a weakened form of a germ to prompt an immune response – the possibility for reaction is very small. There have been reports allergic reactions to the vaccine, but these occurrences are very rare. Vaccine recipients are monitored for 15 minutes after receiving the injection in case of any allergic reaction. Teens with other types of allergies beyond any vaccine component can feel safe receiving the vaccine.

Teens who recently received other vaccinations should wait two weeks before seeking the COVID-19 vaccine.

Parents are always encouraged to speak with their teen’s pediatrician if they have any questions or concerns.

Will the COVID-19 vaccine affect my child’s fertility?

Definitely not. Because it is an mRNA vaccine (see explanation above), the vaccine does not get incorporated into or change the DNA of the body’s cells in any way. There is no reason to worry that the vaccine will affect fertility or future offspring.

The COVID-19 vaccine was developed quickly. Should I be concerned about that?

No. The vaccine was developed quickly because scientists received additional money and resources to support from the government. This allowed scientists to follow all the typical processes but overlap some steps, which sped up the process. Also, it was easy to find volunteers to participate in clinical trials because many were excited by the possibility of receiving the vaccine. None of these factors compromised the quality of the trials, and the same processes for safety and effectiveness was followed. 

I’ve read about COVID-19 variants. Will the vaccine protect my teen against them?

We are still learning about how effective the vaccine is against variants. While there may be some decrease in immune response, the vaccine is still largely protective. An important step in fighting variants is to ensure as many people as possible get the vaccine. The more people who get sick – even mildly – with COVID-19, the more opportunity is presented for the virus to continue to mutate.

My teenager already had COVID-19. Should they have the vaccine?

Yes. We don’t know how long the immunity lasts from natural illness, and the vaccine is made to create a longer lasting immune response.

What if my teenager has COVID-19 now?

Your child should wait until they are feeling better and no longer need to isolate based on guidelines from the Centers for Disease Control.

What if my child has received convalescent plasma treatments?

Your child should wait 90 days to get the vaccine after receiving convalescent plasma or monoclonal antibody treatments. Your child’s pediatrician can help you determine when it’s appropriate to get the vaccine.

Can my child take their normal medications before the COVID-19 vaccine?

Your child should continue to take their normal medications as prescribed.

Can my child take acetaminophen, ibuprofen or an antihistamine before the COVID-19 vaccine to offset any potential side effects?

No. It is best to avoid preventatively administering these medications – either before the vaccination or right afterward if no side effects are present – because there is a chance they can decrease the immune response.

Do I need to accompany my child to the vaccination?

Yes. Anyone under 18 must have a parent or legal guardian present to receive the vaccine.

What should we bring to my teen’s COVID-19 vaccination appointment?

Bring a photo ID and a document verifying your teen’s date of birth. See more details from the Orange County Health Care Agency about what documentation is required for minors. There’s no need to bring your child’s vaccine records, as they will receive a card specific to the COVID-19 vaccine. It would be helpful if the teen wears a short-sleeved shirt, as the injection is administered into the arm.

What should my child expect at the COVID-19 vaccination appointment?

After checking in and taking care of paper work, the teen will be asked some questions about their health. The shot will be administered into the arm. After receiving the shot, the teen will be monitored for 15 minutes to ensure no adverse reactions. The teen will also receive a card indicating when they received the vaccine and information about the vaccine.

What should I do with their vaccination card?

Take a picture of it just in case anything happens to it and store in a safe place. There is no need to laminate it.

Do we really need to come back for a second COVID-19 vaccine?

Yes. Clinical trials that led to the Pfizer vaccine’s licensing incorporated two doses. So, the determined efficacy is based on two doses and we don’t yet know how effective one dose alone is. The Johnson & Johnson/Janssen vaccination is administered in one dose, but at this time it is only approved for people ages 18 and older.

What are the side effects of the COVID-19 vaccine? Are there any different side effects for kids?

The most common side effects are fever and feeling achy or tired. Any side effects should be relatively short-lived and ease within 24 hours. Because teens have more robust immune systems, it’s possible that they may feel these side effects more strongly than adults would. This is a sign that their immune system is mounting a response against the virus.

If side effects do appear after the COVID-19 vaccination, what can I use to treat them?

It is fine to treat side effects once they surface with over-the-counter pain medicine. Either ibuprofen or acetaminophen is fine, so long as the child hasn’t had previous reactions to these medications.

Should my child stay home from school after the COVID-19 vaccine?

If they have a fever, the teen should stay home. Beyond that, so long as they are feeling well, there is no need to limit activities.

What if my child is exposed to COVID-19 after they’ve been vaccinated?

Once two weeks have passed since their second dose, they have reached full immunity and there is no need to self-isolate after exposure to someone with COVID-19. Monitor them closely, however, to ensure they aren’t developing symptoms. If COVID-19 symptoms surface, begin self-isolation and contact your pediatrician.

After receiving both COVID-19 vaccine doses, can my child stop wearing a mask?

No. It’s important that they continue to take precautions against COVID-19. Though they are highly effective, the vaccine is not 100 percent effective, and while among a group of people, it’s impossible to know who is and who isn’t vaccinated.

How will the COVID-19 vaccine change socializing for my child?

Teens and families alike can definitely have more peace of mind about the safety of resuming more typical activities, which will be wonderful for mental health. In group activities, teens should still continue to wear masks. In one-on-one activities where a teen and their friend are both fully vaccinated, they can feel comfortable removing their masks so long as no one in either household is high-risk and unvaccinated.

Should I be concerned about having my older vaccinated teen around their younger siblings who are not vaccinated?

No. These children were already interacting with each other in the same household before one received the vaccine. The entire family can take comfort in knowing that one more person in household who has been vaccinated offers more protection for the whole family.  

Get more information from CHOC experts about COVID-19 and kids.

I’m a pediatrician. Here’s what I want you to know about vaccines.

By Dr. Katherine Williamson, a CHOC pediatrician

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Dr. Katherine Williamson, a CHOC pediatrician

Proper vaccination is important for all people, but especially infants and babies. When children follow the recommended immunization schedule outlined by the American Academy of Pediatrics (AAP), they are better protected against potentially life-threatening diseases.

During the COVID-19 pandemic, your CHOC pediatrician’s office is a safe, physically distant environment to keep your child and family safe while still delivering high quality preventive care.

As a pediatrician during COVID-19, I get a lot of questions about baby vaccination and vaccines for children. Here are the most common questions I’ve gotten about vaccines during COVID-19– and why maintaining your child’s immunization schedule is more important than ever.

Can I delay my child’s vaccines during COVID19?

Getting vaccinated on time is important because even though we have the threat of COVID-19 to contend with, all the diseases that we can prevent easily with vaccines are still a threat. These diseases — such as whooping cough and measles — are ready to emerge at any time that we don’t have the majority of our kids vaccinated.

Recent data released by the World Health Organization and the Centers for Disease Control and Prevention showed that measles deaths worldwide reached the highest level in 23 years last year. Although no measles deaths were reported in the U.S., the number of measles cases nationwide were at their highest point since 1992. Public health experts have linked the increases in measles cases to insufficient vaccine coverage.

If we don’t keep our kids protected against measles and other fatal diseases, the risk for further emergence is going to be very high. While we are waiting for a COVID-19 vaccine to stop the pandemic, it is up to us to keep our kids safe and prevent any future epidemics by using the tools we already have to prevent disease.

Do I really need a flu shot every year?

It’s important that each member of your family get their flu shot every year. This is especially true this year, amid the COVID-19 pandemic. Since both influenza and COVID-19 can have overlapping symptoms, it may be difficult for doctors to determine which virus is behind your symptoms based on a clinical exam alone, according to pediatric infectious disease experts at CHOC.

These overlapping symptoms may include, but are not limited to:
Fever or chills
Cough
Shortness of breath
Fatigue
Sore throat
Runny or stuffy nose
Muscle pain or body aches
Headache

Learn more about why getting a flu shot is more important than ever this year.

Are vaccines safe?

Vaccines are one of the most important things we can do to help protect our children’s health. Vaccines and proper handwashing, more so than all other interventions, have proven to be the most safe and effective ways to prevent disease.

What is the proper vaccine schedule?

The current immunization schedule outlined by the AAP and Centers for Disease Control & Prevention has been researched and proven to be the most effective and safest way for children to be vaccinated against potentially fatal diseases. It’s important to know that no alternative schedule has been shown to be as safe and effective.

Is it better to do multiple vaccines at one time or space them out?

The safest way to keep your child safe from vaccine-preventable diseases is to get all their vaccines on time. There is no advantage to spacing them out, and instead the longer you wait, you increase the risk of them catching one of the preventable diseases before you protect them.

The amount of antigen (protein) in each vaccine is so tiny that your immune system can process multiple vaccines at one time and build an antibody “army” to protect your child for each of those potentially fatal diseases. In fact, the amount of antigen (protein) in each vaccine is 100,000 times less than if your child has a common cold, so there’s no concern about overwhelming their immune system when they get their vaccines.

What can I do to make my child more comfortable while receiving a vaccination?

Studies have shown that preparing your child for vaccinations should ideally include three components: explaining what will happen, how it will feel, and strategies for coping with any related stress or discomfort. Here’s more tips on how to make shots less stressful.

This article was updated on Nov. 16, 2020.

Can HPV really lead to cervical cancer?

Human papilloma virus, or HPV, affects nearly all sexually active men and women at some point in their lives. Many people “clear” or fight off their infections without ever knowing that they had an infection at all. However, a percentage of people with the virus do not clear their infections and may develop genital warts, cervical cancer, or other types of cancer.

We spoke to Dr. Terez Yonan, an adolescent medicine specialist at CHOC, to get the facts on HPV and how it can indeed lead to cervical cancer.

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Dr. Terez Yonan, an adolescent medicine specialist at CHOC.

How common is HPV?

There are nearly 80 million people currently infected with HPV in the United States, according to the Centers for Disease Control, and nearly 14 million people, including teenagers, become infected with HPV each year.

How does HPV lead to cervical cancer?

The most common way to contract HPV is through sexual contact, from a direct transmission from one person’s genitals to the other. When transmitted vaginally, the HPV cells will integrate into cells of the vaginal wall and cervix. This changes the composition of the normal, healthy cells and you end up with dysplasia, also known as abnormal and pre-cancerous cells. This can worsen and turn into cervical cancer.

For people with a normal immune system, it could take years for HPV to turn into cervical cancer, but for someone who is immune-compromised, that process could take just a few months.

HPV does not always lead to cervical cancer. There are what we call high-grade infections and low-grade infections. Low-grade infections are easily cleared by the body on its own. It takes about two years for a healthy person to clear HPV. High-grade infections can last longer in the body and put you at risk for cervical cancer or genital warts. Although not considered dangerous, genital warts are unsightly and can cause irritation depending on where they are. If not treated, warts can grow into different types of cancer, including oral and anal and penile cancer.

What are the warning signs of cervical cancer?

Most of the time, people don’t know they have HPV because there are no warning signs. In some cases, genital warts may appear. Abnormal vaginal bleeding can be a sign of cervical cancer. If you notice abnormal bleeding, consult your primary care provider, gynecologist, or adolescent medicine specialist.

Can I get tested for HPV?

A Pap smear, also called a Pap test, is a pelvic exam designed to test for cervical cancer in women. An HPV test can be done using the same sample of cells collected during a Pap smear.

When should I get my first Pap smear?

A Pap smear is intended for healthy, sexually-active people. They are generally not recommended before 21 years of age. For people who are immunocompromised, Pap smears are recommended when you become sexually active regardless of age because of the increased risk for picking up infections , and for those infections to more quickly develop into cancer.

How often should I get a Pap smear?

Someone who is immunocompromised needs two Pap smears within the first year of becoming sexually active. If those are normal, the exam can be done annually. Healthy women in their 20s need a Pap smear every three years. Beginning at age 30, Pap smears can usually be done every five years.

Who can do my Pap smear?

You can get a Pap smear from your adolescent medicine specialist, family medicine provider, internal medicine provider, or gynecologist. Nurse practitioners and physician assistants  in each of these offices can perform the exam as well.

What does an abnormal Pap smear mean?

If your results are abnormal, you will undergo more frequent Pap smears for monitoring, until your results are in the normal range. The frequency of these Pap smears will be determined by your doctor, but it could range from every three months to every year. Since many people’s bodies clear HPV on their own, when the results are clear again, you will return to an every three- or five-year schedule for Pap smears, depending on your age.

Your doctor may suggest a colposcopy, another type of cervical cancer test. This gives them a better view of your cervix. If they identify cells that may be abnormal, they will perform a biopsy and remove a tiny sample of tissue from either the inside or outside of your cervix. If the biopsy confirms the presence of abnormal cells, your doctor will discuss specific treatment options.

How can I prevent cervical cancer?

Receiving the HPV vaccine is the only way to protect against cervical cancer. Each year in the U.S., 13,200 women are diagnosed with cervical cancer. This number has decreased since the introduction of the HPV vaccine.

What happens if I get cervical cancer?

If you are diagnosed with cervical cancer, you will be referred to a gynecologic oncologist—a doctor who specializes in cancers of the female reproductive system. Most cases require chemotherapy, and some require radiation as well. Surgery may be a treatment option.

Get more facts about HPV

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    Measles outbreaks: What parents need to know

    Measles is one of the most contagious infections. It is so
    contagious that up to 90% of close contacts of someone with measles will also
    get measles if they are not immune. To prevent the spread of measles in a
    community, about 95% or more of the population must be vaccinated or immune to
    measles. This is called herd immunity.

    What caused the current measles outbreak?

    Because of global outbreaks and frequent travel, measles is brought back to the U.S. and can spread in populations of under-vaccinated individuals.

    What are symptoms of measles?

    Measles is highly contagious and transmitted through the air. Contagious particles can remain in the air for hours after an infected person leaves an area. Symptoms typically begin eight to 10 days after initial exposure to the virus, and then develop in stages. Early symptoms include a high fever – typically between 103 and 105 degrees Fahrenheit – cough, red watery eyes and runny nose. A rash develops around the third day of symptoms, starting on the face and continuing to spread downward over the body as the disease progresses. People are contagious for about four days before the rash begins and four days afterward, according to the U.S. Centers for Disease Control (CDC).

    How do you treat measles?

    There is no specific antiviral treatment for measles. Supportive care is provided while monitoring for possible complications, such as dehydration due to diarrhea or pneumonia. The CDC reports that pneumonia is the complication most likely to cause death in young children.

    When can you receive the measles vaccine?

    The MMR vaccination — which covers measles, mumps and rubella — is administered in two doses. The first does is usually given between 12-15 months and the second dose at 4-6 years of age. However, the second dose can be given as soon as 28 days after the first dose. For children traveling internationally, the vaccine is recommended as an extra dose for infants 6 to 11 months of age. To protect those who are unable to receive the vaccination, it’s vital that everyone eligible be vaccinated. Some people, including those with a weakened immune system due to disease or medical treatments, or pregnant women may not be eligible. Ask your healthcare provider for more information. Here’s some tips for making shots less stressful.

    Do I need an MMR booster?

    According to the U.S. vaccination schedule, people who received two doses of the MMR vaccine as children are usually considered protected for life and don’t need a booster dose.

    Is the measles vaccine safe?

    The measles vaccine is safe and readily available. Following the vaccination, some children have mild reactions, such as short-lived, low-grade fever.

    Can you die from measles?

    Measles is a very dangerous disease and can lead to complications including ear infections, pneumonia, a brain infection called encephalitis, and death. Before mass vaccination in the 1980s, measles affected three to four million people per year in the U.S., and 400 to 500 died. We have a very effective and safe vaccine to prevent measles. Getting the measles vaccine is the very best way to prevent measles. All parents should be vaccinating their children at the recommended ages.

    Does my child need the HPV vaccine?

    Human papilloma virus, or HPV, affects nearly all sexually active men and women at some point in their lives. Many people “clear” or fight off their infections without ever knowing that they had an infection at all. However, a percentage of people with the virus do not clear their infections and may develop genital warts, cervical cancer, head and neck cancers, and penile cancers.

    We spoke to Dr. Marisa Turner, a CHOC pediatrician, on the most common myths she hears from parents regarding the HPV vaccine.

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    Dr. Marisa Turner, a CHOC pediatrician, addresses the most common myths about the HPV vaccine.

    Myth 1: My child is too young. They don’t need the vaccine yet.

    Some parents decline the HPV vaccine because they think since they have years until their child is sexually active. However, many parents don’t realize the vaccine is more effective the earlier it is given. The immune response to the vaccine is better when given younger, therefore only two doses are needed if the series is started prior to the 15th birthday.

    The number of recommended doses depends on the child’s age when they receive their first dose. A two-dose series is given for children starting the series before their 15th birthday. Children who start the series on or after their 15th birthday will receive a three-dose series.

    Myth 2: You can only get HPV if you’re sexually active.

    Although sexual intercourse is the most common way to get HPV, it is not the only way to get it. It could take just one encounter to catch the virus, and most people who carry the virus have no symptoms and don’t realize they even have it. Even for those that are having protected intercourse, you can still catch HPV despite using a condom.

    Myth 3: Giving my child the HPV vaccine will make them become sexually active.

    Multiple studies have shown that giving this vaccine doesn’t increase rates of sexual activity in those patients compared to those who don’t receive it.

    It’s important for adolescents to take a part in their own health and begin to realize that decisions they make now can affect them later in life and their future health.

    Myth 4: Getting the vaccine will guarantee my child does not contract HPV.

    Most adults are likely to get HPV at some point in their lives. Some people clear it on their own, but others do not. If your child is vaccinated against HPV and later contracts HPV, it’s s likely to be a strain you can clear on your own.

    The HPV vaccine prevents against the nine strains of HPV most likely to lead to cancer. About half of all new infections are in people 15-24-year-olds, the peak age at which one should receive the HPV vaccine.

    Myth 5: HPV only affects females, so my son does not need the HPV vaccine.

    The HPV vaccine has benefits for males too. It prevents oral, anal and penile cancer, and genital warts. Getting vaccinated will also help prevent them from passing it on to other partners, which can happen even in the absence of visible symptoms of HPV.

    Myth 6: This vaccine is new, so it must not be safe enough to give my child.

    The HPV vaccine was first administered in 2006. Prior to coming to market, it was studied for many years. Ongoing studies have tracked patients for years after receiving the vaccine, and they have not shown any adverse effects. The HPV vaccine is administered and studied all over the world.

    Each year in the U.S., 13,200 women are diagnosed with cervical cancer. This number has decreased since the introduction of the HPV vaccine.

    Myth 7: My child doesn’t need the HPV vaccine. If they contract HPV, we’ll just treat it.

    There is no good treatment for HPV. Some strains clear on their own, but others do not. It’s better to get vaccinated and lower your risk of getting HPV in the first place.

    Myth 8: Getting the HPV vaccine will affect my child’s fertility later in life.

    Receiving the HPV vaccine will not affect fertility. However, having HPV can cause changes in the cervix which can later affect fertility.

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