COVID-19

• Are children at risk of getting COVID-19?

  Everyone, including children, is at risk of getting COVID-19. The Omicron variants of COVID-19 are more transmissible than the ancestral strain and earlier variants and are causing higher numbers of cases in children compared with the original strain and prior variants.^1-3 Household or close family contact from unvaccinated adults poses the greatest risk of spread to children.^4,5 Children tend to get mild disease and the majority do not require hospitalisation.

  Vaccination is available for children aged 6 months and older and has been shown to protect against hospitalisation and severe disease.⁶ Vaccination of adults will also protect against severe disease and is particularly important for those who live and work among young children.

• How serious is COVID-19 in children?

  COVID-19 is usually milder in children than in adults. It is estimated that 37–68% of children and adolescents get mild infection and that 16–28% of children have no symptoms at all.^7,8 The most common symptoms in children are runny nose, fever, cough and headache.^7,8 However, some children require hospitalisation; a smaller number require intensive care.

  Studies show that children and adolescents with underlying medical conditions have a greater risk of developing severe disease and complications from SARS-CoV-2 infection.^9-11 Children very rarely die from COVID-19. Studies early in the Pandemic in the UK suggested that 2 out of every 1 million children infected with the virus died of COVID-19 and that deaths only occurred in children with chronic, complex, often life-limiting conditions. This is lower than childhood deaths from influenza (3–6 per 1 million children).^11-13  

• Which children are at risk of serious illness from COVID-19?

  Conditions that increase the risk of children being hospitalised with COVID-19 include (but are not limited to) congenital heart disease, chronic pulmonary disease, neurological diseases, prematurity and obesity.^8,14

• Can children spread COVID-19 to other children or adults?

  Yes, children can spread COVID-19 to other children and adults.¹⁵ Most children who get infected with the virus have no symptoms or have only mild symptoms;^4,8 however, it is possible that they can still pass the virus on to others in their home and the community. The risk of transmission is higher among unvaccinated household contacts.

• What are the symptoms of COVID-19 in children?

  It is estimated that 16–28% of children who get COVID-19 may not have any symptoms at all.⁸ Of those who do get symptoms, the illness is usually very similar to other respiratory viral illnesses, with the most common symptoms being fever and cough. Children can also have non-specific symptoms such as a runny nose and tiredness. Some children may have gastrointestinal symptoms such as nausea, diarrhoea or vomiting.

• How are people cared for when they get COVID-19?

  Most children diagnosed with COVID-19 will experience only mild symptoms or no symptoms at all. These cases can generally be managed at home and with over-the-counter medications, such as paracetamol and ibuprofen. Children should also be encouraged to continue to drink small volumes of fluid regularly. More information on what to do if you or your child test positive for COVID-19 can be found here.  

  If a child feels unwell and is having difficulty breathing or keeping fluids in, they may need to be reviewed in hospital. Sometimes they may require feeding support, some oxygen or medical treatment. Healthy children rarely need intensive care treatment – this is more likely to be needed for older children with underlying medical conditions, including obesity, who have a greater risk of developing more severe disease.

• What is ‘long COVID’? Do children get it?

  In children, the condition of ‘long COVID’, also known as ‘post-COVID condition’, is not well defined. It usually refers to the persistence of COVID-19 symptoms, such as fatigue and breathlessness, for over 3 months.¹⁶ There is no conclusive evidence that long COVID exists in children, as similar symptoms have been revealed in children who are exposed to frequent lockdowns and the general unease created by the global pandemic.^17,18 It also appears to occur less commonly in children than in adults. Some of the symptoms, such as body aches, difficulty concentrating and changes in mood, have been reported in children and teenagers without prior infection and may be a consequence of living in the pandemic and in lockdown. Longitudinal studies tracking the duration of symptoms in children with COVID-19 frequently find almost complete symptom resolution within a few days.^19,20

• What are the risks and benefits (pros and cons) of COVID-19 vaccination in children?

  There are benefits and risks associated with all medical products and procedures. Throughout these FAQs, we provide information about the benefits and potential safety concerns associated with vaccinating children against COVID-19. Below is a general summary of some of the key points.²¹

  Individual benefits (pros)

  • Protection from COVID-19 disease
  • Protection from severe disease and death
  • Potential protection from PIMS-TS (also known as MIS-C)
  • Potential protection from uncertainty associated with new variants

   

  Individual risks (cons)

  • A small risk of adverse events, including the rare risk of myocarditis or pericarditis
  • Unknown level of protection against PIMS-TS/MIS-C for children aged 5–11 years, though early data suggest vaccines may be protective
  • Unknown level of protection against long COVID in children

   

  A COVID-19 vaccine decision aid is also available to help parents and carers make an informed decision about COVID-19 vaccination for their children. Access this decision aid here. 

• Why do children need to get a COVID-19 vaccine if they usually develop only mild illness?

  It is recommended that all children 5 years of age and older, and some children with certain medical conditions aged 6 months to under 5 years, get a COVID-19 vaccine in Australia for several reasons, including the following:^22-24

  • To protect against severe COVID-19. COVID-19 is usually milder in children than in adults, but it can still, very rarely, cause severe illness, particularly in children with chronic medical conditions. Some children will require hospitalisation or intensive care.^25,26
  • To reduce the spread of virus between themselves and to adults. Household transmission between children and from children to adults is common.²⁶ Vaccinated people are less likely to pass on the virus than unvaccinated people.^27,28 Vaccinating children can potentially reduce the spread of virus between themselves and to vulnerable adults.
  • To prevent other complications such as long COVID or PIMS-TS/MIS-C. Even after recovery from COVID-19, there is a chance of long-term complications. Long COVID is a condition where people with COVID-19 experience persistent symptoms, such as fatigue, shortness of breath and cognitive dysfunction (‘brain fog’), that continue for at least 3 months. There is limited evidence on the severity and duration of long COVID in children, yet it may be less severe and of shorter duration in children than in adults.^17,19 PIMS-TS (also known as MIS-C) is a rare inflammatory condition that has been seen in children following COVID-19 infection. It normally occurs 2–6 weeks after infection and can be mild to life-threatening.
• Why are there different vaccination policies for children in different countries?

  Children aged ≥6 months are eligible for COVID-19 vaccines in many countries globally. However, some countries may be prioritising vaccination for children who are more likely to suffer from moderate to severe illness rather than all children.

  COVID-19 is less likely to cause serious illness in children compared with adults. The vaccines were originally developed for and tested on adults. As there was limited supply of vaccines initially, many countries prioritised vaccination for those most at risk of severe disease. This included older adults. As the vaccination supply increased, younger people became eligible for vaccination.

  In Australia, we are fortunate to have been able to vaccinate over 95% of the adult population. Australia has therefore commenced a vaccination program for children to protect them from severe disease and, potentially, to help stop the spread of the virus.

• What is the minimum age for children to get a COVID-19 vaccine in Australia?

  In Australia, the minimum age for children to get a COVID-19 vaccine is 6 months.^24,29 All children aged 5 years and older can receive a COVID-19 vaccine and some children aged 6 months to under 5 years with certain medical conditions can receive a COVID-19 vaccine.

• Updated - How many doses of COVID-19 vaccine do children and adolescents need? Do they need a booster?

  COVID-19 vaccine is recommended for all people aged 5 years and older and for some children aged 6 months–4 years who are at increased risk of severe COVID-19. For those aged 5–17 years who are at increased risk of severe COVID-19, a single 2023 booster can be considered at an interval of 6 months from either infection or a previous vaccine dose. After this booster, additional doses in 2023 are not recommended for people under 18 years of age, irrespective of risk factors. The recommended vaccine brand and number of doses are based on age and other conditions. Access the ATAGI clinical guidance or the poster of ATAGI recommended COVID-19 doses and vaccines for details (see p. 2 for people with immunocompromise). You can discuss these options with your immunisation provider.

  Some COVID-19 vaccines approved for use in Australia are not currently registered for used in people under 18 years of age. A list of vaccines available by ages can be found here.

  More information can be found here:

  • ATAGI 2023 booster advice
  • COVID-19 vaccine coverage in Australia, refer to the Australian Government Department of Health
  • COVID-19 Vaccine Clinic Finder
• How do mRNA COVID-19 vaccines work?

  An mRNA vaccine contains the genetic code for an important part of the COVID-19 virus called the spike protein. After getting the injection, the body ‘reads’ this genetic code and makes copies of the spike protein. The immune system then detects these spike proteins and learns how to recognise and fight against COVID-19. The genetic code does not combine with the DNA in our cells; it is quickly broken down and cleared away by the body.

• What is Novavax and how does it work?

  Novavax, also called Nuvaxovid or NVX-CoV2373, is a COVID-19 vaccine developed by Novavax. It is an adjuvant protein subunit vaccine. It uses a version of the spike protein of SARS-CoV-2 (the virus that causes COVID-19) and adjuvants within the vaccine that mimic the way the real virus would activate your immune system to boost your immune system and provide protection.

  The adjuvants are based on a natural product known as saponin (an extract from tree bark). The spike proteins resemble the structure of SARS-CoV-2; however, once injected they cannot replicate and cause COVID-19. The vaccine does not contain any live component of the virus.

  People aged 12 years and older can receive 2 doses of Novavax, 8 weeks apart for the primary course, or 18 years and older as a booster.

• Are COVID-19 vaccines effective in children and adolescents?

  Clinical trials of the Pfizer vaccine (Comirnaty) and the Moderna vaccine (Spikevax) in children and adolescents have shown these vaccines provide excellent protection against COVID-19.

  A review of studies in children and adolescents aged 2–18 years found that 2 doses of the Pfizer or Moderna vaccine were 63% effective at preventing hospitalisation, 76% effective at preventing symptomatic infection and 83% effective at preventing hospitalisation due to COVID-19.³⁰

• Are there any activities children and adolescents should avoid after COVID-19 vaccination?

  Most children and adolescents can continue to perform all their regular daily activities after COVID-19 vaccination. If they feel well after their vaccine, they can continue their usual exercise. Those who feel unwell after vaccination (e.g. with a fever or tiredness) are recommended to rest and to seek medical attention for any symptoms that they or their parents/carers are worried about.

• Can you get COVID-19 from COVID-19 vaccines?

  No, you cannot get COVID-19 from a COVID-19 vaccine. To get COVID-19, a live virus that can multiply in your body has to infect you. No COVID-19 vaccine currently supplied in the world contains live coronavirus. All the vaccines currently available in Australia and elsewhere contain the code for the body to make only the spike protein (not the actual virus) that the person’s immune system then responds to, to provide protection against severe COVID-19 in the future.

• My child has had COVID-19. Should they still be vaccinated?

  Yes, children aged 5 years and older and some children aged from 6 months can be vaccinated (with the usual two-dose schedule or booster) after recovery from COVID-19. A COVID infection means you produce antibodies that can help protect against COVID-19. This is known as natural immunity. 

• Can children with underlying health conditions get a COVID-19 vaccine?

  Yes, children with underlying health conditions can get a COVID-19 vaccine, particularly if they have a health condition that increases their risk of severe illness. Talk to your family doctor to find out whether a particular health condition increases the risk of severe COVID-19.

  Children 6 months of age and older who are severely immunocompromised are recommended to receive a third primary dose of COVID-19 vaccine from 2 months after they have had their second dose, as part of their primary schedule.

  Those aged 5–17 years who are at increased risk of severe COVID-19 can consider a 2023 booster dose from 6 months since either their last dose of vaccine or SARS-CoV-2 infection. Speak to your immunisation provider to discuss a risk–benefit assessment.

• Can children and adolescents get a COVID-19 vaccine if they are on other medications?

  In most cases, medication should not be stopped before or after having a vaccine, including a COVID-19 vaccine. There are, however, a few situations in which people might be advised to either delay vaccination or delay a particular medication:

  • Some people taking blood thinners (anticoagulants) may be advised to delay vaccination if there is a high risk of bleeding or bruising at the site where the vaccine is injected. Most people on a stable dose of blood thinner can receive the vaccine without any checking of medication levels or change to their medication.
  • People taking immune-weakening treatments (immunosuppressants), including chemotherapy, have a higher risk of developing severe COVID-19 and – importantly – can have a COVID-19 vaccine, but they should discuss the best timing of vaccination with their treating doctor. For people taking certain immunosuppressive treatments, there may be a time point in their treatment cycle where they are anticipated to have a better immune response to the vaccine. In some cases, it may be possible to withhold a dose of the immunosuppressant to maximise the immune response to the vaccine.

   

  Children and adults taking other medications should continue their regular treatment before and after vaccination.

• Is COVID-19 vaccination mandatory for children and adolescents in Australia?

  COVID-19 vaccination is not mandatory for children or adolescents in Australia (refer to the question ‘Is the COVID-19 vaccine mandatory?’ in NCIRS COVID-19 vaccines: Frequently asked questions). However, all children aged 5 years and older, and some children aged 6 months to under 5 years are recommended to receive a COVID-19 vaccine to protect themselves from serious disease and to potentially prevent spread of the virus to other children and adults.

• My child recently had COVID-19 or a COVID-19 vaccination. Do they need to wait before getting other vaccines?

  Children and adolescents can get non-COVID vaccines, including influenza vaccine, without any minimum interval if they have recently had a COVID-19 vaccine or tested positive to COVID-19. If they have a fever or are feeling very unwell, talk to your doctor about the best time to get vaccinated. If they are feeling well and have no symptoms or only minor symptoms, they can get other (non-COVID) vaccines at any time. It’s important to be up to date with other vaccines, including influenza vaccine, to minimise risk of other infections.

• Are COVID-19 vaccines safe in children and adolescents?

  Clinical trials and real-world studies^31-34 have shown that COVID-19 vaccines approved for children (6 months–11 years) and adolescents (≥12 years) are safe. Children are likely to experience mild side effects, such as fever, fatigue/sleepiness and pain at the injection site after vaccination, but these symptoms usually resolve within 48 hours. Infants and children are prone to febrile convulsions – most frequently, due to viral infection – and these can also occur after vaccination.

  Side effects are expected and reflect a developing immune response to vaccination. Studies have found that rates of side effects after a COVID-19 vaccine in children and adolescents were similar to those experienced by adults and in some instances were milder and occurred less frequently than in adults.^35-37

  A risk of myocarditis and pericarditis has been seen in people who have received COVID-19 vaccines. Myocarditis after a COVID-19 vaccine has been reported most often after dose two of an mRNA vaccine in males under 40, but it can occur at any age, in any gender and after any dose. Data from the US showed no evidence of an increased risk for myocarditis following mRNA COVID-19 vaccination in children aged 6 months to 5 years.³⁸ There is currently not enough evidence to indicate that there is an increased risk of myocarditis or pericarditis in children aged 5–11 years following COVID-19 vaccination; however, cases may occur.

   In Australia, the Therapeutics Good Administration (TGA), part of the Australian Government Department of Health, is responsible for approving medicines and vaccines for use in Australia. The TGA has a rigorous process for assessing vaccine safety, quality and efficacy before approving vaccines for use in the population. Australia’s national active vaccine safety surveillance system AusVaxSafety also monitors vaccine safety in real-time and provides detailed information on age-specific rates of adverse events, as well as adverse events in Aboriginal and Torres Strait Islander people and those with risk conditions.

• Can COVID-19 vaccines cause permanent damage/long-term side effects in children?

  As with any medical product, including vaccines, there is a small risk of rare side effects. However, there are much greater risks associated with the disease itself, and so the benefits of vaccination outweigh these risks.

  Only the Pfizer and Moderna vaccines are licensed for use in children to protect children against COVID-19. Both of these vaccines have been associated with a small risk of the rare side effect of myocarditis or pericarditis. However, there is a risk of myocarditis or pericarditis from COVID-19 as well as a more severe condition called PIMS-TS/MIS-C. In a US study, 87% of those who experienced myocarditis after vaccination had their symptoms resolved by hospital discharge (average length of stay was 1–2 days).³⁹ In early data from the US, follow-up of 12–15 year olds who experienced myocarditis after vaccination showed 92% had their symptoms resolved.⁴⁰ Longer-term follow-up of people who have had myocarditis or pericarditis following a COVID-19 vaccine or COVID-19 disease is ongoing.

  See also ‘What is myocarditis and pericarditis, and can Pfizer or Moderna vaccine cause it?’ and ATAGI advice on myocarditis.

  COVID-19 vaccination primes the immune system to protect against infection and disease from SARS-CoV-2. When a rare serious or permanent adverse event has occurred for other vaccines, it has occurred soon after vaccination (generally within 6 weeks), so it is unlikely to see adverse events from vaccination years after a vaccine has been given. That is, the risk of long-term side effects is very low.

• Have there been any deaths following COVID-19 vaccination in children?

  In Australia, there have been no reports of death linked to COVID-19 vaccination in children.

  Clinical trials and real-world studies31-34 have shown that COVID-19 vaccines approved for children (6 months–11 years) and adolescents (≥12 years) are safe. Both Pfizer and Moderna COVID-19 vaccines have now been administered to many millions of children aged ≥5 years and adolescents around the world.

  In Australia, vaccine safety is monitored by the TGA, to which people can directly report side effects following vaccination. More information about TGA processes for reviewing a death after a COVID-19 vaccination can be found here. There are also other forms of vaccine safety monitoring, such as that done AusVaxSafety, whereby clinics send SMS messages to people receiving vaccines (or their parents or carers) to ask if they had any reactions after receiving a vaccine. Independent experts analyse the responses to ensure that any safety issues are detected quickly. View the data on vaccine safety in children here.

  When vaccines are rolled out to so many people worldwide in a short period of time, it is inevitable that this rollout will coincide with life events. Some people will experience a new illness or die within a few days or weeks of having the vaccine, but usually these events are due to chance rather than caused by the vaccine. The TGA encourages and reviews these reports, but just because a death has been reported it does not mean that the vaccine played a role in the death. There have been large amounts of false information about the COVID-19 vaccines and deaths circulating online and on social media. All deaths linked to a COVID-19 vaccine will be reported on the TGA website.

• What are myocarditis and pericarditis, and can a COVID-19 vaccine cause them?

  Myocarditis is inflammation of the heart muscle. Pericarditis is inflammation of the outer lining of the heart. Myopericarditis is where these two conditions occur together.

  Myocarditis and/or pericarditis can occur very rarely in younger people, including adolescents and children 5 years of age and older, who have had a COVID-19 vaccine. It is more common after dose 2 and in adolescent males.

  Different rates of myocarditis have been reported from many countries as they have different ways of capturing information. The rates after dose 2 for males aged 12–17 years range from 71 to 136 per million doses for Pfizer and 237 per million doses for Moderna. For females aged 12–17 years, the rates after dose 2 range from 2-28 per million doses for Pfizer and 0-28 per million for Moderna.⁴¹ For children aged 6 months to 11 years, there is currently no clear attributable risk of myocarditis and/or pericarditis from the COVID-19 vaccines.

  Rates of myocarditis following a booster (3rd) dose have been observed to be lesser than after dose 2 but greater than after dose 1. Data from the US and Israel suggest the rates in adults following a 4th dose are not above the expected background rates.⁴¹ There are currently no data on rates following a 5th or subsequent dose. Early data from the US and UK suggest there is a risk of myocarditis and pericarditis following the bivalent vaccines.^42-44 The symptoms typically appear within 1–5 days of vaccination and are usually mild. Most children and adults with myocarditis or pericarditis related to COVID-19 vaccination recover quickly after a short period of monitoring (usually in hospital) and either simple treatment, such as anti-inflammatory medication, or no treatment. However, occasionally children need to refrain from returning to sports for weeks or months.

  The symptoms of myocarditis or pericarditis can include:

  • chest pain, pressure or discomfort
  • palpitations (irregular heartbeat, skipped beats or ‘fluttering’)
  • syncope (fainting)
  • shortness of breath
  • pain with breathing.

   

  It is important to note that myocarditis and pericarditis can present with atypical features, such as the absence of chest pain, or the presence of abdominal pain or other non-specific symptoms. If a child or adult experiences any of these symptoms in the weeks following vaccination, they should seek prompt medical attention. Further information can be found in the ATAGI guidance on myocarditis and pericarditis after mRNA COVID-19 vaccines. A tool has been developed by the Paediatric Research in Emergency Departments International Collaborative (PREDICT) to assess children and adolescents with chest pain following mRNA vaccination..

   

  Importantly, there could be other causes for these symptoms. Data indicate that in young adults in Australia, 3–8 cases of myocarditis and pericarditis that are not related to COVID-19 vaccination occur on average each week. Rates of myocarditis and pericarditis are higher in people with COVID-19 disease than in people who have recently had a COVID-19 vaccine.⁴⁵

• Do the COVID-19 vaccines cause PIMS-TS/MIS-C?

  PIMS-TS/MIS-C is a very rare but serious inflammatory complication that has been found to occur after COVID-19 infection in children. There have been some reports of cases of PIMS-TS/MIS-C occurring in the weeks after COVID-19 vaccination, but these don’t prove a causal link. Not all adverse events that occur following vaccination are necessarily caused by the vaccine.

  A study from the US⁴⁶ investigated cases of PIMS-TS/MIS-C following vaccination and found that there were 21 potential reports as of 31 August 2021. Of these cases, 71% had a previous infection with SARS-CoV-2. The study suggested that the rate of PIMS-TS/MIS-C in those who did not have prior SARS-CoV-2 infection was 0.3 cases per million vaccinated individuals.

  In Australia, as of 8 September 2022,⁴⁷ there have been no cases of PIMS-TS/MIS-C linked to COVID-19 vaccination.

• Can COVID-19 vaccines lead to infertility?

  No, there is no evidence that any of the COVID-19 vaccines being used in the Australian COVID-19 vaccination program can lead to infertility. Importantly, COVID-19 vaccines protect young people from getting severely ill and developing serious complications that could affect their ability to become parents.

  Before human trials, the Pfizer, Moderna, AstraZeneca and Novavax vaccines were assessed for their effect on fertility in animal studies. These studies found pregnancy rates in animals that received the vaccine were same as for those that did not receive the vaccine.

  Studies from Israel and the US of mRNA vaccines in women undergoing in vitro fertilisation (IVF) comparing who had and had not been vaccinated or had COVID-19 in the past showed that the Pfizer and Moderna vaccines did not affect fertility treatment.⁴⁸ In studies conducted on healthy men, there were no significant impacts on sperm parameters after COVID-19 vaccination.^49,50

• Can children get COVID-19 in school?

  Yes, children can get COVID-19 in schools. However, research shows they are more likely to catch COVID-19 in their home environment or at gatherings outside of school. An ongoing study of the transmission of COVID-19 in educational settings in Australia shows that, although the risk of child-to-child spread is low (0.3%), infected school staff members (adults) can pass on the virus to children (1.5%).⁵¹

• How can we keep children safe in schools?

  There are many relatively simple measures that can be taken to minimise COVID-19 spread in schools. These include regular hand hygiene, keeping adults and parents off school grounds and avoiding large crowds.

  As always, it is important that children who are unwell with even mild symptoms stay home from school and get tested for COVID-19. Vaccinating adults and children aged 6 months and older will protect people from severe disease and potentially decrease spread among the general population.

• Is it safe for my child to go to school even though they haven’t yet received a COVID-19 vaccine?

  Yes, your child can go to school if they have not yet received a COVID-19 vaccine; however, vaccination is recommended. COVID-19 is usually milder in children than in adults and, since the vaccination rate in adults in Australia is high – over 90% – children are well protected from COVID-19. The spread of COVID-19 is also a lot less common in the school setting compared with the household setting.^26,51

  COVID-19 can still very rarely cause severe illness in children, particularly those with chronic medical conditions. Therefore, all children aged ≥5 years, and some children aged 6 months to under 5 years, are recommended to receive two doses of a COVID-19 vaccine. To find a vaccination provider and book an appointment, visit the COVID-19 Vaccine Clinic Finder, which is available in 15 languages.

• List of references

  1.         Christensen PA, Olsen RJ, Long SW, et al. Early signals of significantly increased vaccine breakthrough, decreased hospitalization rates, and less severe disease in patients with COVID-19 caused by the Omicron variant of SARS-CoV-2 in Houston, Texas. medRxiv 2022:2021.12.30.21268560.

  2.         Wang L, Berger NA, Kaelber DC, et al. Comparison of outcomes from COVID infection in pediatric and adult patients before and after the emergence of Omicron. medRxiv 2022.

  3.         Havers FP, Whitaker M, Self JL, et al. Hospitalization of Adolescents Aged 12-17 Years with Laboratory-Confirmed COVID-19 - COVID-NET, 14 States, March 1, 2020-April 24, 2021. MMWR Morbidity and mortality Weekly Report 2021;70:851-7.

  4.         National Centre for Immunisation Research and Surveillance (NCIRS). COVID-19 Delta variant in schools and early childhood education and care services in NSW, Australia: 16 June to 31 July 2021. 2021. Available from: https://www.ncirs.org.au/sites/default/files/2021-09/NCIRS%20NSW%20Schools%20COVID_Summary_8%20September%2021_Final.pdf (Accessed 29 September 2021).

  5.         Li W, Zhang B, Lu J, et al. Characteristics of Household Transmission of COVID-19. Clin Infect Dis 2020;71:1943-6.

  6.         Price AM, Olson SM, Newhams MM, et al. BNT162b2 protection against the Omicron variant in children and adolescents. New England Journal of Medicine 2022.

  7.         Assaker R, Colas AE, Julien-Marsollier F, et al. Presenting symptoms of COVID-19 in children: a meta-analysis of published studies. Br J Anaesth 2020;125:e330-e2.

  8.         Williams P, Koirala A, Saravanos G, et al. COVID-19 in children in NSW, Australia, during the 2021 Delta outbreak: Severity and Disease spectrum. medRxiv 2021:2021.12.27.21268348.

  9.         Kompaniyets L, Agathis NT, Nelson JM, et al. Underlying medical conditions associated with severe COVID-19 illness among children. JAMA Network Open 2021;4:e2111182.

  10.       Graff K, Smith C, Silveira L, et al. Risk factors for severe COVID-19 in children. Pediatric Infectious Diseases Journal 2021;40:e137-e45.

  11.       American Academy of Pediatrics. Children and COVID-19: State-Level Data Report. 2021. Available from: https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/ (Accessed 29 September 2021).

  12.       Smith C, Odd D, Harwood R, et al. Deaths in Children and Young People in England Following SARS-CoV-2 Infection during the First Pandemic Year: A National Study Using Linked Mandatory Child Death Reporting Data. 2021. Available from: https://www.researchsquare.com/article/rs-689684/v1 (Accessed 29 September 2021).

  13.       Shang M, Blanton L, Brammer L, Olsen SJ, Fry AM. Influenza-Associated Pediatric Deaths in the United States, 2010-2016. Pediatrics 2018;141.

  14.       Shi Q, Wang Z, Liu J, et al. Risk factors for poor prognosis in children and adolescents with COVID-19: a systematic review and meta-analysis. EClinicalMedicine 2021;41:101155.

  15.       Paul LA, Daneman N, Schwartz KL, et al. Association of Age and Pediatric Household Transmission of SARS-CoV-2 Infection. JAMA Pediatr 2021.

  16.       Borch L, Holm M, Knudsen M, Ellermann-Eriksen S, Hagstroem S. Long COVID symptoms and duration in SARS-CoV-2 positive children - a nationwide cohort study. Eur J Pediatr 2022;181:1597-607.

  17.       Zimmermann P, Pittet LF, Curtis N. How common is long COVID in children and adolescents? Pediatric Infectious Disease Journal 2021;40:e482-e7.

  18.       Stephenson T, Shafran R, De Stavola B, et al. Long COVID and the mental and physical health of children and young people: national matched cohort study protocol (the CLoCk study). BMJ Open 2021;11:e052838.

  19.       Molteni E, Sudre CH, Canas LS, et al. Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2. The Lancet Child & Adolescent Health 2021.

  20.       Say D, Crawford N, McNab S, et al. Post-acute COVID-19 outcomes in children with mild and asymptomatic disease. The Lancet Child & Adolescent Health 2021;5:e22-e3.

  21.       Zimmermann P, Pittet LF, Finn A, Pollard AJ, Curtis N. Should children be vaccinated against COVID-19? Arch Dis Child 2021.

  22.       Australian Technical Advisory Group on Immunisation (ATAGI). COVID-19 vaccination – ATAGI clinical guidance on COVID-19 vaccine in Australia in 2021. Canberra, Australia: Australian Government Department of Health; 2021. Available from: https://www.health.gov.au/resources/publications/covid-19-vaccination-atagi-clinical-guidance-on-covid-19-vaccine-in-australia-in-2021 (Accessed 29 September 2021).

  23.       Australian Technical Advisory Group on Immunisation (ATAGI). ATAGI recommendations on the use of the paediatric Pfizer COVID-19 vaccine in children aged 5 to 11 years in Australia. Canberra: Australian Government Department of Health; 2021. Available from: https://www.health.gov.au/sites/default/files/documents/2021/12/atagi-recommendations-on-pfizer-covid-19-vaccine-use-in-children-aged-5-to-11-years_0.pdf (Accessed 20 December 2021).

  24.       Australia Government Department of Health and Aged Care. ATAGI recommendations on use of the Pfizer COVID-19 vaccine for children aged 6 months to 4 years. 2022. Available from: https://www.health.gov.au/news/atagi-recommendations-on-use-of-the-pfizer-covid-19-vaccine-for-children-aged-6-months-to-4-years (Accessed 15 November 2022).

  25.       Antonelli M, Penfold RS, Merino J, et al. Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study. Lancet Infectious Diseases 2021.

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