COVID-19 vaccines for children and teenagers

The vaccines differ in their ingredients and how they activate the immune system:

• mRNA vaccines: mRNA vaccines contain the “blueprint” (copy of a gene) for a protein on the surface of the SARS-CoV-2 coronavirus. This blueprint in the vaccine enters the body’s cells in tiny fat particles (lipid nanoparticles). The cells then make that typical coronavirus protein (spike protein) for a short time. The immune system reacts to the protein, making antibodies and special cells to fight it. The blueprint is then broken down in the cells.
• Protein-based vaccine: The protein-based vaccines contain coronavirus-like particles with the typical spike protein on them. The spike protein in these vaccines is made in a lab and injected directly.

The Comirnaty and Spikevax vaccines have been adapted to provide more protection specifically against the omicron variant of the virus.

COVID-19 vaccines can reduce the risk of catching the virus and becoming ill. But this protection against an infection with symptoms is limited, and hardly there anymore after a few months. Then you may get infected with the virus and have symptoms despite being vaccinated (known as a “breakthrough infection”). Most children and teenagers then have symptoms like a cough or sore throat.

Children only very rarely develop severe COVID-19. The vaccine can probably further reduce that risk, especially for children who already have certain other medical conditions.

Similar to when you're vaccinated, when you recover from a COVID-19 infection the immune system makes immune cells that can protect you from getting COVID-19 again and prevent severe illness if you do.

It is normal for vaccinations to have certain side effects. That can be a sign that your body is reacting to the vaccine and starting to build immunity (protection).

Depending on the vaccine, the following reactions occur in 70 to 90% of vaccinated children and teenagers:

• Reactions where the needle went in, including pain, reddening or swelling
• Physical symptoms such as fever, chills, headache, aching muscles and joint pain

Young children (up to about three years old) are often restless after having a vaccine. It is quite common for them to cry more, eat less and sleep worse. These reactions to a vaccine are usually mild and go away again within a few days.

All vaccines can cause an immediate allergic response (anaphylactic reaction) that usually has no lasting effects. That is very rare, though, occurring in fewer than 1 in 100,000 vaccinations.

In some children and teenagers, the risk of myocarditis and pericarditis may be higher in the first few days after an mRNA vaccine (Spikevax or Comirnaty). Myocarditis is an inflammation of the heart muscle, and pericarditis is an inflammation of the lining around the heart. This side effect mainly affects male teenagers and young men after having the second dose of the vaccine. According to the European Medicines Agency (EMA), it occurs in up to 1 out of 10,000 people who are vaccinated with Comirnaty. The risk is slightly higher with Spikevax (up to 2 out of 10,000 people), so Spikevax is no longer recommended for people aged between 12 and 30.

It is important to see a doctor soon if the following symptoms occur in the first few weeks after vaccination:

• Chest pain
• Shortness of breath
• Unusual racing heart or palpitations

Most children and teenagers recover from myocarditis or pericarditis – but there may be lasting damage.

The safety of the vaccines is monitored by international authorities. In Germany, the Paul Ehrlich Institute is responsible for this.

Please note that some of the following information describes the situation in Germany specifically. You may find that things are different elsewhere.

COVID-19 vaccines (the initial set and boosters) are no longer recommended for healthy children and teenagers.

The German Standing Committee on Vaccination (STIKO) now recommends that children and teenagers should only have boosters if they are more likely to get very ill from COVID-19 due to other medical conditions – including chronic lung or heart diseases, diabetes, Down syndrome or a weakened immune system.

The German Standing Committee on Vaccination recommends basic immunity for all children and teenagers who have such an underlying condition to protect them from more serious complications from COVID-19. This is defined as three contacts with the virus, whether through vaccination or infection. According to their recommendation, at least one of these contacts should be through vaccination.

Three vaccinations are recommended for children who have an underlying medical condition and have not yet been infected or vaccinated. The second vaccination should be given at least three months after the first, and the third vaccination should be given at least six months after the second.

It is best to have yearly booster shots in the autumn because the infection rates are highest in the autumn and winter. They should be given twelve months after the last vaccination or infection.

According to the STIKO, this decision was based on the fact that most children and teenagers only have mild symptoms nowadays, or no symptoms at all. But the STIKO also has no concerns about the safety of vaccinating children and teenagers.

If people still have symptoms more than four weeks after a COVID-19 infection, they are considered to have long COVID. If the symptoms still haven't gone away after more than twelve weeks, it is called post COVID. These longer-lasting symptoms mainly include exhaustion, shortness of breath and difficulty concentrating. There is a lack of research on how well vaccinations can prevent long COVID and post COVID. But the available studies suggest that they also reduce the risk of longer-term symptoms.