Resources and tips for finding immunizations for children:

Navigating vaccines can feel overwhelming. Talk to your pediatrician.

• Schedule an appointment through Cook Children's.
• Find your nearest Texas Department of State Health service clinic for information on clinics.
• Call 211 for help.
• Call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic.
• Check with your local school district for vaccine events.

Raising a child brings up endless questions, especially when it comes to their health and well-being. As back-to-school season approaches, immunizations may be top of mind for families, and searching for clear, honest answers about what goes into their child's body and why. With so much conflicting information online, sorting facts from fear can feel overwhelming. Cook Children’s Health Care System helps parents and caregivers cut through the noise with trusted guidance from medical experts who are parents themselves.

Among the required school shots, the Hepatitis B vaccine often raises the most questions, especially when it comes to why infants and young kids need protection so early.

Hospitalist Laura Romano, D.O., explains the key facts about hepatitis B and the vaccine that prevents it.

What is Hepatitis B?

Hepatitis B is a serious liver disease that is caused by the hepatitis B virus (HBV).

In adults, hepatitis B is usually spread through blood or intimate contact. In young children, however, the virus usually spreads through contact with infected bodily fluids. Transmission most commonly occurs during labor and delivery, but it can also happen through everyday activities, such as sharing a toothbrush or being bitten by a person who has the virus.

People infected with hepatitis B can spread the virus even if they show no symptoms. In fact, children often remain asymptomatic for years while still being contagious. This is especially concerning because infants and young children are more likely than adults to develop chronic, lifelong liver conditions, including permanent liver damage, cirrhosis (severe scarring), and liver cancer.

Treatment options for chronic hepatitis B are limited and focus primarily on halting the progression of liver damage rather than curing the virus itself. For severe cases where the liver has sustained significant damage, a liver transplant may ultimately be necessary.

How can the disease be prevented?

The most effective way to prevent hepatitis B is through vaccination. The vaccine is highly protective, offering about 95% effectiveness in preventing both acute and chronic infections. Since its routine inclusion in infant immunization schedules, rates of hepatitis B cases and associated liver cancer have steadily declined.

What would you like families to know about the hepatitis B vaccine and HBV?

• Hepatitis B is often misunderstood as a disease that only affects people engaging in high-risk or illegal behaviors. Anyone can contract the virus through everyday actions such as sharing a razor or toothbrush with someone who has the infection, even if that person shows no symptoms.
• Prenatal screening and maternal immunity testing alone are not enough to protect all children from hepatitis B. History has shown that targeting only 'high-risk' infants leaves gaps, leading to ongoing infections in both mothers and children that universal vaccination prevents.
• While some countries delay hepatitis B vaccination until children are older, their social and health care infrastructure differs significantly. Longer parental leave in those countries means children spend less time in daycare, where early exposure can occur. Also, universal health care access allows these countries to detect acute infections quickly and manage chronic cases more effectively.

Related Stories:

• Mindful Monday Medicine: Back to School Checklist

• Prioritizing Firearm Safety and Youth Well-being in Fort Worth

• Heat Safety for Kids: Hydration, Heat Illness Signs and Sun Protection Tips

Collin County Health Care Services has issued a health alert due to an increase in chickenpox (varicella) across the county. Chickenpox is an infection caused by varicella-zoster virus, leading to a fever and an itchy rash with spots all over the body.

Because it is highly contagious, chickenpox is a reportable condition in Texas and must be disclosed to the local health department. According to health officials, schools and childcare settings are high-risk environments for outbreaks. Prompt identification and exclusion of cases are critical to limiting transmission.

While chickenpox used to be a common illness in the United States, it has become much rarer due to the chickenpox vaccine which helps prevent the infection.

Cook Children’s Health Care System doctors know parents and caregivers may have questions about this, Laura Romano, D.O., a hospitalist at Cook Children’s and mom herself, addresses some concerns.

• I got chickenpox as a kid. Should I be concerned if my little one gets it?
  • One infection with chicken pox should give you lifelong immunity.
• How effective is the varicella vaccine?
  • Two doses give up to 98% protection and have decreased hospitalizations and death by over 97% since 1995!
• What if my little one only had one dose. What does that mean for them?
  • If your child has already had one dose of the chicken pox vaccine, they will most likely not need another one if they get an actual infection. Please talk with your pediatrician about this.
• What happens if someone is immunocompromised and is around someone who has varicella?
  • The most common complication is a skin infection caused by scratching at the lesions, which may require antibiotics to help treat. Other more serious complications include pneumonia, ataxia (difficulty walking), dehydration, or encephalitis (swelling of the brain). People who also have chicken pox are at risk for shingles later in life. Vaccination against chicken pox helps prevent against all these complications including the furture risk of shingles.
• What complications can arise from chickenpox?
  • The most common chickenpox complications are bacterial infections of the skin and soft tissues in children and pneumonia in adults.
• How do you treat chickenpox?
  • While there is not a single treatment for chicken pox, doctors focus on symptom relief. Doctors recommend Tylenol for fever, calamine lotion or oatmeal baths for itchiness. Lesions should go away in the 10-14 days. 

Symptoms of Chickenpox:

A mild fever may occur 1 to 2 days before rash onset, particularly in adults. In children, the rash is often the first sign of disease.

Seek immediate medical attention when your child:

• has trouble breathing
• has a severe headache
• is very drowsy or has trouble waking up
• has trouble looking at bright lights
• has trouble walking
• seems confused
• seems very ill
• has a stiff neck
• has a fever that lasts for more than 4 days
• has a bad cough
• has an area of rash that leaks pus (thick, yellowish fluid) or becomes red, warm, swollen, or sore
• is vomiting

August is a chaotic month for any busy parent. Between back-to-school preparations and the last days of summer, it's easy to get overwhelmed. On top of that, August is also National Immunization Awareness Month—a perfect time to make sure your children are up-to-date on their vaccinations.

When people learn that I’m a pediatrician they often ask if my own two children are vaccinated and I always reply with a resounding yes. My children are vaccinated for several reasons: 

Vaccines are safe! 

• Every vaccine that is currently in use has gone through a rigorous testing phase to make sure that the vaccine is safe. Side effects and potential reactions are closely reviewed by multiple agencies at the federal level. Even after the vaccine has been approved, the Vaccine Adverse Effect Reporting System (VAERS) continues to monitor for additional side effects. 
• Millions upon millions of vaccines will be administered this year with minimal side effects. The most common side effects are low-grade fever, redness around the injection site or maybe some mild muscle aches. 

Vaccines are effective! 

• Vaccines have led to the eradication of previously fatal diseases like Smallpox. 

Vaccines save lives!

• Vaccines have saved the lives of nearly 200 million people in the past century. Many of those lives saved are of young children and babies. 
• Vaccines prevent diseases and illnesses that have serious consequences, even in healthy children. 
• Vaccines prevent diseases that can lead to hospitalizations, pneumonia, potential hearing loss, potential loss of an arm or a leg, brain damage, and even death. 

Vaccines do not cause autism. 

• Decades of research has shown again and again and again that there is no link between vaccines and autism. 

The ingredients in vaccines are safe. 

• Just as the individual vaccine is studied, the ingredients in vaccines are also rigorously studied. 
• Some vaccines contain ingredients like aluminum, which can be found in fruits and vegetables. Aluminum helps the body produce an immune response and is perfectly safe. 
• Vaccines can be preserved with very small amounts of formaldehyde, so small that it is not harmful at all. 
• These ingredients are like baking powder when you’re making cookies. By itself, baking powder does not taste good but in small amounts, it’s needed for your cookies to come out looking and tasting great! 

Vaccines are recommended by my children’s doctors.

• My kids’ pediatrician - along with the American Academy of Pediatrics, the American Academy of Family Physicians, the Infectious Disease Society of America, the American College of Physicians, the American Medical Association, and the American Nurses Association - all support routine childhood immunizations. 

Vaccines help keep my community safe. 

• My children are vaccinated because doing so protects them and our community. 
• Vaccines can help prevent your child from spreading illnesses to at-risk individuals such as your parents who have diabetes, your child’s classmate who has a newborn at home, your neighbor who is undergoing chemotherapy for cancer, your co-worker who just received a kidney transplant, or the cashier in the grocery store who has an autoimmune condition. 
• We rely on everyone to get their vaccines to keep the community safe. 

And the most important reason to me is that I want to protect my dad. My dad has type 1 diabetes and is immunocompromised. My kids will always get their flu vaccines every year so we can give him the BIGGEST hug without worrying about making him sick. 

So, this month, in between back-to-school shopping, meet the teacher nights and the ever-exciting first day of school, please call your child’s pediatrician and make sure that they are up-to-date on their vaccines. We would love to talk to you more and answer all of your questions and concerns! 

Related Stories
School Checklist: Get a Head Start on Health Requirements
Cook Children’s Comfort Menu Eases Pain, Anxiety for Children Getting a Shot

The first outbreak-related cases were reported on May 13 in Collin and Rockwall counties. Alice Phillips, M.D., director of ambulatory quality and safety, advises parents to be aware but not alarmed.

“These cases remain small in our region. If your children are vaccinated, nothing about activities needs to change,” Dr. Phillips said.

Cook Children’s Health Care System continues to work with local public health departments on any report of measles cases. The Texas Department of State Health Services in April recommended that children between 6 months to 11 months traveling to or living in an area with an active measles outbreak receive a vaccination.

Dr. Phillips explained that the best way to protect a child from measles is the MMR vaccine. One dose offers 93% protection, and two doses provide 97% protection against the virus.

DSHS has designated these counties as outbreak areas: Cochran, Dawson, Gaines, Lamar, Lubbock, Terry, and Yoakum.

Currently, the Tarrant and Denton County health departments, where Cook Children’s Medical Center – Fort Worth and Prosper are located, have not issued this recommendation.

“If that changes due to a rise in cases, we will update,” said Dr. Phillips.

However, Dr. Phillips noted that families planning to travel outside of the United States, should be aware of regions where the MMR and/or Hepatitis A, vaccine is recommended for infants between 6 and 12 months.  She encourages parents to check with their pediatrician.

“If your kids are vaccinated, they are safe and protected,” said Dr. Phillips.

As of Tuesday, April 8, the Texas Department of State Health Services (DSHS) reports 505 cases and 57 patients hospitalized. Of the 505 confirmed cases, 495 are either unvaccinated or their vaccination status is unknown. No cases have been reported at Cook Children’s Medical Centers in Fort Worth or Prosper.

Cook Children’s Health Care System, through Marc Mazade, M.D., medical director of infection prevention and control, and Alice Philips, M.D., director of ambulatory quality and safety, explained what this means and what families should know.

The measles virus is highly contagious and can remain in the air for up to two hours.

“If the children at Great Wolf Lodge (during the exposure dates) were vaccinated then only observation is needed,” Dr. Phillips said. “Vaccination provides excellent protection and these kids have little risk to develop measles.”

Dr. Mazade explained that if a child visited either of these locations during the exposure period and was not vaccinated, they should watch for symptoms related to measles.

“Parents should watch for fever, congestion, cough, and red eyes and development of a rash,” Dr. Mazade said.

There is a 21-day incubation period, which means a child could develop the measles during that time. Children who develop any symptoms during that period should contact their doctor.

Dr. Mazade explained if symptoms develop, the family should keep the child at home and call their primary care physician.

Cook Children’s primary care clinics and neighborhood health centers can do testing on site for existing patients. 

If a parent suspects their child may have measles, they should call the primary care doctor before arriving at the office so arrangements can be made for safety and to minimize potential exposure in the waiting room.

“Parents should not hesitate to call their primary care physician for any questions,” Dr. Phillips said. “We are here to answer them.” 

Cook Children’s Health Care System continues to work with county health departments where clinics, medical centers and urgent cares are located.

DSHS recommendations

DSHS released new guidelines Monday now recommending children living in Cochran, Dallam, Dawson, Gaines, Garza, Lynn, Lamar, Lubbock, Terry, and Yoakum.

Infants
Immediately administer an early dose of measles, mumps, and rubella (MMR) vaccine for infants aged 6-11 months.

Children
Administer a second dose of MMR vaccine for preschool-aged children aged 1 to 4 years who received one prior dose.

Children at least one year of age with no documentation of vaccination history should receive two doses at least 28 days apart.

Adults
Administer a second dose of MMR vaccine for adults who received one prior dose.

Adults with no documentation of vaccination history should receive two doses at least 28 days apart.

Dr. Phillips advised parents that while this does not include Tarrant County, families should watch for any updates to this recommendation and discuss any questions or concerns with their doctor.

Where can you get immunized?

Vaccinations and immunizations 
Here are a few resources and tips for finding a place to take your child for immunizations. 

• Check with your child’s doctor. Ask which vaccines are due and make an appointment. If your child needs a doctor, see our locations or call 211 for help. 
• Visit a public health vaccine clinic. Anyone from any county can call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic. 
• Check with your local school district for vaccine events. 
• Enter your zip code at Vaccines.gov to find other options. 
   

What are symptoms of measles?

Measles symptoms typically appear seven to 14 days after infection. They can include:

• Fever, sometimes over 104º Fahrenheit or 40 º Celsius
• Runny nose
• Cough
• Red, watery eyes
• Sore throat
• Tiredness

Following the initial symptoms, a rash will develop that starts on the forehead and spreads down the body and out to the hands and feet.

Related Stories

What Parents Need to Know About the Measles Vaccine
Proactive Protection: Cook Children's Measles Response Plan
Cook Children's Addresses Rising Measles Concerns
Measles FAQs: What Parents Need to Know
Measles and Community Health 

Marc Mazade, M.D., Cook Children’s medical director of Infection Prevention and Control, encourages anyone who has not received the vaccine to do so. Vaccinations not only protect you, but also help limit the spread to others.

As of March 14, the Texas Department of State Health Services reported 259 cases of measles in Texas.

“I'm worried. It's a real dangerous situation right now,” Dr. Mazade said.  “There are lots of people who are eligible to receive the vaccine and haven't. There are areas where vaccine uptake has been really poor and it is likely to rip through these communities like wildfire, like it did in West Texas.”

The best way to prevent getting and spreading the virus is to get the measles, mumps and rubella (MMR) vaccine. We talked with Dr. Mazade about what makes this vaccine effective, who can get it and why vaccination is important.

Measles is one of the most contagious diseases humans have faced. Descriptions of the disease date back to at least the 9th century, according to the World Health Organization (WHO), and became more widespread in the 16th century. Prior to the vaccine, the Centers for Disease Control and Prevention (CDC) estimates three to four million people became infected per year, and 400 to 500 died.

Before the measles vaccine, which became available in its current form in 1968, most everyone got measles, Dr. Mazade said. While measles can be mild, it is “pretty miserable.” The virus can cause a fever from 104 to 106 degrees, congestion, cough and a red rash that spreads across the body. Complications from the measles are not uncommon, including ear infections and pneumonia. As of March 14, one child has died from the current measles outbreak.

“People don’t understand how dangerous it is and how dangerous vaccine preventable diseases are,” Dr. Mazade said. “It can be really serious for people who are pregnant, people with immunodeficiencies and people who are on immunosuppressants that would make them more susceptible.”

Herd Immunity

The current measles outbreak shows just how contagious it is.

In general, measles has not been transmitted within the U.S. for years due to herd immunity.

Herd immunity is the idea that when enough people are vaccinated against a disease, it is much harder for the disease to spread. Herd immunity for measles is reached when 90% of a population is vaccinated, Dr. Mazade said.

Imagine a group of 100 people spread out across a room. Ninety of them have been vaccinated and cannot get or give anyone else measles. One person in the room brings in the virus.

Perhaps the people nearby are all vaccinated; the virus will likely not spread or will only spread to a few people.  But if only half of the people are vaccinated, the infected person is likely standing near at least one other unvaccinated person. The disease can spread through the community, and can do so at an increasing rate.

With measles, face-to-face contact is not required to contract the disease, Dr. Mazade said. The infectious aerosol that is created when someone with measles coughs or sneezes fills the entire air space and even lingers in the air for up to two hours after a person with measles leaves the area. To go off of the room metaphor, measles can spread throughout a space quickly and endanger more people.

For years, the U.S. was like the first room. Sometimes, an unvaccinated person would travel abroad and bring back measles, but it was not able to spread due to herd immunity. In 2000, the U.S. documented zero cases of measles, and the virus was declared eliminated from the United States.

About 92 to 94% of a population needs to be vaccinated in order to achieve herd immunity for measles, according to the American Academy of Pediatrics. The current outbreak is due to that vaccination percentage dropping, Dr. Mazade said. Over the past few years, fewer and fewer people received the MMR vaccine.

Misinformation about vaccines has contributed to that decrease. Mazade encouraged people to seek direct sources for accurate vaccine information. The CDC, WHO and Cook Children’s vaccine resource page are good places to find accurate information.

Asking your doctor directly may be the best way to get information on your vaccine questions.

 “Trust your doctor,” Dr. Mazade said. “He or she is the best source of information about vaccines and vaccine safety.”

Getting Vaccinated

Fortunately, future measles outbreaks are preventable.

The MMR vaccine is safe and available for unvaccinated adults to receive -- and it is extremely effective. The first dose grants about 93% immunity and the second, and final, dose grants 97% immunity. This means that 97 out of 100 vaccinated people exposed to measles will not become sick.

The measles vaccine can be administered to children who are 12 months old and is part of the recommended vaccine schedule that the CDC recommends. If you did not get the vaccine as a child -- or are not sure if you did -- talk to your doctor.

Some people may want their children to get the vaccine early due to the outbreak. As of now, this is not recommended by our local health department. Babies who are younger than six months will likely not respond to the vaccine and not achieve immunity, Dr. Mazade said. Even if the baby has been exposed to measles, the vaccine is not recommended at this age. Dr. Mazade recommends talking to your doctor if you have concerns about measles exposure.

Even if this outbreak slows down, it is still important to get vaccinated.

“If people who are fully eligible are not fully vaccinated, we will be in the spot time and time again,” Dr. Mazade said. “Until we have a huge outbreak with lots of sick people."

Vaccinations and immunizations

Here are a few resources and tips for finding a place to take your child for immunizations. 

• Check with your child’s doctor. Ask which vaccines are due and make an appointment. If your child needs a doctor, see our locations or call 211 for help. 
• Visit a public health vaccine clinic. Anyone from any county can call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic. 
• Check with your local school district for vaccine events. 
• Enter your zip code at Vaccines.gov to find other options. 
   

 Julee Morrow, M.D., a pediatrician at Cook Children’s Harris Parkway, is one of the few current doctors at Cook Children’s who treated patients during that time.

“A majority of the kids that I took care of had to get admitted to the hospital,” Dr. Morrow recalls. “We needed a way to keep them hydrated. We needed a way to keep their oxygen levels up.”

More than 30 years later, Dr. Morrow did not expect to see another outbreak, especially with the availability of the measles, mumps, and rubella (MMR) vaccine.

Cook Children’s has tested patients for the measles; there have been no confirmed cases at its  Fort Worth and Prosper medical centers.

“We are in such a good place from a standpoint of the science and the technology we have now, it can be prevented, ” Dr. Morrow said.

According to the Center for Disease Control and Prevention (CDC), measles was declared eradicated in the United States in 2000.

“We were the only country that didn't have a travel advisory for measles, because our rates were so low, because we had such good vaccination rates,” said Alice Phillips, M.D., Director of Ambulatory Quality and Safety.

The Texas Health and Human Services reported the first measles death on Feb. 26, A school-aged child who was not vaccinated died. The child had been hospitalized in Lubbock and tested positive for measles.

“I feel sad because measles is so easily prevented,” Dr. Morrow explained. “One dose of measles vaccine gives 93%. Two doses give people 97 to 99% immunity.”

As of Feb. 28, the state reported 146 measles cases, mostly in children. Rockwall County reported its first measles case on Feb. 25. Cook Children’s Medical Centers in Fort Worth and Prosper are prepared to treat patients.

Cook Children’s Health Care System is prepared

To prevent potential spread, Cook Children’s Medical Centers, primary care, and urgent care offices ask families to call ahead and inform staff if they believe their child may have measles.

“We will likely be donning all of our personal protective equipment (PPE) to go to the family’s car to screen children before bringing them into the waiting room, so as not to expose any other susceptible patients,” said Dr. Morrow.

If the child is taken into an exam room, the room will be closed for two hours afterward. Families will be provided with a handout on quarantine and measles information. 

Cook Children’s continues to monitor the cases in the state and will revise protocols as necessary.

Thirty-eight years ago, there was no rapid test. Doctors diagnosed patients based on symptoms.

“We now have better testing,” explained Dr. Morrow.

Now, patients are given a nasal or throat swab, similar to the tests used during the COVID-19 pandemic. The sample is sent to a lab. While patients await results, Dr. Morrow said families must quarantine.

“Measles virus is one of the most contagious germs on the planet,” said Dr. Morrow. “It would be very easy to spread it to someone whose immune system is not very strong, like a person who has finished chemotherapy, or has heart or lung problems. It would be very dangerous for a premature baby.”

Dr. Phillips understands that parents may have concerns about the science of vaccines and encourages them to discuss these concerns with their pediatricians.

The CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 - 15 months of age, and the second dose at 4 through 6 years of age.

“We are here to help them, for them to understand the science and to give them the vaccines that their children need,” Dr. Phillips said.

A native Texan, Dr. Morrow urges people to care for one another. The MMR vaccine provides 93% to 95% protection with one dose and 97% effectiveness with two doses.

She encourages families to have a plan in place if they are unable or reluctant to get the vaccine.

Vaccinations and immunizations

Here are a few resources and tips for finding a place to take your child for immunizations. 

• Check with your child’s doctor. Ask which vaccines are due and make an appointment. If your child needs a doctor, see our locations or call 211 for help. 
• Visit a public health vaccine clinic. Anyone from any county can call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic. 
• Check with your local school district for vaccine events. 
• Enter your zip code at Vaccines.gov to find other options. 
   

El martes, Cook Children's Medical Center en Fort Worth atendió 572 pacientes en el departamento de emergencia. En los siete Centros de Cuidado de Urgencia hubo 842 pacientes. Entre el 10 de noviembre y 16 de noviembre Cook Children's Medical Center en Prosper evaluaron a 113 pacientes por Virus Respiratorio Sincitial (RSV, por sus siglas en ingles) y 29 resultaron positivos.

Cook Children's Medical Center en Prosper también ha notado un gran volumen de pacientes en la sala de emergencia. La mayoría de los pacientes admitidos ha sido debido a VRS, influenza o neumonía.

El aumento de las visitas al hospital se debe a una fuerte propagación del VRS y neumonía ambulante (mycoplasma pneumoniae) en Dallas-Fort Worth.

Cada año por estas fechas, los casos de VRS aumentan más rápidamente de lo habitual este año, dijo El Director Médico de Servicios de Emergencia, Dr. Taylor Louden.

"Hemos visto a más de 1,100 pacientes en los últimos dos días a través de la sala de emergencias, y ha sido es muy difícil para nosotros manejar este volumen de una sola vez", dijo Louden.

De los 972 pacientes examinados en Cook Children's Medical Center entre el 10 y el 16 de noviembre, el 39% de los niños tenían VRS o neumonía ambulante. De ellos, 224 dieron positivo para el VRS y 99 resultaron positivos para neumonía.

¿Qué es el VRS y cuando debo de ir a la sala de emergencia?

El VSR generalmente afecta más a niños menores de dos años y puede causar una acumulación de moco y congestión que dificulta la respiración de los niños. Los padres deben tomar precauciones para limitar la propagación del virus. Quédese en casa si están enfermos. La vacuna contra el VRS está disponible para mujeres embarazadas, bebes, y personas mayores.

Si su hijo está enfermo, los padres y cuidadores pueden ayudar a reducir el estrés en el sistema de servicios de emergencia sabiendo cuándo llevar a su hija a la sala de emergencia y cuándo programar una cita. Limitar el tráfico de la sala de emergencias a verdaderas emergencias ayuda a evitar que el sistema se sobrecargué.

Si su hijo está enfermo, pero no tiene problemas agudos, consulte con su pediatra. Si es posible, programe una cita con unos de los Centros de Cuidado de Urgencia en lugar de visitar la sala de emergencias.

El tratamiento para el VSR es monitoreando y tratando los síntomas. No hay cura para el virus. Muchas enfermedades respiratorias virales se pueden tratar en casa con descanso, hidratación y electrolitos. Para la congestión, los padres y cuidadores pueden usar solución salina nasal para diluir la mucosidad y succionarla con una pera.

¿Qué es neumonía ambulante?

Desde el verano casos de neumonía ambulante han estado alto, dijo Louden. Entre el 10 y el 16 de noviembre, 99 niños resultaron positivos para la enfermedad. A comparación del año pasado, durante la misma temporada, Cook Children's reportó menos de 10 de casos de neumonía ambulante entre agosto y diciembre.

La neumonía ambulante suele afectar a los niños en edad escolar. Algunos de los síntomas incluyen: fiebre leve, fatiga y tos. La mayoría de los casos de neumonía atípica se pueden tratar con antibióticos, pero si su hijo tiene neumonía y ha tenido fiebre durante más de cinco días y/o dificultad para respirar, busque atención de emergencia.

La neumonía, el VRS, la gripe y el COVID-19 pueden tener síntomas similares. La gripe y el COVID-19 también pueden incluir dolor de garganta, dolores de cabeza, dolores corporales, escalofríos y cambios/pérdida del gusto y el olfato. Los padres no deben acudir a atención de urgencia ni al departamento de emergencias para hacerse una prueba de RSV, gripe o COVID. Su pediatra puede realizar pruebas para todos estos.

En muchos casos, los médicos pueden evaluar y tratar a un paciente mediante una cita de salud virtual. Descargue la aplicación MyCookChildrens para programar una cita virtual de salud/telemedicina aquí.

¿Cuándo acudir la sala de emergencia?

•  La temperatura mayor de 100.4F o 38°C en bebes menores de dos meses, es una emergencia médica.
•  Si su hijo tiene fiebre por más de tres días, comuníquese con su pediatra o el centro de cuidado de urgencia.
• Preocupación por deshidratación.  En bebes deshidratados habrá menos pañales mojados o falta de lágrimas. La fontanela hundida puede ser un signo de deshidratación.   
• Su hijo está respirando inusualmente rápido y se puede ver la piel entre las costillas.
• Su hijo requiere más su inhalador de rescate o los síntomas de asma empeoran

Síntomas

Síntomas de Virus Respiratorio Sincitial (RSV, por sus siglas en ingles) en bebes menores de 6 meses:

• Irritabilidad
• Letargo
• Apetito reducido
•  Episodios en donde dejan de respirar
•  Fiebre

Síntomas en bebes y niños mayores de 6 meses:

• Mocos
• Congestión
• Apetito reducido
• Tos
• Estornudos
• Fiebre
• A veces sibilancias

¿Cómo prevenir?

•  Nunca es tarde para vacunarse. Llame a su pediatra para obtener la vacuna contra el COVID-19 y la influenza.
• Adopte buenas prácticas de higiene como cubrirse al toser y estornudar.
•  Lavarse o desinfectarse las manos a menudo.
•  Limpiar las superficies que se tocan con frecuencia.
•  Si usted o su hijo se sienten mal, quédense en casa para prevenir la propagación de enfermedad. Tome tiempo para descansar y manténganse hidratado.

It’s a dose of antibodies that works right away to help fight off severe RSV infection for at least five months. Getting the shot in October – just before RSV season -- provides an infant with extra antibodies to build their immunity during the fall and winter months.  

In November 2023, Cook Children’s saw a spike in RSV at our Urgent Care centers and Emergency Departments, the highest volume of cases in recent years.   

“RSV is one of the most common winter viruses. All of us catch RSV in the first couple of years of life," said Mary Suzanne Whitworth, M.D., Medical Director of Pediatric Infectious Diseases at Cook Children’s.

In older children, RSV typically causes cold-like symptoms such as cough and runny nose. But babies under 12 months don’t have fully developed immune systems, Dr. Whitworth said. They tend to get sicker with RSV, a leading cause for wintertime hospitalization in infants.

Severe RSV in infants tends to impact the lungs. Infants should be seen by a doctor if they’re struggling to breathe. If your baby is sick, Dr. Whitworth said, watch for rapid breathing, flared nostrils, airway congestion, wheezing or a rattle you can hear or feel in their chest. Other concerning signs are excessive sleepiness, lack of appetite and trouble feeding.

The Food and Drug Administration (FDA) approved the preventive medication, called nirsevimab, in 2023 after clinical trials showed it reduces the risk of hospitalization for RSV by 75%.

Every infant under age 1 needs the medication ahead of RSV season, Dr. Whitworth said. Some older babies need the shot too if they have certain underlying health conditions. Here’s the breakdown. 

Stopping RSV Two Ways

The first option Pfizer's Abrysvo, given during weeks 32-36 of pregnancy.  Maternal antibodies are passed to your baby and protect against RSV for about six months after birth.   

Infants who don’t have maternal antibodies should get a dose of nirsevimab shortly before the RSV season. Infants born from October to March should receive the medication within one week of birth, according to the U.S. Centers for Disease Control and Prevention (CDC).

The CDC also recommends nirsevimab for certain young children shortly before their second RSV season. This higher-risk group includes children who were preemies, or those with chronic lung disease, compromised immune systems or cystic fibrosis.

The injection delivers safe and effective antibodies, Dr. Whitworth said, and the most common side effect is soreness from the needle stick. She encourages parents to ask their baby’s pediatrician for the shot in October, before hospitalizations for RSV start climbing in infants.

“They are going to be exposed to RSV. It is a virus we are exposed to regularly all winter long.” she said. “The immediate benefits of the shot are huge.”

Cook Children’s has the RSV shot available at our seven Neighborhood Health Centers in the Fort Worth area and more than 40 pediatric offices from Aledo to Willow Park.

Additionally, the Tarrant County Health Department is offering this product to infants ages 2 – 8 months with state-funded insurance or no insurance and infants 8 – 19 months with a qualifying diagnosis.   

Related Stories

Physicians Say New Antibody Shot Could Be Game Changer
Medication to Prevent RSV

When people hear that I’m a pediatrician they often ask if my own children are vaccinated and I always answer with a resounding yes! The next question I’m asked is why I chose to get my kids vaccinated. Here are just a few of my reasons why:

1. Vaccines are safe!

• Millions and millions of vaccines are administered every year with minimal side effects.
• The most common side effects are a low-grade fever, some redness around the vaccine site and maybe some muscle aches.
• Every vaccine went through the same process to ensure they are safe. Side effects and potential reactions are reviewed by multiple agencies including the Centers for Disease Control and Prevention and the Food and Drug Administration.

2. Vaccines are effective!

• Across the world, diseases like smallpox have all but been eradicated because of vaccines!

3. Vaccines save lives!

• Vaccines prevent diseases and illnesses that have serious consequences, even in otherwise healthy children.
• Vaccines prevent diseases that can lead to hospitalizations, pneumonia, potential hearing loss, potential loss of an arm or a leg, brain damage and even death.

4. Vaccines do not cause autism.

• Science and research has proven again and again that there is absolutely no link between vaccines and autism.

5. Vaccines are recommended by my kids’ own pediatrician.

• Vaccines are also recommended by the American Academy of Pediatrics, the American Academy of Family Physicians, the CDC and others.

6. Vaccines help keep my community safe.

• Vaccines protect more than just kids. They protect your child’s grandparents, their classmates, your neighbors, and the community at large.
• Vaccines can help prevent your child from spreading illnesses to at-risk individuals such as your parents who have diabetes, your child’s classmate who is undergoing chemotherapy for cancer, your neighbor who just received a kidney transplant or the cashier in the grocery store who has an autoimmune condition.
• We rely on everyone to get their vaccines to keep the community safe!

7. I want my kids to give their grandparents a big hug at Thanksgiving!

• My father has multiple medical conditions including rheumatoid arthritis and Type 1 Diabetes. We get our vaccines so every time we see him, my kids can run and give their Pap the BIGGEST hug in the world without worrying about giving him the flu!

If you have any questions or concerns about vaccines, please reach out to your pediatrician or primary care provider. We would love to talk to you more and answer all of your questions and concerns! 

National Infant Immunization Week (April 22-29) is a yearly observance highlighting the importance of protecting children 2 years and younger from vaccine-preventable diseases (VPDs). The Centers for Disease Control and Prevention and the American Academy of Pediatrics (AAP) recommend that children stay on track with their well-child appointments and routine vaccinations. On-time vaccination is critical to provide protection against potentially life-threatening diseases.

Measles is one of the most contagious infectious diseases on the planet. This year alone, there have been seven outbreaks across the United States, compared to four in 2023. An outbreak is defined as three or more related cases.

“If you’re in a room with someone who has measles and you’re not vaccinated or immune, there’s a 90-95% chance you now have the disease,” said Cook Children’s Infectious Diseases physician, Nicholas Rister, M.D. 

So far in 2024, there have been 121 cases of measles across 17 states, according to the Centers for Disease Control and Prevention. Ninety-five percent of these cases have occurred in unvaccinated or under-vaccinated populations. Fifty-six percent of cases, the majority of which have been in children under 5 years old, resulted in hospitalization due to severe complications. Though no cases have been reported in Texas, the virus is spreading rapidly and the Cook Children’s team is prepared. 

“Hopefully we won’t need it, but we are developing a workflow so that our clinics know exactly how to recognize, handle, test for, and guide our families through measles,” said Cook Children’s Medical Director for Ambulatory Quality, Alice Phillips, M.D.

Because cases have remained relatively contained over the last few decades, Julee Morrow, M.D. is one of the very few pediatricians at Cook Children’s who has cared for measles patients. She saw an influx of the disease during the last major outbreak from 1989-1991, during which cases in the U.S. spiked to roughly 55,000. 

“My partners and I diagnosed about 30 cases here in Fort Worth, and every single one of them had to be admitted to the hospital due to the severity of their infection,” Dr. Morrow said. “If another major outbreak happens, there’s a possibility we could run out of beds.”

Measles is not to be taken lightly—but it is easily preventable. Dr. Rister, Dr. Phillips, and Dr. Morrow shared vital information about the virus, its risks, and vaccination protocols to help families be proactive in protecting their children. 

What is measles? 

Measles is a highly contagious virus that spreads through the air via coughing and sneezing. It can even enter the body through the mucus membranes of the eyes. 

Common symptoms include:  

• Fever
• Cough
• Conjunctivitis (red eyes) 
• Coryza (runny nose)
• Sore throat
• Rash (after 3-4 days)

What are the risks of measles? 

While most people fully recover from measles, it can still pose life-threatening and potentially fatal risks. For every 1,000 children who get measles, one to three will die, even with the best care.

As many as one out of 20 children with measles will also develop pneumonia, which is the most common cause of death from the virus in infants.

One in 1,000 children with measles will develop encephalitis, or severe brain inflammation, which can lead to convulsions, deafness, disability, or death.

Though it is extremely rare, a fatal disease of the central nervous system, SSPE, can appear as late as seven to 10 years after a child is infected. 

Who is most at risk? 

Any unvaccinated or non-immune person of any age can contract measles, but it is most common in children. Unvaccinated children—particularly infants under 1 year of age—are at the highest risk of severe complications or death. 

“Who we need to worry about is not so much ourselves and our staff, but our tiny patients coming through the door,” Dr. Morrow said. “Measles is a disease of unvaccinated people, and our biggest concern is infants and immunocompromised kids.” 

Dr. Rister pointed out that unvaccinated pregnant women are also at high risk, as measles can have devastating effects on a developing fetus.

What is the MMR vaccine? 

The measles, mumps, and rubella vaccine is a safe, tried-and-true immunization that prevents people from contracting and spreading measles. It is 93% effective after one dose and 97% effective after the recommended two doses. 

“There is no reason a disease that is preventable with a safe and effective vaccine should harm one of our children,” Dr. Phillips said.

When should my child get vaccinated? 

The CDC recommends that children receive two doses of the MMR vaccine—the first between 12 and 15 months old, and the second between 4 and 6 years old.

If you’re an adult and you’re unsure if you’ve completed your vaccines—especially if you are pregnant—ask your doctor to check your vaccination records and make sure you are up to date. 

Can my child get vaccinated early for international travel?

If your child is at least 6 months old, they can get one dose of the MMR vaccine before traveling internationally. Plan to get your child fully vaccinated at least two weeks before your trip. Follow the below vaccination schedule from the CDC based on your child’s age:

Infants Under 12 Months Old: 

• Get an early dose at 6-11 months
• Follow the recommended schedule and get another dose at 12-15 months and a final dose at 4-6 years

Children Over 12 Months Old:

• Get first dose immediately
• Get second dose 28 days after first dose

Teens and Adults With No Evidence of Immunity*:

• Get first dose immediately
• Get second dose 28 days after first dose

*Evidence of immunity includes at least one of the following: Written documentation of adequate vaccination, laboratory evidence of immunity, laboratory confirmation of measles, or birth in the U.S. before 1957. 

What if my child is immunocompromised and can’t get vaccinated?

Dr. Rister said the best way to protect your immunocompromised child is to ensure everyone surrounding them is fully vaccinated—including family, friends, and classmates. 

If a case appears in your area and your child is in daycare or another environment around other children, consider keeping them home until the outbreak passes.

What should I do if my child is exposed to measles?

If you think your child has been exposed, call your pediatrician right away. It’s important to alert your doctor before bringing your child to the office. That way, staff can take precautionary measures to prevent further spread and ensure they have the necessary supplies to care for your child.

If your child has a confirmed case of measles, don’t panic—you will receive step-by-step guidance from your physician and the Texas Department of State Health Services. They will evaluate the individual risk of everyone in your household and tell you the exact steps to take to keep everyone safe.

Information from Cook Children’s and the Centers for Disease Control and Prevention:

• CDC: Top 4 Things Parents Need to Know About Measles
• CDC: Measles
• Go here to view photos of measles from the CDC.
• What to know about vaccines and immunizations | Vaccine fact and fiction | Cook Children’s

Related content on CheckupNewsroom.com:

• Infectious Diseases Doctor Shares Why Measles Vaccination is So Important (checkupnewsroom.com)
• Infant Immunization Week Encourages Babies' First Shots (checkupnewsroom.com)
• Get Immunized for a Healthy School Year (checkupnewsroom.com)

The flu is an infection of the respiratory tract (nose, throat, and lungs) that is caused by a virus. It can spread easily from person to person. Usually during cold and flu season, most children will experience very mild symptoms that normally self-resolve within a few days, said Cook Children’s hospitalist Laura Romano, D.O.

Flu activity is considered widespread in Tarrant County, according to Tarrant County Public Health. This flu season, we are admitting larger numbers of older, previously healthy children with difficulty breathing and flu-related pneumonia at the Cook Children’s Medical Center - Fort Worth, Dr. Romano said.

Most are requiring supplemental oxygen and some require ICU admission. While this has not been uncommon during prior flu seasons, this is now becoming the norm for admissions rather than the exception, Dr. Romano said.

“Overall, it seems that the flu is not going away anytime soon this season,” Dr. Romano said.

From Feb. 4 to Feb.10, out of 1,593 tests conducted, 16% were positive for flu A and 21% were positive for flu B, according to lab data at Cook Children’s Medical Center - Fort Worth.

This is a decrease compared to the prior week (Jan. 28 to Feb. 3), which showed a 22% positivity rate for flu A and 24% positivity rate for flu B.

High Patient Volume

Cook Children’s Urgent Care Centers and the Emergency Department at Cook Children’s Medical Center - Fort Worth are experiencing high volumes from circulating viruses such as COVID, flu and respiratory syncytial virus (RSV).

From Jan. 9 to Feb. 5, Cook Children’s Urgent Care Centers saw 6,806 patients, and the Emergency Department in Fort Worth saw 3,437. These numbers are almost double what they were in early January and leading to crowded medical facilities and long wait times.

On Friday, Feb. 9, our UCCs saw 760 patients in 24 hours and the Emergency Department at Cook Children’s Medical Center – Fort Worth saw 435 patients.

“We are seeing tons of flu,” said Kara Starnes, D.O., medical director of Cook Children’s Urgent Care Centers. “I have three kids of my own, so I know having a sick child can bring some anxiety but, in many cases, children with upper respiratory illnesses like COVID, flu and RSV do just fine being cared for at home and do not require a visit to urgent care or the ER.”

Dr. Starnes says it is safe to manage your child’s symptoms at home as long as they are not displaying signs of respiratory distress or dehydration. Reserving visits to urgent care or the emergency department for truly urgent needs will help reduce wait times, conserve resources and limit your child’s exposure to other viruses.

Signs and Symptoms

COVID-19, flu and RSV are caused by different viruses, but all are upper respiratory illnesses that share similar symptoms such as:

• Fever
• Cough
• Fatigue
• Sore throat
• Runny or stuffy nose
• Muscle pain and body aches
• Headache
• Vomiting and diarrhea
• Loss of appetite, taste or smell
• Shortness of breath

Managing Symptoms

There are a few things you can do to keep your child comfortable while the illness runs its course.

Over-the-counter medications such as ibuprofen and acetaminophen can help reduce fever, aches and pains. Ibuprofen should not be given to infants younger than 6 months.

A fever is defined as a temperature of 100.4 or above. A temperature above 100.4 in babies less than 2 months old is a medical emergency and needs to be evaluated in the emergency room. Any fever lasting longer than four to five days, or one that continues to climb and does not break with fever reducers, should be evaluated by a physician. Otherwise, it’s safe to manage fever at home.

Keep your child hydrated by encouraging fluids every few hours. Electrolyte drinks can be helpful if you suspect your child is dehydrated or at risk of becoming dehydrated. If they aren’t interested in drinking, have them suck on a popsicle.

To help reduce congestion, keep the sinuses moist with saline drops and a cool-mist humidifier. This is especially helpful during sleep times.

If your child appears to be in respiratory distress or severely dehydrated, it’s time to go to urgent care or the emergency department.

●      Signs of respiratory distress:

• Increased number of breaths per minute
• Increased heart rate
• Bluish color around the mouth, on the lips or on the fingernails.
• Pale or grayish skin
• A grunting sound during exhale
• Nose flaring
• Chest appears to sink in with each breath
• Head bobbing when breathing in
• Change in alertness

●      Signs of dehydration:

• Urine output significantly below the child’s normal (Your child should be producing urine at least once every 8 hours.)
• Not producing tears when crying and eyes appear sunken
• In infants, the soft spot on top of their heads looks sunken
• Dried mucus membranes (lining within the nostrils, mouth, throat, ears, genitals and anus)
• Sleepy and unresponsive

Respiratory illness is on the rise, causing a jam of patients at the Cook Children’s Emergency Department (ED) and Urgent Care locations.

In the last 24 hours, our Urgent Care sites across North Texas saw 731 patients, many with respiratory syncytial virus (RSV) and other seasonal illnesses. That compares to 684 visitors the previous day.  

At the same time, our ED was treating 524 patients, up from 448 one day earlier. That’s nearly a patient checking in every three minutes.

Swabs for the virus came back positive on 29% of the 834 patients who were tested at Cook Children’s Medical Center – Fort Worth during the week of Oct. 29-Nov. 4. That’s an increase from the 25% who tested positive for RSV one week earlier. Numbers for COVID-19 and influenza, meanwhile, are running much lower at the current time.

RSV is a common respiratory virus that usually causes mild, cold-like symptoms such as runny nose, cough and fever. But it can be serious when it turns into bronchiolitis and pneumonia. RSV sends anywhere from 58,000 to 80,000 children under 5 years old to the hospital each year, according to the Centers for Disease Control. Infants are particularly vulnerable if they were born premature or have weakened immunity or heart or lung conditions. 

Our ED and Urgent Care centers are crowded, and wait times are longer for non-emergency illnesses and injuries. How do you know if your baby with RSV needs medical attention – and where to go? The doctors at Cook Children’s have answers.

Your Pediatrician

Go to your primary care physician if your child is experiencing mild respiratory symptoms but is not having difficulty breathing. Your pediatrician can test for RSV, COVID or the flu.

Jonathan Nedrelow, M.D., associate chief medical officer for the Medical Center, said infants should be seen by a doctor if they’re struggling to breathe. Watch for faster breathing than normal, flared nostrils, airway congestion, wheezing or a rattle you can hear or feel in their chest. Other concerning signs are excessive sleepiness, lack of appetite and trouble feeding.

“If parents notice their infant’s breathing is hard or labored, they need to be evaluated,” Dr. Nedrelow said. “RSV is not the only virus that can cause these symptoms, so it’s good to be checked out.”

Urgent Care

If you can’t get in to see your child’s primary care physician for mild difficulty breathing or wheezing, then Urgent Care is the next best place to go, said Kara Starnes, D.O. medical director of Cook Children’s Urgent Care Services. Decreased fluid intake (not as many wet diapers) is another sign to watch for. 

“There is no medication to treat RSV,” Dr. Starnes said. “Treatment for mild to moderate RSV involves frequent saline and suction of the nose and supportive care for fever as well as increased fluids. Cough and cold medications are not recommended.”

Virtual Care Visits

Cook Children’s primary and urgent care locations both offer virtual visits that can be accessed from the comfort of your home. Cook Children’s Virtual Care appointments can help you avoid packed waiting rooms and allow you to see a physician at your convenience. This is also a great option if you need a doctor’s note for school. Visit our website to learn more.

Hospital Emergency Department

Call 911 if your child is having severe difficulty breathing, is turning blue or has become lethargic. Don’t seek RSV treatment at the ED unless you see signs of struggling to breathe, such as the muscles sucking in between the ribs, or if your child can’t stay hydrated.

“If your child has mild symptoms such as cough, congestion, or low-grade fevers, we recommend following up with your pediatrician or urgent care, please do not come to the emergency department,” said Taylor Louden, M.D., in pediatric emergency medicine at Cook Children’s.

Severe cases of RSV typically need supplemental oxygen until the virus runs its course. IV fluids may also be necessary.

Preventing RSV

RSV season typically runs from October through early spring. These steps help avoid catching the virus or passing it along:

• Wash your hands frequently
• Cover your sneezes and coughs
• Stay home when you’re sick

And a new antibody-boosting injection, called nirsevimab, helps prevent severe RSV by providing a temporary boost to the immune system. The medication is in short supply nationwide, and available doses are reserved for patients at highest risk. Additional doses are on order at Cook Children’s, so check with your pediatrician for availability.

RELATED STORIES:

• CDC Recommends RSV Shot for Infants. Infectious Diseases Doctor Shares What Parents Need to Know 
• Clinic Watches out for Respiratory Trouble After Prior RSV Care

A new shot that helps prevent respiratory syncytial virus (RSV) is in short supply nationwide and Cook Children’s is following guidelines to prioritize infants at the highest risk of illness.  

Like other health care organizations across the country, Cook Children’s has limited doses of the new medication, called nirsevimab. Eligible patients are receiving the antibody injection as it arrives at Cook Children’s locations.

“While availability remains limited, patients may find their offices intermittently out of the product,” said Alice Phillips, M.D., at Cook Children’s Pediatrics Cityview. Additional doses are on order and Cook Children’s sites remain in contact with supply sources to maximize access for high-risk infants. 

Meanwhile, cases of RSV are on the rise at Cook Children’s, including at the Emergency Department (ED) and Urgent Care locations. At Cook Children’s Medical Center – Fort Worth during the week of Oct. 22-Oct. 28, tests for the virus came back positive on 25% of the 764 patients who were tested. That compares to a 6% positivity rate for COVID-19 tests and 1% positivity for influenza A.

Jonathan Nedrelow, M.D., associate chief medical officer for the Medical Center, said infants should be seen by a doctor if they’re struggling to breathe. Watch for faster breathing than normal, flared nostrils, airway congestion, wheezing or a rattle you can hear or feel in their chest. Other concerning signs are excessive sleepiness, lack of appetite and trouble feeding.

“If parents notice their infant’s breathing is hard or labored, they need to be evaluated,” Dr. Nedrelow said. “RSV is not the only virus that can cause these symptoms, so it’s good to be checked out.”

The Centers for Disease Control and Prevention on Oct. 23 advised health care providers to allot any available doses for patients most susceptible to severe RSV. That group includes:

• Premature infants
• Infants 6 months and younger
• Children younger than 2 years old with chronic lung disease or congenital heart disease
• Children with weakened immune systems
• Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions

In July 2023, the Food and Drug Administration (FDA) approved nirsevimab, a monoclonal antibody to prevent severe respiratory disease due to RSV infections in infants and young children with underlying medical conditions. An injection provides a temporary boost to a child’s immunity to get them through the worst of the RSV season, typically the fall and winter months.

Cook Children’s pediatrician offices, neighborhood clinics, specialty clinics and Medical Center -- Fort Worth are navigating the shortfall by following the CDC advisory until the supply improves. At the Medical Center, supply is reserved for the highest risk patients such as infants admitted to the neonatal, cardiology and pulmonology units.

“All areas of Cook Children’s are working diligently to provide this product and to keep our families up to date with the most current information on supply and recommendations,” Dr. Phillips said. “Cook Children’s Health Care System remains actively engaged to provide this important preventative medication to our most vulnerable infants.”

The medication comes in single-dose syringes of 50mg and 100mg. The smaller dose is meant for infants weighing less than 5 kilograms (11 pounds). High-risk infants weighing more than 5 kilograms would receive the larger dose, which is especially scarce.

“Many infants pass this weight by 1-2 months of age, so careful consideration and early administration are key,” Dr. Phillips pointed out.

The CDC also recommended that doctors not give nirsevimab to children who are eligible for another medication, called palivizumab, instead. 

It’s important for parents to talk with their child’s health care provider to find out which medications are appropriate and available. And follow these key tips to prevent the spread of RSV: Wash your hands frequently, cover your sneezes and coughs, and stay home when you’re sick.

Background on RSV

RSV is a common respiratory virus that usually causes mild, cold-like symptoms such as runny nose, cough and fever. Virtually all children will be infected by RSV by the time they are 2 years old. Most recover in a week or two.

But RSV can be serious when it turns into bronchiolitis and pneumonia. RSV sends anywhere from 58,000 to 80,000 children under 5 years old to the hospital each year, according to the CDC. Dr. Nedrelow said those with severe cases typically need supplemental oxygen until the virus runs its course.

Taylor Louden, M.D., in pediatric emergency medicine at Cook Children’s said the recent increasing number of RSV patients has led to longer wait times in the ED. If your child has only mild symptoms -- including cough, congestion, or low fever -- please do not come to the ED, Dr. Louden said. 

“For milder symptoms we recommend frequent nasal suctioning at home, appropriate hydration, and follow up with your child’s pediatrician,” he said.

If you can’t get in to see your child’s primary care physician, then Urgent Care is the next best place to go, said Kara Starnes, D.O., medical director of Cook Children’s Urgent Care Services. Call 911 if your child is having severe difficulty breathing, is turning blue or has become lethargic, Dr. Starnes said.

Boosting Immunity

Clinical trials show that nirsevimab reduces the risk of hospitalization for RSV by 75%. Research and clinical trials show the medication is safe and causes only mild side effects. The injection is neither a vaccine nor a treatment.

This particular use of monoclonal antibodies for the prevention of severe RSV is new even though a similar type of RSV protection has been on the market for more than a decade. Nirsevimab needs just one injection to provide a period of protection that lasts about five months. The older medication requires an injection each month during the RSV season.

RELATED STORIES:

• CDC Recommends RSV Shot for Infants. Infectious Diseases Doctor Shares What Parents Need to Know 
• Cook Children’s | Medication to Prevent RSV 

As COVID-19 cases rise at Cook Children's, the Food and Drug Administration has approved an updated COVID vaccine.

The Centers for Disease Control and Prevention recommends that anyone 6 months and older should get the new shot to protect against serious illness.

COVID cases at Cook Children’s Medical Center have been steadily increasing since early July. From the week of Sept. 17 through Sept. 23, the positivity rate is 10% or 69 positive cases out of 679 patients tested.

The new vaccines from Pfizer and Moderna are matched to protect against the most common COVID variants circulating now. Please contact your pediatrician's office to schedule an appointment.

The fall and winter months are a common time for respiratory illnesses to spread in our community; in addition to COVID-19, there is typically a rise in flu and RSV cases.

Schedule you and your child’s flu shot as soon as possible to help prevent severe illness and spread of the flu.

Respiratory syncytial virus (RSV) is a common respiratory virus that usually causes mild, cold-like symptoms. It is the leading cause of hospitalization for infants, who are much more susceptible to the disease.

This year, infants will have a better chance of protection if they receive the new monoclonal antibody injection for the prevention of severe RSV, which has been shown to reduce the risk of hospitalization and health care visits in infants. This one-time injection was recently approved by the FDA and recommended by the CDC. The treatment will be available at Cook Children's pediatrician offices soon.

Laura Romano, D.O., a hospitalist at Cook Children’s Medical Center, answers some of the top questions from parents regarding these respiratory illnesses, treatment and prevention.

COVID

What are COVID cases like right now? Why should my child get the new COVID vaccine?

Positive COVID cases at Cook Children’s Medical Center have been steadily climbing since the end of June and early July. Across the country, there are higher rates of COVID hospitalizations in both adults and pediatrics. Your child should get a yearly COVID vaccination because we know that this will protect them. People who are vaccinated against COVID have a significantly decreased risk of hospitalization, ICU admission, and death.

What are the symptoms of most COVID cases right now?

Symptoms are mainly upper respiratory symptoms (cough, nasal congestion, sore throat). It’s also causing fevers, muscle aches, and fatigue. And yes, these symptoms are very similar to the flu! 

Should my children and I be wearing face masks? 

You should consider wearing a mask if you, your child, or anyone in your home is at high risk for severe COVID-19 infection. This includes people who are 65 years and older and people with certain medical conditions such as heart conditions, lung disease, diabetes, sickle cell, or a neurologic condition.

During flu, RSV, and COVID-19 seasons, it is very reasonable to wear a mask whenever you are in crowded indoor spaces. This includes pediatric office and emergency room waiting rooms!

My child is involved in many in-person activities this fall. What can we do to protect against COVID?

• Consider wearing a mask
• Get the latest vaccine
• Stay home if you are sick

My child’s classmate tested positive for COVID. What should I do?

• If your child is having symptoms, test immediately. If the initial test is negative, repeat in 48 hours if your child is still symptomatic.
• If your child does not have symptoms, wait five days and take another test.

If my child received a COVID vaccine more than six months ago, should they get the new vaccine?

Yes, they should! The CDC recommends that anyone 6 months and older who is two months out from their last COVID vaccine get the new vaccine.

Will it protect my child against the latest variant?

Yes, the newest vaccine was designed for the currently circulating variants so it should help protect your child.

FLU

What are flu cases like now? When is flu season?

Flu cases are currently low at Cook Children’s. Flu season typically begins in the late fall and stretches into the winter. However, last year we saw unprecedented numbers of influenza very early in the season.

Why should my child get a flu shot?

 Flu vaccines help protect against severe cases of the flu. If your child gets the flu vaccine, they may still get the flu, but they will have more mild symptoms and should not need to be hospitalized with a severe infection.

When will flu shots become available?

Flu shots are currently available at many Cook Children’s pediatrician offices. Check with your pediatrician’s office. Many local pharmacies have them as well.

RSV monoclonal antibody shot

What age groups can get the RSV monoclonal antibody injection?

Infants under 8 months during their first respiratory season and children who are at high risk up to 24 months of age. Talk to your pediatrician about your child’s risk, especially if they have a history of prematurity, heart disease, or chronic lung disease.

What should parents consider with this antibody treatment?

Our babies and infants are the most vulnerable population during cold and flu season so this will give them some protection and lower the chances of having a severe infection.

RSV can cause symptoms ranging from a runny nose to respiratory failure, requiring an ICU admission. It usually causes mild, cold-like symptoms, but it can be serious, especially for infants.

RSV causes bronchiolitis, which can be very serious and sometimes fatal in babies. The new antibody treatment has been shown to reduce the risk of hospitalization by nearly 80%, according to the CDC.

When will the new antibody be available?

The new antibody treatment will be available soon. For newborns, it may be given in the nursery prior to your infants discharge after birth. For older infants, families should reach out to their pediatrician about availability.

Will my child show symptoms once they receive the antibody shot?

Your child may still get symptoms of RSV after receiving the treatment but they are expected to be less severe.

Your doctor will monitor for any signs of a reaction during the infusion and after with your assistance.

How long is it effective?

Since this is an antibody and not a vaccine, it is designed to provide a temporary boost in immunity only. It will provide short-term protection lasting about 5 months which should cover the 2023-2024 RSV season.

If my child previously had RSV, do they have antibodies?

Yes, but the antibodies your body’s immune system makes to RSV last only two to three months. It is very possible for a child to get RSV multiple times in one respiratory season.

Related stories:

• Fighting RSV: Physicians Say New Antibody Shot Could be Game Changer 
• CDC Recommends RSV Shot for Infants. Infectious Disease Doctor Shares What Parents Need to Know 
• Curious About Health and Safety Requirements at Day Care? We Have Answers
  
   

The Centers for Disease Control and Prevention has recommended a new antibody shot to help prevent severe respiratory syncytial virus (RSV) disease in all infants.

RSV is a leading cause of hospitalization for infants. The use of nirsevimab (trade name Beyfortus) is a long-acting monoclonal antibody infusion, which has been shown to reduce the risk of both hospitalization and healthcare visits in infants by about 80%, according to the CDC.

The CDC recommends:

• One dose for all infants 8 months old and younger born during or entering the RSV season (fall through spring)
• One dose for children between 8 and 19 months old who are at an increased risk of severe RSV, including severely immunocompromised children

“This new antibody treatment, which has now received the Food and Drug Administration approval and CDC's Advisory Committee on Immunization Practices recommendation, will truly be a game-changer,” said Jason V. Terk, M.D. of Cook Children's Pediatrics Keller Parkway. “This will dramatically reduce the burden of this infection among infants in their 1st year of life and I am excited about that!”

What is RSV?

RSV is a common respiratory virus that usually causes mild, cold-like symptoms. Virtually all children will be infected by RSV by the time they are 2 years old. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults.

Every year, there are between 58,000 and 80,000 hospitalizations for RSV for children under 5 years old, according to the CDC.

RSV can also cause severe illnesses such as bronchiolitis and pneumonia. The risk is especially high for premature infants.

According to the CDC, those at greatest risk for severe illness from RSV include:

• Premature infants
• Infants, especially those 6 months and younger
• Children younger than 2 years old with chronic lung disease or congenital (present from birth) heart disease
• Children with weakened immune systems
• Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions

Previously, there were limited treatments for RSV; most are available only for premature infants, infants with other lung diseases, infants who are considered immunocompromised, or patients with congenital heart disease.

Nicholas Rister, M.D., of the Cook Children's Infectious Disease team, shares what parents and caregivers need to know.

How severe can RSV be, if my baby is infected?

RSV is a very common infection for infants and young children. Most will only have a typical “cold” or “viral URI.” Although, given how many infants become infected, many children are admitted to the hospital and intensive care unit each year.

RSV infections can be very serious for some babies in particular. This includes very premature infants 36 weeks gestation or younger, but especially if younger than 32 weeks gestation. This also includes babies with congenital heart disease and babies who required several weeks of oxygen support after birth, such as ventilators or cannulas.

What is the difference between this antibody and a typical vaccine?

A vaccine is designed to trigger your body to produce its own antibodies to a disease. This provides both immediate protection and longer-term memory. An antibody infusion gives you protection immediately but has not trained your body to continue creating those antibodies. This leads to a quick but only temporary period of protection.

Many vaccines work well in older children but not infants. Providing antibody infusions can cover at-risk infants who would otherwise not create antibodies in response to a vaccine.

Can my baby show symptoms once they receive the antibody? Are there any side effects?

With any infusion of medication that was not created inside your baby’s body, there is always a chance their immune system will notice it and react. Thankfully young infants, due to their immune tolerance of recently living inside of another human body, develop these reactions less frequently. Your doctor will monitor for any signs of a reaction during the infusion and after with your assistance.

How long has this antibody been tested? How do I know it is safe for my child this fall?

The use of RSV antibody infusions has been present and tested for over a decade. While this newer treatment provides more widespread application, the core safety of the treatments is well established.

What is the most important takeaway for parents of infants?

RSV is a highly prevalent disease and every family should talk with their pediatrician about the potential benefit of this antibody infusion for their child. While some children will clearly benefit more than others, it is an important conversation to have for all families.

How soon will it be available at pediatrician offices?

The CDC expects nirsevimab to be available this fall. Expectant parents and parents of infants under the age of 8 months, as well as those with older babies, should talk with their pediatrician

A new school year is just around the corner and it’s time for incoming kindergarteners and seventh-graders to get caught up on their routine immunizations.

Vaccines to protect against certain contagious diseases – including measles, polio and chickenpox – are required for students in Texas. Your child or teen might need a few boosters depending on their grade and whether they’re behind on their shot schedule.

Cook Children’s wants parents to know that vaccines for school are safe and proven tools to prevent diseases from spreading through the classroom and beyond.

“These vaccines have been around for a long time. There's nothing new to these vaccines, and they're as safe as they've ever been,” said Erin Bridgewater, M.D. at Cook Children’s Pediatrics in Celina.

The 2023-2024 Texas Minimum State Vaccine Requirements lists the number of doses that students need. If an incoming kindergartener has missed out on vaccines normally given at age 4, these additional vaccines are due now:

• MMR (measles, mumps and rubella)
• DTaP (diphtheria, tetanus and pertussis)
•  IPV (inactivated poliovirus)
•  Varicella (chickenpox)

And between the ages of 11-12 years, these additional vaccines are due:

• MCV4 (meningitis)
• Tdap (tetanus, diphtheria and pertussis)

About 7% of seventh-graders statewide either submitted exemptions or were delinquent in their meningitis and Tdap vaccines in the 2022-2023 school year. The concern is that a decline in the vaccination rate makes the general population more vulnerable to a disease catching hold.

“These illnesses are still very much present and could possibly cause serious illness in our children, especially if we don't continue to vaccinate and keep that high level of herd immunity that keeps these things from spreading,” Dr. Bridgewater said.

For example, a pediatric patient in June 2023 was diagnosed with the first confirmed measles case in Texas since 2019. And in New York in 2022 an adult was diagnosed with the first case of polio identified in the United States in nearly a decade.

Making an Appointment

If your child or teen needs an up-to-date shot record before school starts in August, it’s best not to put it off. Schedule your child's appointment earlier in the summer to get what you need for the school year. A spike in appointments and rush for vaccinations and school physicals can cause delays at Cook Children’s pediatrics offices. You can make an appointment at any Cook Children’s neighborhood clinics or pediatric office, including the site in Celina, which opened in April.

Dr. Bridgewater understands that it’s easy to lose track of checkups and shots -- especially for families in transition, like the influx of residents moving into the fast-growing area around Celina and Cook Children’s Medical Center - Prosper.

“A lot of parents meant to come in,” she said. “Things got busy and so they just kind of forgot. We certainly want to help people in those situations.”

The boosters required for kindergarten and for seventh grade can usually be administered in one visit to the clinic or office.  If the patient needs a checkup, it’s an appointment with the doctor. If the patient needs vaccinations only, it’s an appointment with the nurse.

How do vaccines work? The needle injects a portion of a pathogen into the body so that the immune system learns to recognize the virus or bacteria, Dr. Bridgewater said. Vaccines don’t cause infection.

“It's kind of like we're giving their immune system a snapshot of the most important piece of the puzzle so that if their immune system sees that piece again, they already know how to respond,” Dr. Bridgewater said.

She explains to her patients that it’s better to get one preventive poke than to catch a disease that might put them in the hospital. She welcomes any questions they or their parents want to ask so that they can feel confident and informed. Dr. Bridgewater wants to dispel any myths and misinformation that might be a stumbling block.

Dr. Bridgewater believes in vaccines not just as a pediatrician, but as a mom. She points out that her own two kids in recent years got the shots they needed for school.

“I want other parents to have the same reassurance that I have,” she said. “If they've heard anything at all that makes them concerned, I really encourage them to reach out and ask those questions instead of living in fear and then maybe avoiding something that could truly be lifesaving for their children.”

A case of measles was confirmed in a pediatric patient last week in Texas, according to Texas Health and Human Services. The last confirmed measles case in Texas was in 2019. Cook Children’s is sharing what parents and caregivers should know.

Measles is highly contagious. It causes severe pneumonia and can cause a progressive form of encephalitis or inflammation of the brain.

Measles spreads through the air when an infected person coughs or sneezes. You can get measles by being in a room where a person with measles has been, even up to two hours after the person has left. An infected person can spread measles to others even before knowing he/she has the disease.

Some of the more common measles symptoms include:

• high fever (may spike to more than 104° F),
• cough
• runny nose
• red, watery eyes (conjunctivitis)
• rash (3-5 days after symptoms begin)

If you think you have measles or may have been exposed, isolate yourself and immediately call your health care provider and your county health department. It is recommended to wear a face mask.

Even children who recover from measles, especially those younger than 2 years old, are still at risk for developing SSPE – delayed brain inflammation – seven to 10 years later.

Two doses of MMR vaccine provide the best protection against measles for your child. The Centers for Disease Control and Prevention recommends that all children receive two doses of the measles-mumps-rubella (MMR) vaccine – one at 12 to 15 months old and another at 4 to 6 years old. One dose is 95% effective against measles and two doses are 97% effective.

People at high risk for severe illness and complications from measles include:

• Infants and children aged <5 years
• Adults aged >20 years
• Pregnant women
• People with compromised immune systems, such as from leukemia and HIV infection

According to the Centers for Disease Control and Prevention, 16 cases of measles have been reported this year as of June 8, 2023. The CDC warned in November 2022 that a record of nearly 40 million children missed a measles vaccine dose, leaving them susceptible to infection.

Protection

The best protection against measles is MMR vaccine. MMR vaccine provides long-lasting protection against all strains of measles.

Here at Cook Children's, we follow the same guidelines that we recommend to our patients and their families.

• Vaccines save lives
• Vaccines are safe
• Vaccines protect those that cannot be vaccinated
• We vaccinate our own children

Nicholas Rister, M.D., of the Cook Children's Infectious Disease team, answers questions about measles and shares what parents and caregivers need to know.

What should I do if my child has only received one dose of the MMR vaccine so far?

If your child has received only a single dose of the MMR vaccine and is >4 years of age, then they are due for a second dose which can help boost their immunity.

In the meantime, the single dose they have gotten should provide substantial protection from severe disease. This is great for their safety but can make how they may present more subtle. While they may still have a fever, cough, red eyes, and a rash, these may be much more subtle or absent. However, they will still be contagious and can infect other children and adults who are non-immune.

If your child is only partially immunized and has some of these symptoms, especially a red rash that starts on the head and spreads downwards, be sure to ask your pediatrician about measles to review if testing is indicated.

How do I know if my child has been exposed to measles?

In many cases, you will not unless you are contacted by the health department. Sometimes an outbreak will occur through schools or daycares, and you will be alerted through these contacts as well. However, if your child or close contacts develop the constellation of symptoms above, be sure to discuss with your physician about the need for monitoring and testing.

How does measles transmission occur?

Measles transmission occurs via person-to-person contact as well as airborne spread. Infectious droplets from the respiratory secretions of a patient with measles can remain airborne for up to two hours. Therefore, the illness may be transmitted in public spaces, even in the absence of person-to-person contact.

Additionally, if someone is exposed to measles and is not immunized, they have a 90% chance of contracting the disease. It is highly contagious without vaccination.

What are the physical signs of measles in children?

The classic findings of measles in addition to fever and rash are cough, pink eye, and a runny nose. These are often prominent. The rash is also unique in that it starts on the head and spreads downward over the body. While other viruses can cause some or all of these symptoms, the constellation should raise the question of measles if there has been a known exposure or if a patient is unimmunized.

Where do measles come from?

Humans are the only natural source of the measles virus. While it could be spread in a laboratory setting, virtually all disease we see is from natural infection between person-to-person and airborne contact.

Information from Cook Children’s and the Centers for Disease Control and Prevention:

• CDC: Top 4 Things Parents Need to Know About Measles
• CDC: Measles
• Go here to view photos of measles from the CDC.
• What to know about vaccines and immunizations | Vaccine fact and fiction | Cook Children’s

Related content on CheckupNewsroom.com:

• Infectious Diseases Doctor Shares Why Measles Vaccination is So Important (checkupnewsroom.com)
• Infant Immunization Week Encourages Babies' First Shots (checkupnewsroom.com)
• Get Immunized for a Healthy School Year (checkupnewsroom.com)

The first vaccine to protect babies from the respiratory syncytial virus (RSV) is one step closer to approval after the Food and Drug Administration’s advisory committee met to discuss the efficacy and safety of the vaccine.

If approved by the FDA later this year, this could be the first vaccine to protect infants from RSV, which is a leading cause of hospitalization for infants. The vaccine would be issued to expecting mothers during the second or third trimester of pregnancy to prevent RSV and prevent severe RSV from birth through six months of age.

The Centers for Disease Control and Prevention is also weighing recommendations for a monoclonal antibody for babies and toddlers, as well as a RSV vaccine for older adults.

Virtually all children get an RSV infection by the time they are 2 years old. RSV is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. RSV can also cause severe illnesses such as bronchiolitis and pneumonia. The risk is especially high for premature infants.

Some children require hospitalization, but most do not. Currently, there is no vaccine to prevent RSV infection. To prevent RSV infection, Cook Children’s encourages children to continue health habits learned in the pandemic, including hand hygiene, coughing/sneezing into a tissue and staying home if you or your child feel sick.

There are limited treatments for RSV; most are available only for premature infants, infants with other lung diseases, infants who are considered immunocompromised, or patients with congenital heart disease.

In fall 2022, Cook Children’s experienced an early spike in RSV and influenza A cases. Our Emergency Department and Urgent Care Centers were overwhelmed with patients. By November 2022, our patient census was full across the board due to many patients with flu, RSV and respiratory illnesses. If patients were inoculated with the RSV vaccine, this could help alleviate stress on our health care system by keeping children out of the hospital.

During the FDA’s advisory committee meeting, the discussions were complicated so the recommendations were split to vote on efficacy and safety. They unanimously approved based on the efficacy of the vaccine. However, based on available safety results, the decision was split (10 would approve, 4 would oppose).

The vaccine had serious safety concerns in the elderly patient trials that were submitted with 1 patient out of 2,500 having Guillain-Barre syndrome and another with acute disseminated encephalomyelitis (ADEM), both serious central nervous system diseases. Both diseases occur outside of trials in this population, but they are also known to be rarely related to both vaccines and due to the diseases they help prevent. There are post-marketing studies in place in elderly patients to further evaluate the exact risks of these diseases.

Additionally, a pregnancy trial was in progress but it was paused due to safety concerns. In addition to the diseases noted, there were more preterm births in the vaccine group. These were mostly babies born a week or two early which is generally safe, but due to the trend, the trial was paused while the safety is better assessed.

Nicholas Rister, M.D., of the Cook Children's Infectious Disease team, shares what parents and caregivers need to know.

Why should I consider getting the RSV vaccine? Is it safe?

Right now, the vaccine is only approved for elderly patients over the age of 60. People in this age range should talk with their doctor about the vaccine.

There is an ongoing discussion about making the vaccine available for pregnant women so that the antibodies it induces can be passed to their infants via the placenta. It has been difficult to develop an RSV vaccine for very young infants since they do not react readily to the vaccines that have been developed. However, young infants are the group most at risk for severe and prolonged disease with RSV so providing them protection via their mother is an important opportunity.

The safety questions are the issue here. Right now, the vaccine is not approved for pregnant women so it is not an option. However, the vaccine appears very effective so it may still gain approval in some form once the exact risks are better understood.

Importantly, this is not a vaccine that is going to be mandated for pregnant women. The ethical issues with having a person get a vaccine (the mother) to provide protection for someone else (the infant) and the risks assumed between them is going to make this a more nuanced discussion between OB/GYNs, pediatricians, and families.

How long and how strong is the protection against RSV infection if vaccinated?

Initial results from pregnancy trials showed 82% protection from severe RSV disease from 0-3 months of life and still 69% percent at 6 months of life. While this doesn’t prevent disease or even all severe disease, since RSV is so common in infants and particularly dangerous in preterm infants, this level of protection is very significant and dramatic.

What should parents of toddlers and young children know about the RSV vaccine since, if approved, it would only pertain to pregnant women?

RSV is a very low-risk infection for children outside of the first year or two of life and in younger adults. Until vaccine risks are clarified, there likely will be no push for using this vaccine outside of infants (via pregnant mothers) and elderly adults. Should further evaluation (or a new vaccine) emerge to show minimal risk to getting the vaccine, there may be a role in vaccinating older children to prevent the spread within families to high-risk groups. But, for now, the discussion is likely to stay with pregnant women and older adults.

Why is there a need for the vaccine? How will this impact health care systems?

The Centers for Disease Control and Prevention reports that per year, there are between 58,000 and 80,000 hospitalizations for RSV among children under 5. Because so many children get RSV every year, the actual number of children with severe disease is very high. This leads to a massive use of health care resources each year. That’s why there is so much effort into evaluating the vaccine despite some significant safety questions that need answering.

Go here to view more info about RSV from the CDC.

According to the CDC, those at greatest risk for severe illness from RSV include:

• Premature infants
• Infants, especially those 6 months and younger
• Children younger than 2 years old with chronic lung disease or congenital (present from birth) heart disease
• Children with weakened immune systems
• Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions

Editor's note: An earlier version of this story included information about deaths during the measles outbreak in Ohio which was incorrect. We regret the error.

By Heather Duge

During the recent measles outbreak in Ohio, the majority of children under 5 years old who were infected did not receive the measles, mumps and rubella (MMR) vaccine. Of the 85 children infected with measles, 25 of those children were hospitalized and several were treated in intensive care. Mary Suzanne Whitworth, M.D., Medical Director of Pediatric Infectious Diseases at Cook Children’s, said the under 5 age group is more at risk for severe cases of measles.

Not only that, but even children who recover from measles, especially those younger than 2 years old, are still at risk for developing SSPE – delayed brain inflammation – seven to 10 years later.

“Delaying the vaccines only leaves children vulnerable for longer than necessary,” said Dr. Whitworth, who never questioned vaccinating her children. “I could not sleep until my children were vaccinated.”

The Centers for Disease Control and Prevention recommends that all children receive two doses of the MMR vaccine – one at 12 to 15 months old and another at 4 to 6 years old. One dose is 95% effective against measles and two doses are 97% effective.

Some areas in the U.S. are more at risk for outbreaks – particularly communities with anti-vaccine sentiment. Age makes a big difference – being exposed in early infancy can be devastating which is why herd immunity is crucial to protect the vulnerable ones.

Herd immunity means enough people are immune through having the disease or vaccination so the disease does not have an easy place to land and cannot spread. If a person with measles coughs in a room with 10 people and everyone has been immunized, it will not spread. But if four of those people are not vaccinated, it will begin to spread.

Devastating Effects of Measles

Measles infections typically begin with high fever, congestion, cough and watery eyes. Three to five days later a rash may appear with flat red spots starting at the head/neck area and working its way down the body along with spots in the back of the throat. For some children, the infection worsens to measles pneumonia.

“One out of 1,000 children have brain inflammation and one to three children out of every 1,000 will die from respiratory or neurological complications,” Dr. Whitworth said. “These potentially tragic effects of measles are completely preventable.”

View CDC facts about measles.

No doubt – the HPV vaccine (Gardasil) is the vaccine I hear the most hesitancy about. And yet I convince parents each and every day to get it – with patience, understanding, and some awesome, strong evidence that it works and is safe.

Little background: HPV (Human Papilloma Virus) is a nasty little virus that you get from other people – through intercourse, oral sex, or just heavy “making out” (yes: kissing can spread HPV).

The CDC states that at least 75% of the reproductive-age population has been exposed to HPV!

HPV lays dormant in most people, but sometimes it causes growth. Sometimes, uncontrolled growth.

Uncontrolled growth = cancer. Cancers of the cervix, vagina, anus, mouth, throat, head and neck in women and men. It also causes anogenital warts. Fun times.

HPV is one of the main reasons women get Pap smears – to see if this virus is causing trouble.

“The HPV vaccine? Isn’t that the new one? It seems like it hasn’t been out very long.”

• The first HPV vaccines were released in 2006.  That’s almost 17 years ago! 17 YEARS!
• The updated version (from the 4-strain to the 9-strain) came out in 2014. 9 years ago!
• It ain’t new! It’s been used for almost two decades and has been given safely to over 270 million people across the world!

“Isn’t this a little early to get a vaccine for something that’s transmitted through sex? My kids aren’t having sex.”

• The vaccine works BETTER when you are YOUNGER. Your immune system is SMARTER when you’re younger, and holds onto the “information” for longer periods of time!
• As evidence of this, you only need two shots if you get the series before age 15. After age 15, you need three shots.
• It is devastating to think about – but why not protect our kids from things that are out of our (and their) control as well? What if something happened to them, like sexual abuse?

“Are there any bad side effects or reactions to this vaccine?”

• In my 12 years of practice as a general pediatrician, I have never seen a severe reaction to an HPV vaccine.
• A sore arm, dizziness, and fainting can be common 15 minutes following the vaccine, so we often will watch them in the office for a while after they get the shot.

“Does it work?”

• Heck yes, it does. Like, really well. Better than most vaccines, actually.
• The longest studies done on these vaccines are at 10+ years, and they seem to be between 90-97% effective at preventing these cancers and warts.
• There is evidence nearly 99.9% of people who get the shot create some form of antibody to the virus.

“Why should boys get this vaccine?”

• Boys give HPV to girls. And vice versa.
• Boys can get anal cancer, anogenital warts, oral cancer, and throat cancer from this virus.

“Why should I believe you about all this? The internet says I shouldn’t get this vaccine.”

You don’t have to believe me. Though I am a pediatrician who has given thousands of HPV vaccines in my practice.  It’s OK. I know some vaccines just seem plain ole scary.

Maybe believe my cousin, though? She’s a cancer doctor. A gynecologic oncologist, to be exact. And what virus does she spend all day battling in order to save the lives of women? HPV.

My cousin is Mae Zakhour, and she practices gynecologic oncology at Spectrum Health Medical Center in Grand Rapids, MI. She treats HPV cancers in women, daily - some as young as 25!

Her exact words to me – to share with you – are:

“Timely HPV vaccination is the safest and most effective way to prevent cervical cancer and other HPV-related diseases. As a gynecologic oncologist, I see and treat young women with cervical cancer on a weekly basis, and even for those in whom cure is a possibility, it comes with a cost.

The treatment for cervical cancer, > 95% of which are caused by HPV, can have devastating effects on a woman’s fertility and quality of life. I want to do everything possible to prevent that for my children. They are getting the HPV vaccine.”

So there you have it. Two moms, who also happen to be doctors, sharing information with you to help you make a very important decision for your child.

And both letting you know we’re getting our kids vaccinated for HPV at age 9 without hesitation!

It’s normal to be nervous about vaccines. What I hope you take from this is more confidence in the HPV vaccine - by knowing it’s super safe, it’s been out a long time, it’s super effective, and it’s super important.

RELATED: New Study Says Boys Less Likely to be offered HPV vaccination (checkupnewsroom.com)

Vaccine and Immunization (cookchildrens.org)

‘We Have a Vaccine That Can Prevent Cancer' (checkupnewsroom.com)

Texas Ranks Near Last in HPV Vaccination Rate (checkupnewsroom.com)

Children and teens need up-to-date shot records to start the new school year, and the doctors at Cook Children’s are eager to help get students caught up on their routine immunizations.

Alice Phillips, M.D. at Cook Children’s Pediatrics Cityview said vaccines can prevent contagious diseases such as hepatitis, measles and mumps from spreading through the classroom and to family members at home.

“We can look back at history and see stories about polio and whooping cough and the toll that that took on our kids and on our society. We do not want to go back to that,” Dr. Phillips said. “Vaccines are safe. They work. And they are tried and true and proven over many decades.”

But the latest annual immunization report by the Texas Department of State Health Services identified a drop in overall vaccination coverage among kindergarteners during the 2021-2022 school year. The report also cited a high number of seventh-graders behind on shots for meningitis and Tdap (tetanus, diphtheria and pertussis).

In the report, the COVID-19 pandemic was listed as the main reason more children missed out on their required vaccines last year. Additional barriers to immunization include lack of transportation, missed opportunities, lengthy wait, and lack of culturally appropriate educational materials, according to the state health department.

Dr. Phillips pointed out that only 85% of Fort Worth Independent School District kindergarten students were current with their measles shots last school year. To reach herd immunity, and limit transmission, the rate should be 90-95%, she said.

Many families were afraid to come to the pediatrician for their child’s annual checkup during the early months of the pandemic in 2020, Dr. Phillips said. Most of her patients have since received any overdue vaccines.  

Heather Miller, M.D. at Cook Children’s Neighborhood Clinic Northside also saw a trend of families not making appointments -- or canceling, or not showing up -- for well-child visits because of COVID-19 concerns during the past two years. To make up for the shots they missed, some 6-year-olds are now coming in for vaccines normally given at age 4.  

Dr. Miller has good news for children and teens who fell behind: There are combination vaccines that can be given in most cases, meaning “fewer pokes,” as she puts it.

Most of the patients that Dr. Miller and her colleagues see at the Neighborhood Clinic Northside are on Medicaid or the Children’s Health Insurance Program (CHIP), which is available to those who can’t afford private health coverage. She wants parents to know that the Texas Vaccines for Children Program provides vaccines to eligible children from birth through age 18.

Dr. Miller says getting back-to-school vaccinations will help protect children from potentially serious complications from those diseases. “That’s why we’re here,” she said, “to help keep children healthy.”

Cook Children’s families can go to the MyCookChildren’s patient portal to schedule an appointment or access the immunization records needed for school registration. Dr. Miller said the staff at the neighborhood clinics can help their families navigate the portal or print out a copy of immunization records. 

In addition to the delays the pandemic caused, Dr. Phillips believes vaccine hesitancy also played a role in the 2021-2022 drop in the immunization rate.  She invites parents to ask questions and talk to the doctor about any concerns.  

“Let me discuss with you what I know – the science, the data – to tell you why these vaccines are safe for your child and why they are effective at preventing illness for not only your child but all of their friends and the community,” said Dr. Phillips, who describes a team partnership of trust between the physician and patient families working together to keep kids healthy.

“I truly believe after 25 years of doing this, that what’s absolutely best for their child is to be fully immunized and protected, because these diseases are still out there,” Dr. Phillips said.

Vaccines Checklist

Because many vaccines are typically given in the first 12-18 months of life, an incoming kindergartner might not have received a vaccine since her first birthday. Between the ages of 4-6, these additional vaccines are due:

• MMR (measles, mumps and rubella)
• DTaP (diphtheria, tetanus and pertussis)
•  IPV (inactivated poliovirus)
•  Varicella (chickenpox)

And an incoming seventh-grader might not have received a vaccine since he was a preschooler. Between the ages of 11-12 years, these additional vaccines are due:

• MCV4 (meningitis)
• Tdap (tetanus, diphtheria and pertussis)
• HPV (human papillomavirus)

A booster of the meningitis vaccine is also recommended at age 16.

Cook Children’s follows the vaccine schedule adopted by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

____________________________________________________________________________________________________________________________________

For 10 key facts about immunizations, including why it’s important to follow a vaccination schedule, go to Vaccine and Immunization (cookchildrens.org)

To view the recommended ages for shots from birth through the teen years, go to cook-childrens-vaccinefacts2.pdf (cookchildrens.org)

Meet Heather Miller, M.D.

Dr. Miller’s desire to become a doctor took root as she grew up in the Piney Woods of East Texas. She earned a Bachelor of Arts in Biology from the University of Texas at Austin, then attended the University of Texas Medical Branch for medical school and residency. Along the way she proudly served in the U.S. Air Force for three years as a General Medical Officer at Lackland Air Force Base in San Antonio. After fulfilling her military commitment and completing pediatric residency training, she started her career at Cook Children’s Northside Clinic in 2002. Then came a 10-year journey following other career opportunities in San Antonio, Mississippi and New Mexico.

With a happy heart, this native Texan returned to Fort Worth and rejoined the Northside Neighborhood Clinic. Reconnecting with Cook Children’s has been a wonderful homecoming. She feels blessed to have this opportunity to provide care for the children and families of North Texas once again. Her special interests in pediatric care include safety and prevention as well as behavior and development

With her husband Steven and son Andrew, Dr. Miller enjoys exploring the world and taking trips by train.

Learn more about Dr. Miller here.

As people gather and travel during the summer months, the COVID positivity rate continues to rise. The seven-day average positivity rate reported at Cook Children’s Health Care System is 21% as of Tuesday.

Many Cook Children’s primary care offices are offering COVID vaccines. Patient families can check MyChart for online scheduling options or call their pediatrician’s offices.

In June, the Centers for Disease Control and Prevention and the Food and Drug Administration cleared the way for children 6 months to 5 years old to get the COVID-19 vaccine.

Our health care providers and pediatricians at Cook Children’s strongly recommend that parents get their children vaccinated. Vaccines are the best way to prevent serious illness in people of all ages, including children.

The COVID positivity rate has slowly increased at Cook Children's.  

Rolling seven-day average positivity rate at Cook Children’s:

• May 5 - 3.5%
• May 16 - 3.3%
• June 5 - 8.4%
• June 20 - 10.6%
• July 6 - 21.6%
• July 11 - 24.5%

On July 6, there was one COVID patient in the ICU and two others in non-ICU beds at Cook Children's.

On Wednesday, Tarrant County Public Health moved the community spread level to High after 774 new COVID cases were reported in the county. 

Positive cases and hospitalizations are increasing across Texas, according to Texas Health and Human Services.

The biggest thing the community can do to help is to take precautions against COVID-19, including masking indoors, hand washing, social distancing and getting the COVID-19 vaccine and booster if eligible.

Not only will this help prevent COVID-19, but it may also prevent multisystem inflammatory syndrome in children (MIS-C), which has continued to affect kids throughout the pandemic.

It’s also important to avoid Cook Children’s urgent cares and emergency department for simple COVID-19 testing. These locations should be used for severe COVID-19 symptoms such as:

• Difficulty breathing
• Difficulty staying hydrated
•  High fever for more than four days

If you need a COVID-19 test for your child, please call your pediatrician’s office to schedule an appointment. At-home tests and community testing locations are also great options when available. Tarrant County’s website is a great resource for finding testing locations.

RELATED:

COVID Vaccine Authorized for Young Children (checkupnewsroom.com)

Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

Vaccines are the best way to prevent serious illness in people of all ages, including children. Based on available data, our health care providers and pediatricians at Cook Children’s strongly recommend that parents get children vaccinated and booster shots as soon as they are eligible. Children ages 5 to 11 will now be eligible for the extra dose at least five months after their second shot.

This news comes after the first booster (third dose) of the Pfizer-BioNTech vaccine was approved for children ages 12 to 17.

We asked Nicholas Rister, M.D., of the Cook Children's Infectious Disease team to answer some of the top questions that parents and caregivers might have.

Why should my child get the COVID vaccine booster? 

Children are at risk to get sick from COVID-19 disease, requiring hospitalization, and in rare cases, dying from the infection.  More commonly they will get a mild infection and recover quickly, but vaccination can prevent more severe disease from developing. This is especially true for children with underlying risk factors including obesity, chronic lung disease including asthma, seizure disorders, and immunodeficiency.

How do we know it’s safe for children 5 to 11?  

A pediatric drug trial involving 140 children aged 5 – 11 years was submitted to the FDA showing high efficacy and safety.  Additionally, blood samples showed similar antibody development compared to data in older children and young adults. A large increase in antibodies that specifically target COVID-19 were observed in patients after a third dose of the vaccine, regardless of whether they had previously had COVID disease.

How long until the booster will be available for children 5 to 11?

With formal FDA approval, all children ages 5 to 11 can be offered a Pfizer vaccine. However, be sure to check with your vaccination site if they currently have the Pfizer vaccine available for these children.

If my child recently had COVID, how long should we wait to get the booster vaccine?  

There has been little in the way of formal recommendations regarding when to get booster vaccination following COVID infection. This is largely because there is tremendous variability in different individual’s infection and how robust their antibody response is. It is generally thought that after COVID infection, there is a period of 3 to 6 months during which repeat infection, especially severe infection, is unlikely. However, there is no reason that you or your child needs to wait to get the booster. Whether a booster is given immediately after recovering from the illness or a few months later, the antibody response has been excellent.

What should parents do if they have more questions?

Talk to your pediatrician. They have your child’s medical history and are the best source of information for this topic. They have the latest information available and want to help you make an informed decision.

If your child is eligible for the COVID-19 vaccine, please contact your local pediatrician's office to schedule an appointment.

Parents may be wondering if they should get their children vaccinated. Vaccines are the best way to prevent serious illness in people of all ages, including children. 

Based on available data, our health care providers and pediatricians at Cook Children’s strongly recommend that parents get children vaccinated as soon as they are eligible.

“It is important to keep our children safe now and in the future," said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. "This is one way to safely protect your children AND protect people who they might expose from catching SARS-CoV-2."

We asked Dr. Whitworth to answer some of the big questions and shed a little light on the subject.

Why should my child get the COVID vaccine? 

Children are at risk to get sick from COVID-19 disease, requiring hospitalization, and in rare cases, dying from the infection.  More commonly they will get a mild infection and recover quickly. But while they are contagious they can spread this to others such as vulnerable grandparents.

How do we know it’s safe for children 5 and under?  

The children who participated in the vaccine research had no serious adverse events and we know that the FDA is extremely cautious and will review the data quite carefully before approving this.

Should parents get their children vaccinated, even if their child recently had COVID?  

Yes. Those who have been infected with this virus can get infected again. This second infection may be the same, milder, or more severe – and they are able to transmit SARS-CoV-2 to those who are more vulnerable.

What about if I live in an area with a low number of cases?  

SARS-CoV-2 will not be eradicated.  We will have this infection with us for years to come, just like influenza.  Low numbers now are something to enjoy, but we will all be exposed at some point in the future. 

What should parents do if they have more questions?

Talk to your pediatrician. They have your child’s medical history and are the best source of information for this topic. They have the latest information available and want to help you make an informed decision. 

If your child is eligible for the COVID-19 vaccine, please contact your local pediatrician's office to schedule an appointment.

RELATED: BioNTech Asks the Food and Drug Administration to Authorize COVID-19 Vaccine for Children Under 5

Morgan was born with a very rare and life-threatening condition called Maple Syrup Urine Disease (MSUD). Because of this metabolic disorder, Morgan’s body lacks the enzymes necessary to break down amino acids found in protein. Those amino acids build up, become toxic and cause severe health issues.

Catching COVID-19 could land Morgan in the hospital or cause life-threatening complications. It was a risk his mother wanted to minimize, so when the COVID-19 vaccine became available Sonji jumped at the chance to get vaccinated. After speaking with Morgan’s physician, she wanted the same for him and his brother. But getting Morgan out of the house is a daunting task. He is developmentally delayed, wheelchair dependent and relies on a feeding tube for nutrition. On top of that, Sonji worried about the potential exposure to the virus while out in public to get the vaccine. She found herself in a Catch-22.

Then came a call from the Gentry twins’ insurance provider — Cook Children’s Health Plan (CCHP). The health plan offered to have the COVID-19 vaccine delivered and given to Morgan and Hayden in their home thanks to a unique partnership between CCHP and MedStar, a Tarrant County emergency medical services (EMS) agency.

The partnership is the result of a simple ask.

“I’m trying to sort out options on how to provide COVID vaccinations to our homebound members. Might MedStar be able to assist?” read a text message from Kimberly Aaron, M.D., to her long-time colleague Matt Zavadsky.

Dr. Aaron is the vice president of clinical affairs at CCHP and Zavadsky is the chief transformation officer for MedStar. The two have a history of working together within their various roles in the health care industry.

Zavadsky responded with a quick yes and, within minutes, that single text put into motion a partnership between the two organizations to offer medically fragile and homebound children access to the COVID-19 vaccine without ever having to leave their home.

The program is a unique one, according to Zavadsky.

“I'm pretty well plugged in nationally in EMS circles and this isn't happening in most communities,” he said. “This type of innovation is what Cook Children’s is known for.”

The program targets CCHP STAR Kids members who are either ventilator dependent or technology-dependent for continuous feedings or other medications.

“It’s hard for a child dependent on this type of technology to get out and go to a pharmacy to get a vaccine,” Dr. Aaron explained. “It’s just too cumbersome.”

There’s the issue of exposure, too. These families often do not elect to leave their home for anything other than visits with their health providers because medically complex children are at high risk for severe disease when exposed to any virus, not just COVID-19.

“We wanted to see what we could do to remove these barriers, such that the only barrier was whether or not the family was comfortable getting the vaccine for the child,” Dr. Aaron said.

That’s where MedStar comes in. The nature of their business makes MedStar uniquely suited to help CCHP get vaccinations to their homebound members. After all, who better to take health care to the home front than those who already do it every day?

“We’re used to working in a mobile environment and inside people’s homes,” Zavadsky said. “It’s what we do. It’s a natural fit for us to go into the community and provide medical care.”

Most people know MedStar, especially families with homebound children who have likely had an experience with the agency responding to an emergency call at their residence. They’re a familiar and trusted community service. That trust goes a long way when opening the door to someone offering your child a vaccine.

MedStar is also an authorized vaccine provider. This gives the agency ample access to free vaccine materials directly from the federal government, which means no vaccine cost is passed on to CCHP or its members. Not all EMS agencies in the country have this authorization.

The process is simple. CCHP identifies qualifying members according to their medical condition and makes initial contact with the family to see if they are interested in the service. If yes, CCHP notifies the child’s primary care physician that the family has opted in to receive the vaccination at home. MedStar then makes contact with the family to schedule the home visit where emergency medical technicians (EMTs) administer the vaccine to the child and any other household members, like parents and siblings, who want it. MedStar administered both rounds of Morgan and Hayden’s vaccination and boosted their mom and dad.

The health plan reimburses MedStar for the administration of the vaccine, so it’s all done at no cost to CCHP members. The service is completed by EMTs who wish to pick up extra shifts. No personnel or MedStar units are taken out of normal daily service to make home vaccination visits.

MedStar administered the first in-home vaccination on Dec. 22, for a total of 16 to date.

“For every member we vaccinate, we feel like it’s worth the effort to do our best to make sure these families and their children have access to the vaccine in a way that doesn’t further marginalize them in terms of their ability to get that protection,” Dr. Aaron said.

Response to the program has been positive.

“I love it,” Sonji said. “We don't have to wait in lines. We don't have to be standing or sitting around other people. We get to stay in the privacy of our home. It was very convenient.”

Like the Gentrys, other families participating in the program are grateful for CCHP’s efforts to bring the vaccine to their doorstep and for MedStar going above and beyond to vaccinate other members of the household.

“These families are so appreciative,” Zavadsky said. “In many cases, I've heard from the EMTs that have gone out and given the vaccine that the families are shocked that CCHP would make this arrangement to have someone from MedStar come to their house and do preventive care. They're so used to seeing us when somebody is hurt or having trouble breathing or has an allergic reaction. The fact that we're coming out and doing something that will prevent a 911 call, I think it's like the best partnership ever.”

UPDATE

The Food and Drug Administration now says it will wait for Pfizer and its partner, BioNTech, to release data on how well three doses of the vaccine works for children under 5.

The reversal by federal regulators was announced Friday, Feb. 11, after Pfizer-BioNTech requested the delay. The companies said new data from clinical trials showed a higher rate of infection with the omicron variant than previously recorded, highlighting the fact that two doses of the vaccine for this age group were not enough.

For families, this means the COVID-19 vaccine will not be available for this age group until later this spring, possibly April.  

You’ve probably heard the news about Pfizer and its partner, BioNTech, asking the Food and Drug Administration to authorize its COVID-19 vaccine for children under 5. This has raised a lot of questions for parents, and maybe even a little confusion. We asked Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s, to answer some of the big questions and shed a little light on the subject.

What is going on with the COVID-19 vaccine for children under the age of 5?

In early February, Pfizer asked the FDA to authorize two doses of their coronavirus vaccine for this age group. This created some confusion because the drug company released a statement in December stating that two doses did not produce the immune response they hoped for in clinical trials of children 2 to 4 years old. I think some people took that to mean the vaccine does not work for this age group, which is not the case. It means children ages 2 to 4 may need a third dose of the vaccine, but that research is still underway.

What’s the difference in the doses for this age group compared to older children and adults?

The dose for children under 5 is much lower than what’s authorized for older kids and adults. Pfizer has been testing 3 microgram doses for this age group while kids 5-11, have been authorized to receive 10 microgram doses. The dose for 12 and up (including adults) is 30 micrograms.

What’s the risk of my child developing myocarditis after receiving the COVID-19 vaccine?

We’re still waiting for the FDA to release their findings, but studies have proven that COVID-19 infection is more likely to cause myocarditis than Pfizer’s COVID-19 vaccine. Many viruses, including the common cold, can cause myocarditis, which is the inflammation of the heart muscle. Most cases, especially in children, are mild. The risk of complications from COVID-19 infection far outweighs the risk of myocarditis from the vaccine. 

What should parents do if they have more questions?

Talk to your pediatrician. They have your child’s medical history and are the best source of information for this topic. They have the latest information available and want to help you make an informed decision. 

Watch the videos here: 

Positive cases now account for 31% of tests throughout Cook Children’s Health Care System, about 600 a day. It’s the highest number seen at Cook Children’s since the pandemic began in March 2020 and surpassing the height of the delta surge in September. As of Tuesday, 33 patients were hospitalized, with three being treated in the Pediatric Intensive Care Unit (PICU).

The latest explosion in COVID-19 cases may be fueled by both the omicron and delta variants at work, according to a report released last week by the Centers for Disease Control and Prevention (CDC). As of the week ending Dec. 25, omicron appeared as the dominant variant, but the delta variant still comprised roughly 40% of reported cases, the report states.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s, was interviewed on “CBS Mornings” this week. She says the hospital’s pediatricians and clinics have seen children and teens of all ages testing positive.

“It’s really anywhere on the spectrum,” she says of the recent spike. “We’ve had some babies who were only a few weeks old.”

Other children’s hospitals in Texas and across the country have seen a similar uptick in sick children overwhelming the health care system. More than 325,000 positive cases were reported during the week ending Dec. 30, the American Academy of Pediatrics reported, adding it was the nation’s highest increase in child COVID cases since the pandemic began. The unprecedented number represents a 64% jump from reported cases the previous week.

Top health officials in the country have voiced predictions that a surge may continue as a result of holiday gatherings and vacations but expect it to peak by the end of January based on how the omicron variant behaved in South Africa last month.

With numbers of child cases still on the rise, parents are grappling to address all things COVID. Here’s what families need to know:

How can you tell the difference between COVID and the common cold or the flu? Basically, it’s tough to distinguish between them.

Similar to a cold, the most common symptoms of the omicron variant (found to be much more transmissible) are sore throat, cough, fatigue, congestion and runny nose. The delta variant (thought to cause more severe illness) also generally presents with common cold-like symptoms, such as cough, fever or headache, but also may cause a significant loss of smell.

To complicate matters, COVID-19 also shares some common symptoms with the flu, according to the CDC. Both can show a wide-range of symptoms, including sore throat; fever and chills; headache; cough; shortness of breath or difficulty breathing; fatigue; runny or stuffy nose; body or muscle aches; vomiting and diarrhea; and a change or loss of taste or smell, though that appears more prevalent in COVID.

Since it can be difficult to distinguish between the cause of these symptoms, a test is the best way to determine what it is. COVID testing can be done at home (although tests may be difficult to find right now), at a laboratory or at a test site provided in your area.

 “At this point, it’s probably best to assume you are positive until you are proven otherwise,” says Marc Mazade, M.D., director of Infection Control at Cook Children’s. If family members are having symptoms, they should get tested as soon as possible, which may take longer than usual.

See the CDC website for additional guidelines on who and when someone should get tested.

 Are vaccines the best way to keep my kids from getting seriously ill with COVID-19?

Yes. As it stands, COVID-19 vaccinations are highly effective at preventing severe illness, hospitalizations and death, the CDC reports. And the emergence of the highly contagious variant omicron and its ability for breakthrough infections further emphasizes the importance of vaccination and boosters, the report states.

Children ages 5 and up are eligible for COVID-19 vaccines. This week the Federal Drug Administration (FDA) approved an additional Pfizer booster shot for children ages 12-15, and an additional dose for certain children ages 5-11 if they are immunocompromised.

Cook Children’s pediatrician Diane Arnaout, M.D., encourages eligible children to get COVID-19 vaccines and boosters.

“Don’t let the number of shots worry you,” she says to parents who may have concerns. “There are lots of vaccines that require boosters, and I give them to your kids throughout their early years at timed intervals to make sure they’re protected into adulthood.”

The second, third and fourth shots do what their name says, Dr. Arnaout says. They boost the antibody response to a certain antigen and assure a large portion of the population develops immunity, she says.

“Some shots give us long-term immunity with just two doses and others with five. It just depends on the nature of the vaccine,” she says. “Sometimes viruses mutate so quickly, we need a slightly adjusted vaccine every year to help us fight what’s circulating that year, like the flu shot.”

Although it’s difficult to know at this point, she says, the COVID vaccine may someday become like the annual flu shot.

“Again, we are building this boat as we float in it,” Dr. Arnaout says. “I admire and thank all the scientists, doctors and data collectors who are helping us with this guidance.”

It’s not uncommon for kids to be nervous about needles. So the experts at Cook Children’s offer some advice to provide reassurance and support throughout the vaccination process. Honest conversation, creating a comfort plan, and distraction techniques can help put children at ease. Reinforcing a positive mindset helps too: You can do this!

“If you go in with the high expectation that your child can handle this and our staff is going to take good care of your child and make it as comfortable as possible, the kids will rise to the occasion,” said Kim Mangham, M.D. at Cook Children’s Pediatrics Keller Parkway.

The U.S. Centers for Disease Control and Prevention (CDC) on Nov. 2 approved a lower-dose Pfizer-BioNTech vaccine for ages 5-11. Children ages 12 and up were already eligible for immunization against the virus that causes the illness known as COVID-19.

Dr. Mangham said some of her younger patients have been eager for their turn at vaccination. “Some of them are so excited about being protected,” she said.

Clinical coordinator Trish Skelly, LVN estimates she has given hundreds of COVID-19 shots to 12-year-olds and teens through Cook Children’s during the pandemic. It’s a two-shot vaccine, so Skelly gets the chance to follow up when the patients return three weeks later for the second round.

“Usually, I ask how they did after the first one, and they say it was a lot better than they expected,” she said. “They’re handling it much better than the adults with the side effects.”

To help alleviate fears about the shot, Skelly wears her fun nurse’s scrubs and relies on an assortment of aids including stickers, suckers and a topical spray that feels like ice on the skin, relieving the needle’s sting. Most of her patients opt for the nicknamed “Elsa spray” or “magic spray” before the injection. Skelly also answers any questions that come up.

“I explain everything I’m doing when I’m doing it so that there’s no surprises. Most of them don’t even feel it. It’s actually an easier shot than the flu vaccine,” she said.

As coordinator of the Comfort Menu program at Cook Children’s, Whitney Brosey works to educate medical personnel about techniques that can make children feel less leery about going to the doctor. And Brosey promotes the strategies that caregivers can follow – at every point from scheduling the vaccine appointment, to the shot itself, to the 15-minute monitoring period afterward -- for a happier end result. Let’s take a closer look at each stage.

Get Ready, Get Set

Parents should start by informing themselves about the vaccine, Brosey recommended. Next, try to schedule an appointment time that doesn’t interfere with sleep, meals or extracurricular routine so that the child isn’t hungry/cranky and coping poorly.

“If you have to wake them up from a nap or if they have to miss one of their activities, there's going to be added disappointment,” she said. “As much as possible, don't disrupt their normal schedules, so that they don't have added stressors.”

When is the best time to give your child advance notice of a vaccine? It depends, Brosey said, on the child’s personality. Some kids might worry excessively if they know multiple days ahead of the appointment. Brosey informed her 8- and 6-year-old daughters the night before their recent flu shots.

“It’s important to tell kids what is happening to their body. Surprises are fun, but not when it comes to things at the doctor” in order to build trust in medical experiences, she said. “I want to make sure that my kids feel like it's OK to feel nervous or it's OK to be a little bit scared, but to have time to process those feelings so that then there's also time to come up with a plan to help it not be so scary.”

Don’t wait to break the news until you arrive at the doctor's office or vaccination clinic, she said.

More pointers beforehand… Explain in simple words that vaccines help keep our bodies from getting sick. Friendly resources include “Daniel Goes to the Doctor” for younger kid and an animated video from the American Academy of Pediatrics. Allow your child to make appropriate choices, such as whether to bring along a special blankie or stuffed animal from home.

“One of my daughters had dance class after her flu shot, so she wanted to get it on her right leg because she does all of her turns on her left leg,” Brosey said. “That was the control piece for her. She felt empowered.”

And Go

Once at the clinic, parents should talk with the medical staff about the preferred approach for their child’s vaccine. Find out if cold spray or other options are available for comfort. Parents might want to call ahead if the child has developmental delays or sensory needs, Brosey said. Be your child’s advocate.

“Sometimes parents feel like they're being a difficult parent by saying what works, or they think that they're inconveniencing someone, and that is not the case,” she said. “We trust that they know their child best. We want you to communicate with us and have a conversation with us about your child. If you want to hold and hug your child while they're getting their vaccine, then you communicate that with the medical team.”

Distraction is key, according to everyone interviewed for this article. Distract your child by playing a game like I Spy. Sing a song or listen to music. Recite the ABCs backwards. Prompt your child to talk about a favorite memory. Brosey calls this therapeutic conversation.

To keep the child from feeling overwhelmed, only one parent should speak to the child at a time, she said. Reinforce the message of the child’s main job – to hold still. Recognize it’s OK if they cry. If possible, don’t bring siblings who aren’t getting vaccinated, because total attention belongs on the child receiving the shot.

TLC after the Shot

Brosey recommends coloring books or games to pass the time during the 15-minute observation period after the COVID-19 vaccination. Follow up your child: Do you feel like that went well? Or what could we have done differently? Give a treat or some extra one-on-one time later at home.

“It’s so important to help your child return back to baseline after they've gotten nervous or scared. It's almost like the next step in distraction,” she said. “And so I may say, ‘Hey, we can run by the donut shop!’”

Also, let your child know they might experience soreness or other side effects the next day. Brosey said it’s important for the child to report to you if they don’t feel well.

Although CDC approval of the pediatric COVID-19 vaccine is new, kids usually have some familiarity with getting immunized against other illnesses. Brosey said parents should use age-appropriate vocabulary and detail to help explain the purpose of vaccines. The bottom line is to work out a comfort plan, collaborate with the medical team, and stay positive.

“When it comes to coping or how children perceive shots, they're not too big at 11 to be scared,” she said. “We care about our kids' emotional safety. We don't want to have a traumatic experience. We want them to feel safe and we want them to feel heard and seen and acknowledged, and all of that can be done.”

1. One-third of you will RUN, not walk, to get it.
2. One-third of you will absolutely refuse it, for varying reasons.
3. One-third of you will wait a little bit….to see what other families do, and watch how other kids feel after getting it.

I write this for those of you in the gray zone. And maybe even a few in the “no” zone?

Every family is different. And I get that.

Some of you are really nervous about COVID, and some of you aren’t. I get that.

And some of you are nervous about a “new” vaccine, and some of you aren’t. I get it.

And I’ll never judge you for questioning what goes in your child’s body. It is natural to be skeptical of new knowledge.

But I will be getting it for my kids. And after reviewing every page of the data, here are my reasons:

1. My perspective is unique.

I think this is one of the biggest reasons this decision was easy for me. Being a pediatrician gives me a unique perspective.

I have worked in pediatric ICUs and ERs. I have seen children suffer tremendously and even die at the result of viruses.

I have seen the flu cause a heart infection so bad in a child they required a heart transplant within 7 days of contracting it.

I have seen a “tummy bug” kill an infant in 24 hours.

I have seen the common cold put children on ventilators.

It’s true – COVID is typically very mild in kids. No one disputes that.

But I will give you my perspective: I have seen COVID make kids so sick they need to be in the ICU. Multisystem Inflammatory Syndrome in Children (MIS-C). Double pneumonias. I have watched it torment some kids for months after the initial infection, both physically and psychologically. Let’s not even talk about the anguish of losing a parent or grandparent to COVID.

I hate COVID. And I want to protect my kids against it.

And this vaccine is all I have. This is the only protective measure I can take to protect my kids, now that universal masking and social distancing seems to be merely a fleeting thought in my state. And I’m just as tired of social distancing as you are.

When it comes down to it, the one thing I pray to never experience as a parent is to sit next to a hospital bed, regretting a decision I made for my child. Regretting not getting the only thing that may protect him from this virus. I’ve watched too many parents go through this, and it breaks my heart. And I know what you’re thinking – well what if I have that same regret, except it’s the vaccine’s fault?

Sometimes, when I talk with someone who is nervous about mRNA COVID vaccines, I take for granted the fact that I am a physician. I’ve been trained and educated for years in vaccinations, immunology, how mRNA works, vaccine reactions, statistics, and epidemiology. I am not scared of this vaccine giving my kids COVID, changing my DNA, or giving my kids long-term side effects. Like, at all.

Which leads me to the next component of my decision:

2. Pediatricians know vaccines. Probably better than any other type of physician out there.

As pediatricians, we give thousands of kids vaccines each year. We give more vaccines than any family practitioner or internist, by a landslide. And we field more phone calls and questions about post-vaccine reactions than any other specialty.

We are not worried about this vaccine causing long-term problems in children. Why? Because reactions to vaccines just don’t work that way. If a child is going to have a severe reaction to a vaccine (something so rare I’ve seen literally one time in 12 years of practice– and it was a seizure in a child with a known seizure disorder), it is overwhelmingly going to happen within 6-8 weeks of getting the vaccine.

If the immune system gets “too revved up”, we see the inflammation cause problems – like the rare myocarditis we’ve heard about in young men. And – those few young men who got myocarditis? It was typically mild. They spent a couple days in the hospital and were discharged home, unlike the myocarditis associated with COVID – which is much more common, and can make you much more sick.

The 2000+ children studied in the Pfizer study are now going on over 3 months post-vaccine and are doing great, with not a single severe side effect (including myocarditis). And the dose is 1/3 that of the older kids’ dose, which means it will cause less “revving up”, if you will, while still doing a good job of getting antibodies made.

And let’s not forget the tons of data we already have from adults, and kids 12-15. It looks overwhelmingly positive.

3. I’m not worried about post-vaccine “fertility issues” and you shouldn’t be, either.

Jeez, if there’s one social media myth that I wish would die, it’s this one.

The mRNA COVID vaccines don’t cause infertility.

I’m not diving into the details here, of which there are plenty, but some simple common sense makes me not worried about this for my daughter. As of today, 3.8 BILLION people across the world have had at least one COVID vaccine. The vaccine has been put in human bodies now (starting with the first studies) for over 14 months.

Doesn’t it make sense that if there was this overwhelming effect on fertility, doctors across the world would be noticing? Wouldn’t we notice pregnancy rates going down, miscarriage rates go up, and birth rates drastically reduced? But we haven’t seen that.

“But I’m reading about women whose menstrual cycle changed the month after they got the shot!”

Here’s an insider tip: it’s the immune response that makes cycles a little wonky in the 1-2 months following the COVID vaccine. This is because the menstrual cycle is very sensitive to any change – more exercise, any form of illness, dietary changes – you name it. It is joked in medicine that the wind blowing a certain direction can cause a shift in a woman’s cycles.

Just in case you don’t want to hear it from a pediatrician, I asked my friends, the Obstetricians/Gynecologists over at FENOM Fort Worth, for their input:

Dr. Andrea Palmer: “We see menstrual changes sometimes after vaccination as part of a woman’s immune response. But we’ve seen nothing long term. I’ve seen no increase in infertility in our practice or in nationwide data.”

Dr. Lori Atkins: “The way I like to explain it is, the body will have a natural inflammatory response – and this is short-lived. The lining of the uterus will also respond, so there may be an irregular period for a few months. But there are numerous studies and opinions from reproductive endocrinologists who highly recommend the vaccine as it poses no risk to fertility. At this point, it’s well documented.”

So…I’m just not worried about the vaccine causing fertility issues in my daughter.

4. We have people we love in our family who are immunocompromised.

This point hits a lot closer to home for me, and is something unique to each family’s decision.

We have immunocompromised people in our family whom we love very much, and see often. They are vaccinated. But sometimes, the vaccines don’t work as well in people who are immunocompromised.

Children can spread COVID.

I do not want my children to be the possible source of infection for beloved family members.

Vaccinating my kids will cause less of a chance for them to give others COVID, as there is less of a chance they will carry it or be symptomatic with it (thus less sneezing, coughing, and general viral spread).

5. I care about my community.

I will keep this short and sweet: if vaccinating my kids will lower the chance that your daughter with asthma, or your son with diabetes, or your mother with lupus, will get sick with COVID, then sign me up. I consider this a small part of my journey in trying to love my neighbor (even if we hung different flags on Election Day! Gasp!).

6. My kids are tired of wearing masks.

I mean. Not much else to say here. If my kids are fully vaccinated and the community numbers stay down, we’re eventually going to take them off in school.

7. My kids have missed enough school, and we want to avoid quarantining.

Current CDC recs say if you’re vaccinated and exposed, you don’t have to quarantine unless you’re symptomatic. Less school missed is a great thing.

So there you have it. My many reasons for vaccinating my kids.

I know this was a lot to digest. I think what it whittles down to is this: the most important question in my mind as a mother is: “is the vaccine safer and less risky than COVID infection?”….and I think the answer to that question is yes. Especially when we take family members and community spread into account.

Again, this decision is personal and unique to each family. And I won’t judge you at all if you want to learn more from me before you decide to get it for your kids. I hope my thought process for my own kids helps you with yours.

Many parents say they’re anxious about getting their children vaccinated against COVID-19. We decided to ask several Cook Children’s physicians what they think about all of the recent vaccination news regarding children. Here are their responses:

How do you feel (or what do you think) about the recent news of a Pfizer vaccine potentially being available to children 5+ in early November?

Excited. This opens up a preventative treatment for kids in this age group. The sooner this is evaluated and approved, the more illness we can prevent. Especially going into the holidays. – Nicholas Rister, M.D., pediatric infectious diseases physician at Cook Children’s

This is great news. The vaccines are very important to get ahead of this pandemic. – Ana Rios, M.D., pediatric infectious diseases physician at Cook Children’s

I cannot tell you how excited I was to hear Pfizer asking for emergency use authorization (EUA)! I cannot wait to begin vaccinating our younger and more vulnerable patients. Vaccinating as many people as possible is the only way to end the spread of this disease and restore some degree of normalcy to our lives. I’m hoping that families who are planning on traveling for the holidays or seeing extended family for the first time in months will consider vaccinating their children to protect their families while traveling and to protect at-risk older relatives. I know that my 5-year-old niece will be getting her vaccine as soon as it’s available. I know my own two children (3 years and 1 year) will have to wait a few more months but they will be first in line as soon as it’s approved for their age group! - Laura Romano, D.O., hospitalist at Cook Children’s

We want to make sure that we are moving forward in the safest way possible but having protection for children would be great before holiday gatherings begin. – Justin Smith, M.D., pediatrician at Cook Children’s Pediatrics Trophy Club

Excited and very much full of anticipation as both a pediatrician for my patients and as a mom for my littles who are 5 and 7. – Bianka Soria-Olmos, D.O., pediatrician at Cook Children’s Pediatrics Haslet

I am looking forward to being able to provide my patients who are 5-11 years of age the same protection that my older patients have been getting for the last several months. It is so important that we extend the protection of this vaccine to this age group so that they can stay in school and not spread the disease in the community to those more vulnerable among them and around them.

– Jason Terk, M.D., pediatrician at Cook Children’s Pediatrics Keller Parkway

Are you concerned about how long it’s taking for the COVID vaccine to be approved for kids 5+?

No, in the contrary. I think that the evaluation of safety and efficacy of vaccines in children take longer and this means that they are taking the time to analyze the data and evaluate for potential signals of concerns. – Ana Rios, M.D.

While we always want to have treatments available for children as soon as possible, it’s important they be rigorously evaluated. Especially with concerns for some rare side effects that skewed to younger age groups like myocarditis, it was important that the vaccine application have adequate data from children and not extrapolate only from adults. – Nicholas Rister, M.D.

I am not concerned about the length of time, if anything I am comforted by the process. I’ve heard from a lot of families in the hospital that one of the reasons they have decided not to vaccinate their children is that this is such a new vaccine and the process has been rushed. They are concerned since it was called “Operation Warp Speed” that corners have been cut. It’s nice to be able to reassure them that both Pfizer and Moderna increased their study length and their study size to make sure that this vaccine was safe and effective! While the mom in me wishes it would have happened three months ago, the scientist and the pediatrician in me appreciates the process and the time that it has to take. - Laura Romano, D.O.

I would want things to be done in the safest way possible. If that means taking some more time to get information and thoroughly review it, I am fine with that. – Justin Smith, M.D.

No concerns given my hopes are that people gain perspective of how the data was gathered and analyzed to ensure efficacy, safety and other measures considered when vaccine trials are conducted. – Bianka Soria-Olmos, D.O.

No. It is so important to make sure that we understand how the vaccine works in younger children. Younger children are not little adults and the physiology is unique. Making sure that the vaccine is safe and effective in this population is something that must be appropriately studied. The clinical trials show that the Pfizer vaccine works very well in 5-11 year olds and is associated with the same common side effects that are seen in older eligible teens and adults.

– Jason Terk, M.D.

What should parents consider when deciding whether or not to get the COVID vaccine for their children?

Parents should consider that COVID can affect children more than what we originally thought. COVID is here to stay, and it’s better to get vaccinated against it than to get the viral disease. – Ana Rios, M.D.

Assuming the vaccine is approved, the major consideration should be where and when to get vaccinated! As with adults, the risk for these vaccines is likely to be extremely low while the benefits are relatively high. Of course, children that have risk factors (chronic disease, obesity, asthma) should expect even more benefit from vaccination, but the general population should plan to get it as well. There are so many people who are at risk of severe disease and death from COVID that the benefit we get form widespread vaccination isn’t just about our children or ourselves, it’s about many people who we can prevent from getting sick without ever even knowing them. – Nicholas Rister, M.D.

Parents need to be aware that, although COVID has been mild for most kids, that is not always the case. Severe COVID and MIS-C continue to be a problem in children but these can be eliminated with an effective vaccine. – Justin Smith, M.D.

Parents should continue to have conversations with their child's doctor. Each child's particular situation is better discussed between and parent and pediatrician that knows the child. Because although the vast majority of children will have mild disease the recent surge has shown that children can get severely ill from COVID-19 and even deaths have occurred. The recent surge has shown that besides underlying health conditions being unvaccinated is a risk factor for severe illness. – Bianka Soria-Olmos, D.O.

Parents need to know that while most children who have gotten sick with COVID-19 have had a fairly mild illness, many have gotten more seriously ill and have required hospitalization. At the very least, illness in children has required that they isolate and that their household contacts quarantine for even longer. This has deprived them of their ability to go to school and to return to normalcy. – Jason Terk, M.D.

Parents need to consider the risks of being infected with COVID versus the risks and benefits of the vaccine. COVID, despite what some of our families still believe, is not simply a bad flu. COVID can be just as serious in our children as it can be in adults. Children’s hospitals, including Cook Children’s here in Fort Worth, have unfortunately had children pass away from COVID. Some of these children could have been vaccinated but parents decided to wait. Others were too young to be vaccinated. I’ve heard some parents say that it’s “only 500” or so children that have died. “Only” and “children who have died” are two phrases that do not belong together. Any child that dies from a preventable illness, which COVID now is, is a tragedy. And I’m sure that the parents and families of the “only 500” children if given the opportunity would have vaccinated their children. 

COVID infection causes many severe complications such as blood clots, myocarditis, pneumonia, and acute respiratory failure. We are seeing children be affected with daily fatigue and headaches as long haul symptoms. We still see multisystem inflammatory syndrome in children (MIS-C), which is always serious and can be fatal itself. These are all things that can be prevented with the vaccine. 

The vaccine will also protect against subsequent infection. Some families and parents believe that if they have previously been infected with COVID, they cannot get ill again. Studies are now showing that protection from COVID only lasts about 6 to 8 months. After that, these patients are at risk for a second, more severe infection. 

Yes, there are risks to the vaccine. Many people experience injection site pain, muscle and joint aches, fatigue, and maybe fever/chills. Yes, there can be more serious side effects such as myocarditis. But these risks are extremely rare (less than 1 in 20,000 people experience myocarditis following a COVID vaccination) when compared to the actual infection itself (almost 1 in 40 experience myocarditis with an actual COVID infection). 

The vaccination also does not affect fertility and it does not cause miscarriages. 

We have administered almost 3 billion doses of the vaccine to the 6 billion people in the world. Half of the world’s population is now at least partially vaccinated against COVID and we are not seeing any serious sustained side effects. 

The vaccine is safe. The vaccine is effective. It protects against a life-threatening and fatal illness. The benefits of the vaccine far outweigh the risks associated with the vaccine and the risks associated with the actual virus. - Laura Romano, D.O.

For those of you with young children, do you plan to get your child vaccinated against COVID? Why?

My children are 3 years old and 1 year old. They will be first in line to get vaccinated once they are eligible! I’m doing this for their own protection since I treat COVID patients on almost a daily basis. I’m doing this for their protection since they are both in daycare. I’m also doing this to protect my father and their grandfather. My father is a Type 1 diabetic with rheumatoid arthritis and I’m always terrified of accidentally spreading COVID to my father when he visits his grandchildren. My children being vaccinated will give me so much peace of mind. - Laura Romano, D.O.

I plan to review the data gathered and released just like I have for every other vaccine in past. As a physician scientist, I will evaluate the data objectively and make recommendations based on this data. This will afford me a good basis for helping me make the decision for my own children. As long as the data shows good efficacy, high safety (minimal risk of adverse side effects) then I will vaccinate my children. Although the official data has not yet been released so far from what I have heard from my expert colleagues the data is promising. – Bianka Soria-Olmos, D.O.

I’m still waiting on the official data and FDA panel’s recommendation but expect that it will be favorable. – Justin Smith, M.D.

I don’t have children but I do recommend my friends and relatives to get their children vaccinated since the benefits outweigh the risks. – Ana Rios, M.D.

With COVID-19 cases decreasing, should children still wear masks to school?

I think that that physical measures such as wearing masks to school should continue in the meantime since we still have many cases in the community and a lot of people that are not vaccinated, children and adults, especially in Texas. – Ana Rios, M.D.

We are happy to see cases decreasing but there is still a lot of COVID out there. As long as total cases remain high, there is still a significant benefit from wearing the masks at school. As we get into lower and lower case counts, this will likely change but it remains unclear exactly how long. – Nicholas Rister, M.D.

Yes, although it is very promising that cases are decreasing, community spread remains high and at this point mitigation policies are the only way to bridge the gap of time between now and an EUA for COVID-19 vaccine for school aged children which will hopefully create a continued decline in disease burden and safer schools. – Bianka Soria-Olmos, D.O.

Yes. We know that masking substantially reduces risk of transmission and subsequent illness in schools. We encourage all of our patients to maintain masking whether or not they are vaccinated. – Jason Terk, M.D.

Yes, children should absolutely continue to wear masks to schools! This will continue to help decrease the number of cases not only of COVID but of RSV and influenza. 

I also tell my patients that I got my initial vaccination series when I was 6 weeks postpartum. I was exclusively breastfeeding my infant son and was so happy to be able to pass some antibodies to him to offer him some protection. He unfortunately tested positive for COVID in August of this year. While it was an extremely terrifying time for our family, he luckily managed to escape with 3-days of nasal congestion and one day of fussiness. I tell my patients and their families that the only reason we were not in the hospital with severe respiratory distress was because of the antibodies he received from me, from my vaccine. My vaccine not only protected me but protected my son as well. I tell my families that I would have gotten the vaccine even while pregnant because I knew that it would not harm me or my baby and that it would protect both of us. - Laura Romano, D.O.

Anything else you’d like to add?

Being a pediatrician mom has been such roller coaster, especially this last year and half. It has made living life in a pandemic a bit more complicated than most may think and have experienced. Knowing the "worst case scenario" while parenting during a pandemic makes me want to keep my kids in a "bubble" which of course is impossible and has proved to be nothing less than nerve-racking. It however has allowed me to counsel families with the assurance that I would not recommend anything for their children that I would not do for my own. – Bianka Soria-Olmos, D.O.

Today’s announcement means the public can be very confident that this vaccine is safe, effective and meets the highest standards for manufacturing quality. Since becoming available for emergency use in individuals 16 years of age and older in Dec. 2020, more than 92 million people in the U.S. have received two doses of this vaccine. The Food and Drug Administration (FDA) spent the past several months reviewing updated data from clinical trials, which supported the emergency use authorization (EUA) late last year. This data showed the vaccine to be 91% effective in preventing COVID-19 disease. The most common reported side effects were pain, redness and swelling at the injection site, fatigue, headache, muscle or joint pain, chills, and fever. It also proved the vaccine is effective in preventing COVID-19 and potentially serious outcomes including hospitalization and death. With full FDA approval, the Pfizer-BioNTech vaccine will be marketed under the name Comirnaty (koe-mir’-na-tee).

What age is the vaccine fully approved for?

Comirnaty is fully approved for individuals 16 years of age and older. The vaccine also continues to be available under the EUA for kids 12 through 15 years of age, and for the administration of a third dose in certain immunocompromised individuals.

Why is the vaccine still under EUA for individuals under 16?

While the vaccine became available under EUA for 16 years and older in Dec. 2020, authorization was not expanded for 12-15 year olds until May 2021. Much like the emergency authorization process, the FDA will need more time to review data for this younger population before it can grant full approval.

Do you still recommend the vaccine for kids under 16?

Yes, Pfizer-BioNTech’s COVID-19 vaccine is recommended for children 12 years and older. Many people mistakenly believe that children cannot become ill from COVID-19 and this is simply not true. Unfortunately, children and teens can become very ill from the virus and need hospitalizations, even intensive and life-saving care. The Pfizer-BioNTech vaccine is safe for children and teens, and protects them from potentially developing severe illness and long-term issues.

What does this approval mean for children under 12?

At this time, no COVID-19 vaccine has been authorized for children under the age of 12. This means it’s vitally important for this population to wear a mask around non-family members, stay six feet apart from others and practice frequent handwashing. Families can also protect these children by ensuring those closest to the child (parents, older siblings, grandparents) are all vaccinated. This will help decrease the chances of the child becoming exposed to COVID-19.

Watch the video above to hear Nicholas Rister, M.D., pediatric infectious diseases specialist at Cook Children's, answer these questions and more. 

As parents, we want to make the best decisions for our baby. We’ve been asked a lot lately if it’s safe for pregnant women, or women planning on becoming pregnant, to get the COVID-19 vaccine. We met with Shanna Combs, M.D., a gynecologist, to answer some of our most frequent questions.

Dr. Combs oversees the Cook Children’s Pediatric and Adolescent Gynecology department. She is the Obstetrics and Gynecology Clerkship Director with the TCU and UNTHSC School of Medicine and has been an assistant professor for the Texas College of Osteopathic Medicine since completing her residency.

Q: What are the differences between the vaccines?

A: All three of them have been shown to be efficacious at preventing worse outcomes with the COVID-19 infection. Two of them are what we call the messenger RNA vaccines, which is a newer process for vaccination and requires a two-shot series. And then the other one is the Johnson & Johnson vaccine, which is a one-shot series to fight off the infection.

Q: What should I know about the Johnson & Johnson (J&J) vaccine?

A: With the Johnson & Johnson vaccine, one of the biggest things that has come out is a concern for higher risk of blood clots, and so there is a warning about that. That being said, there are many things in life that can also cause blood clots such as smoking, or even being pregnant or having a baby actually increases your risk for blood clots. So while there is that increased risk with the vaccine overall, it's still a very low risk.

Q: If I decide to get a COVID-19 vaccine, what should I expect?

A: It’s a shot, so I always say your arm is going to be sore the next day. I usually tell people to get it in the hand they write with, so they move it around and it's not quite as sore. What has been seen, especially with the two-shot vaccine series, Pfizer and Moderna, vaccines is that you do get a little bit of rundown feeling after the second vaccine. Some have it with the first shot, but more so with the second shot where you just kind of feel body aches, maybe a little feverish, just kind of run down. But that usually goes away within the first couple of days after receiving the vaccine.

Q: I have heard rumors about how the vaccines can affect my body. What is the truth?

A: It has no impact on your genetic makeup. Basically what is in your cells, the way you are, that doesn't change. All it's doing is teaching your body how to fight the infection. It's a normal, natural response. With the vaccine, when you feel that bad is your immune system learning the process. It just means that your immune system is working really hard to figure out how to fight off this virus, but we're not actually giving you COVID with the vaccine.

Q: Should I get a COVID-19 vaccine if I am trying to get pregnant?

A: There has been no evidence to show that it affects your fertility. I know there have been reports that it causes infertility. That has not been shown at all. There’s a continuous registry and nothing has been reported regarding infertility. And so we do recommend it, even if you are considering getting pregnant or planning on getting pregnant, as well as once you are pregnant. We highly recommend the vaccine.

Q: Should I get a COVID-19 vaccine during pregnancy?

A: When you are pregnant, if you get infected with COVID, unfortunately you are more likely to get sicker. So, you know, we're seeing patients who are healthy young, pregnant women in the ICU with COVID infection. So being intubated, not being able to breathe on their own, or if they are able to breathe on their own requiring a large amount of oxygen. Unfortunately with pregnancy, if you get COVID, you are at much higher risk of getting sick. The unfortunate thing is you're growing your baby. And so if you get sick, there's risks that you may have to deliver your baby early, causing a lot more problems than not getting vaccinated.

Q: Should I be worried about getting the shot during the first trimester?
A: Thus far, we have not seen any fetal abnormalities or developing abnormality in babies of moms who got the COVID vaccine. So even in the first trimester, we still recommend it. One of the things that we've known from prior vaccines that we recommend in pregnancies, such as the whooping cough vaccine or flu vaccine, is when you, as a woman, build your antibodies, the things that fight infection, after a vaccine when you're pregnant, you actually give those antibodies to your baby through the placenta. So when your baby is born, you're actually giving them a little bit of protection in those first couple months of life. You are actually doing something good for yourself by making yourself be able to fight off the virus, but you're also doing something for your baby.

Q: Is ther e enough research to know my child will not have any long-term effects?

A: As a physician (and) a woman’s health specialist and OB-GYN, I would not recommend something to my patients if I thought it was going to endanger them or their child. I say follow the science. This has been studied. This has been approved. It's gone through the normal FDA processes. The only difference with this vaccine right now is it's under emergency use authorization, which does not mean it's experimental, because there is a category for that. It's gone through all the usual processes, it’s just expedited some of the FDA processes to get it out. But it's been studied in many, many people and I highly, highly recommend it for women.

To learn more about the COVID-19 Vaccines While Pregnant or Breastfeeding, click here for information from the Centers for Disease Control and Prevention (CDC).

This means all employees, physicians, providers, credentialed staff, students, volunteers, contractors and on-site vendors will have to receive either one dose of the Johnson & Johnson vaccine or two doses of the Moderna or Pfizer vaccine by the deadline.

Why is Cook Children’s taking this step?

Because COVID-19 is spreading like wildfire among unvaccinated people in Tarrant County and surrounding areas. The highly contagious delta variant has taken hold and is driving up hospitalizations across age groups.

“We are seeing more children sick with COVID-19 than we have seen in months,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “We were very hopeful that the worst was behind us but that may not be true. The rate of COVID-19 cases being diagnosed at Cook Children’s is alarming. This is not a slow upward trend, it is a rapid and dramatic rise in cases not seen since November of 2020.”

As of Tuesday, 23 patients were being treated for COVID-19 at Cook Children’s, which is a figure not seen since the height of the pandemic in January. On top of that, nearly 100 new cases are being diagnosed in children each day. The rate of positive COVID-19 cases seen at Cook Children’s in a seven day period is now 11.2%. On June 2, that number was 1%.

“What’s happening at Cook Children’s is a reflection of what’s happening across the county and region,” said Dr. Whitworth. “With vaccination rates in the community below 50%, and the delta variant spreading rapidly, the stage is set for an outbreak similar to, if not worse than, last winter.”

Dr. Whitworth says it’s also important to recall that children under the age of 12 are not yet able to get vaccinated. While most children do not typically get as sick from COVID-19 as adults, that is not the case for all kids. It’s a myth that children don’t get severely ill from COVID-19. In fact, Cook Children’s treated hundreds of hospitalized patients with the virus over the past 17 months.

Kids are also at risk of developing multisystem inflammatory syndrome in children (MIS-C), which usually develops about four weeks after a COVID-19 infection (even if the child never had any symptoms). Initial symptoms of MIS-C include fever, rashes, red eyes, diarrhea and vomiting. The inflammation from MIS-C can affect the heart, blood vessels and other organs, making it essential for them to receive high level medical care.

For Rick W. Merrill, president and CEO of Cook Children’s, the decision to mandate the COVID-19 vaccine among the health care system’s workforce was made with children in mind.

“The delta variant is very contagious and many of our patients are vulnerable to COVID-19 because they can’t get vaccinated at this time,” said Merrill. “I personally received the vaccine in December, as did more than 95% of our physicians and two thirds of our employees. Given how close we are to critically-ill children, we know this is the right decision for our system and ultimately our patients.”

While Cook Children’s is doing its part to lower the spread of the virus through mandatory vaccination, now is the time for everyone in the community to do what they can as well. This means getting vaccinated, wearing a mask, social distancing and practicing good hand hygiene. Together, we can slow the spread of COVID-19.

COVID-19 Cases Across Cook Children's Health Care System - August 4, 2021

In an email to more than 8,000 Cook Children’s employees, President and CEO Rick W. Merrill attributed the decision to the increasing rates of COVID-19 in Tarrant County. Public health officials in the region say community spread of the virus is once again considered ‘high’ due to the surging delta variant.

“The delta variant is very contagious and many of our patients are vulnerable to COVID-19 because they can’t get vaccinated at this time,” said Merrill. “I personally received the vaccine in December, as did more than 95% of our physicians and two thirds of our employees. Given how close we are to critically-ill children, we know this is the right decision for our system and ultimately our patients.”

The number of COVID-19 cases among patients at Cook Children’s has increased dramatically over the past few weeks. There are currently 24 children being treated at Cook Children’s Medical Center for COVID-19. The rate of positive cases seen across the health care system over the past week is now 11.3%. On June 2, that rate was 1%.

With the mandate in place, Cook Children’s joins several hospital systems in Dallas-Fort Worth and dozens of health care institutions across the U.S. requiring COVID-19 vaccination for its workforce. Such mandates regarding the COVID-19 vaccine and health care workers are supported by organizations such as the Children’s Hospital Association, American Hospital Association, American Nursing Association, American Medical Association and Texas Nurses Association.

About Cook Children’s

Cook Children’s Health Care System embraces an inspiring Promise – to improve the health of every child in our region through the prevention and treatment of illness, disease and injury. Based in Fort Worth, Texas, we’re proud of our long and rich tradition of serving our community.

Our not-for-profit organization encompasses nine companies – a medical center, two surgery centers, a physician network, home health services and a health plan. It also includes Child Study Center at Cook Children's, Cook Children's Health Services Inc., and Cook Children's Health Foundation. With more than 60 primary, specialty and urgent care locations throughout Texas, families can access our top-ranked specialty programs and network of services to meet their unique needs.

We’ve worked to improve the health of children from across our primary service area of Denton, Hood, Johnson, Parker, Tarrant and Wise counties for more than 100 years. Based on the exceptional care we provide, patients travel to Cook Children’s from around the country and the globe to receive life-saving pediatric care built on leading technology, extraordinary collaboration and the art of caring.

For more information, visit cookchildrens.org.

It’s a good question and one that Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s understands.

“It can be confusing because there are viruses that you can catch that trigger long-term immunity,” she said. “However, COVID-19 is not one of them.”

She explains it this way – COVID-19 is in the coronavirus family. We all get a coronavirus each year and it usually feels like a cold. Even though we catch a coronavirus, our immunity is temporary so we may catch it again the next year, and the year after that. COVID-19 is the same. Even though you’ve had it once doesn’t mean you won’t catch it again.

“It’s very different from, say, the measles where you probably won’t catch the measles twice in your lifetime. Coronaviruses are different,” said Dr. Whitworth.

So what about the COVID-19 vaccine? We don’t know how long immunity lasts with it either, but Dr. Whitworth says it does appear to provide protection for a longer period of time than getting COVID-19. She points to this study released by the Centers for Disease Control and Prevention (CDC) that examined two outbreaks at a nursing home in Kentucky. The first outbreak in July sickened 20 residents and killed five. Three months later in October, another outbreak hit the same nursing home. There were 12 residents who tested positive the first time who were still living at the facility. Five tested positive again.

“Three of those five had no symptoms during the first outbreak. This means those three were made worse by the second infection,” said Dr. Whitworth. “So, we know our immunity wears off after getting the virus.”

Another CDC study released in June shows people who had COVID-19, but didn’t get very sick, likely didn’t build up a strong antibody response, likely making them more susceptible to catching it again.

“The good news about this study is that it shows if you had COVID-19 and you got the vaccine, your protective antibodies will be even higher than someone who only got the vaccine,” she said. “The bottom line is that a lot of people who get COVID disease, but aren’t very sick, do not develop very good antibodies.”

Still, she knows a lot of people are worried about the potential side effects of the COVID-19 vaccine. It is a new vaccine, but scientists have been following the data and risks for seven months now. At this point, more than 155 million people in the U.S. have been fully vaccinated. That’s a lot of people. However, no vaccine is 100% effective. According to the CDC, 4,115 vaccinated people have been hospitalized or died with COVID-19 as of June 21. Of those “breakthrough infections,” 750 were asymptomatic.

“About 20% of the deaths in this group were not related to COVID-19. They were car wrecks, heart attacks, other things that people died from,” said Dr. Whitworth. “All of this is to say, it’s incredible how safe and effective this vaccine is. There’s not another one on earth like it. It’s as good of a vaccine as there has ever been.”

Recent reports about myocarditis, or inflammation of the heart, in young people have raised new concerns about the COVID-19 vaccine. Since April, there have been more than 1,000 reports of myocarditis in people who received one of the two COVID-19 mRNA vaccines (Pfizer and Moderna).

The CDC reports:

• Confirmed cases have occurred:
  • Mostly in male adolescents and young adults age 16 years or older
  • More often after getting the second dose than after the first dose of one of these two mRNA COVID-19 vaccines
  • Typically within several days after COVID-19 vaccination
• Patients can usually return to their normal daily activities after their symptoms improve. They should speak with their doctor about return to exercise or sports.
• CDC continues to recommend COVID-19 vaccination for everyone 12 years of age and older, given the risk of COVID-19 illness and related, possibly severe complications.

While this can sound scary, especially for parents trying to make the right decision for their child, Dr. Whitworth shares this:

• The number of vaccinated people who have contracted myocarditis is about one in 10,000 to 50,000.
• The NCAA tracked rates of myocarditis among its athletes who contracted COVID-19 before the vaccine was available. Thirty-seven, or 2.3%, of 1,597 Big Ten college athletes were found to have myocarditis through regular EKGs and MRIs.
• The risk of myocarditis from contracting COVID-19 infection is much higher than from the vaccine.

She adds that, like other coronaviruses, COVID-19 isn’t going anywhere anytime soon. She fully expects to see it circulating for years to come, making it even more important to get vaccinated. And if you think it’s easy to be the bearer of bad news day after day, it’s not. She’s going on 17 months of advising us about preventing COVID-19.

“It’s a lot of pressure sharing these opinions all the time, but I’m not scared of telling people to get the vaccine. I saw so much heartbreak watching the adult hospitals in Fort Worth have to call in morgue trucks because they ran out of places to keep the bodies. And we’ve held a lot of scared families’ hands here whose children required ICU care,” she said. “I got the Pfizer vaccine the week after it received emergency use authorization. My adult children got vaccinated. My parents were vaccinated. I firmly believe that it’s safe and it’s our best protection.”

The Center for Children’s Health, led by Cook Children’s, developed the seven-video project along with three partner agencies: Tarrant County Public Health, the Early Learning Alliance and the University of North Texas Health Science Center (UNTHSC). The videos feature leaders from diverse professional, racial and religious backgrounds who talk about the science behind the COVID-19 vaccines. But they also speak from the heart in sharing their personal and relatable experiences.

The series showcases several doctors from Cook Children’s as well as Dr. Kenton Murthy, assistant medical director at Tarrant County Public Health. The physicians explain the vaccine’s development and its safe and effective track record. You’ll also see and hear from nonmedical people too, including clergy and promoters of day care and parenting education – and even the chief of the Fort Worth Fire Department. The videos come across with respect and empathy that acknowledges the complexities involved in deciding whether to receive the vaccine.

“We’re living in a very politically polarized time right now, and this is a very sensitive topic for a lot of people,” said Breanna Anderson, program manager for the Center for Children’s Health. “And so the fact that they were willing to speak out as leaders in their own community and speak about their own perspective, it was really brave on their part.”

Some of the panelists on video #4, for instance, discuss why they initially felt suspicious and opposed to the vaccine. Other panelists discuss how they jumped at the chance to get vaccinated against the virus that causes COVID-19. They talk about rumors on social media, objections from a religious standpoint, and lack of trust rooted in historical instances of racism in health care. The panel discussion was facilitated by Cook Children’s own Chief Diversity Officer Winifred King.

Anderson said the videos give viewers access to a candid dialogue among people representing various perspectives. The webinar aims to provide factual content in plain language to help viewers make an informed decision.

“We need to be prepared to educate our folks and get them answers to the questions they’re asking, and then provide encouragement and support,” said Fire Chief Jim Davis on video #4, who called the vaccine “the right thing to do. It provided me with a little bit more of a sense of security. I wasn’t somebody who could do my work from home.”

Or consider Misty Wilder, program director at the UNTHSC’s Healthy Start, who said she hesitated at first because she worried about possible side effects. Now fully vaccinated, she speaks out as an example to the pregnant women and new moms at Healthy Start. “For me, I’m leading the way for my team, because my team is those younger people who say, ‘I ain’t getting it,’” Wilder said on the video.

The Centers for Disease Control (CDC) reports that 65.7% of Americans have received at least one shot of the COVID-19 vaccine. The CDC recommends the vaccine for people ages 12 and up. Doses are free and available at retail pharmacies and other locations. In a pilot program at Cook Children’s, three pediatrician offices in the network now offer the vaccine to eligible patients. But the vaccination rate has slowed in recent months even as virus variants became more widespread. Click here to find a vaccine near you. 

Information about the vaccines can be confusing, and people need help sorting it out, which is where the idea for the webinar originated. Back in March, Dr. J’Vonnah Maryman, associate director for Family Health Services at Tarrant County Public Health, pitched the suggestion to the Center for Children’s Health as a collaboration. Dr. Maryman proposed a video that would target parenting educators and daycare operators, who could then explain the vaccine’s benefits to their clients.

“It was a train-the-trainer sort of concept, but we needed it to be at a level that was relatable and not too technical that people didn’t feel comfortable passing the information along,” she said. “A lot of information is still shared by word of mouth.”

The scope of the project grew when the collaborators realized they needed more than one video to address a range of vaccine issues. They saw the webinar series as filling an information gap and potentially reaching a wider audience, distributed through organizations and faith groups. So they drew up these goals:

• Provide reliable information and practical resources
• Answer questions and acknowledge the obstacles for some people, such as language barriers or lack of transportation to a vaccine site
• Include a diverse mix of presenters
• Make the videos short, accessible online, and easy to understand

Video #1, for instance, features Mary Suzanne Whitworth, M.D., medical director of pediatric infectious diseases at Cook Children’s. Dr. Whitworth explains some of the technical concepts – spike proteins, antibodies, clinical trials – using illustrations and conversational wording: “Just to compare it for you … Look at this top bar with me … The point of this slide is to let you know …”

Other videos in the webinar series cover topics such as how to find a vaccine site in Tarrant County and what to expect afterward. Video #5 addresses some of the popular myths, including claims that the vaccine causes infertility or gives you COVID-19 (no and no).

Dawn Hood-Patterson, Ph.D., program manager for the Center for Children’s Health, praised the presenters for not trivializing the myths. “They weren’t flippant about it. They didn’t brush it off as silly,” she said. “They spoke about it seriously not only from their expertise as a professional, but they spoke from their expertise as a human being.”

The webinar intentionally includes people of different races and walks of life in order to appeal to a wide audience. Why? Because representation matters, and viewers need to trust and connect to the presenters on the screen. When it came to religion, for instance, the videos included the perspectives of a Baptist pastor, a Catholic bioethics professor, a Muslim imam and a hospital chaplain.

“Do your research. Pray for our government. Seek wise counsel. Engage in conversation with those around you who have different opinions. Listen with integrity,” advised Pam Foster, director of pastoral care at Cook Children’s, on video #5.

Developers of the webinar series hope the information helps not only the undecided unvaccinated crowd, but also those who already are vaccinated when it comes to explaining the vaccine’s benefits. Advocates for the vaccine can learn to approach the subject with greater understanding.

The series “gives me a good tool when I speak to people in the community who are less interested, who are hesitant, who are resistant to the vaccine,” Dr. Hood-Patterson said. “It’s given me the capacity to think more critically about how do I address the issue of vaccination with the people I come into contact with.”

An overview video in Spanish is in the works, with a version in Vietnamese under consideration. Closed captioning is available.

Anderson said that the cooperation by the Center for Children’s Health and its three other partners in the webinar series shows the benefit of working together. Stronger relationships and better rapport can develop among the groups, for the good of everyone involved.

“It’s a huge thing to move toward not working in silos within our own areas,” she said. “We’re able to elevate all of our programs across the board to better serve our community.”

Dr. Terk routinely addresses questions and concerns about the vaccination, which the Centers for Disease Control and Prevention (CDC) recommends for everyone ages 12 and older. He wants parents to understand the vaccine is safe and effective against the virus that causes COVID-19. 

“It’s an exciting time to be able to provide protection against the pandemic virus for the younger population,” said Dr. Terk, who treats patients at Cook Children’s Pediatrics at Keller Parkway. “I’m encouraging my families to get that done as soon as possible.”

The U.S. Food and Drug Administration has authorized the Pfizer-BioNTech vaccination for children as young as 12 years old, who receive the same dosage as adults -- in two shots, three weeks apart. Potential side effects include pain at the site of the injection, tiredness and headache.

Cook Children’s has teamed up with Texas Health Community Clinics to provide the Pfizer vaccines at clinic locations throughout the North Texas region. Appointments may be made but aren’t necessary. There is no cost.

Dr. Terk, who is also the chair of the Texas Public Health Coalition, pointed out that some families in 2020 delayed their children’s scheduled checkups. The summer break from school provides a good opportunity to receive not only the COVID-19 vaccine but any overdue vaccinations, such as Tdap (tetanus, diphtheria, pertussis). The COVID-19 vaccination may be given along with other vaccines that adolescents need.

“We have a backlog of people who didn’t come to the doctor because of the initial concerns about safety at the beginning part of the COVID-19 pandemic, and so we’re still in the process of catching people up,” he said. “We want to try to leverage this time to get these things done.”

Some children who are infected with the coronavirus show symptoms at all. Others can experience fever, cough, nausea, sore throat and body aches. While children generally do not get as sick from COVID-19 as adults, in rare cases some kids become severely ill or even die. Recent news reports have also zeroed in on the Delta variant of COVID-19, which was first detected in India. According to the CDC, it now accounts for 6% of all infections in the United States. The Delta variant is highly transmissible and may be associated with more severe disease.

At Cook Children's, the seven-day rolling average of COVID-positive tests has fallen from 170 daily in January to fewer than 20 per day, or 1%. Dr. Terk called the trend good news across the United States but subject to new variants that seem to spread easier and cause more severe symptoms in younger people.

In a report released June 4, the CDC noted a rise of adolescents hospitalized primarily for COVID-19 in April – lower than the peak in January, but higher than in March. Risks in these severe cases include the need for intensive care admission and mechanical ventilation. “Highly effective COVID-19 vaccines are now available to adolescents as an additional evidence-based prevention measure,” according to the CDC.

Dr. Terk discusses the vaccine with all of his patients who are eligible for the immunization, and with the parents of every child who comes to his office. He urges teens and adults alike to get vaccinated soon. The responses vary.

“I just saw someone today who is a 12-year-old who affirmatively said on the very first day that the authorization came out ‘I want to get this done. I want to do my part.’ She was motivated,” he said. “Then you have other 12-year-olds and 13-year-olds who look at it as another shot to try to avoid just because it’s a shot.”

For those who respond with hesitancy or objection, Dr. Terk explains what he described as the appropriate development and testing of the vaccines. His message: Vaccine manufacturers proceeded rapidly but cautiously without cutting corners. Dr. Terk also shares the data on the vaccine’s track record of success against the spread of coronavirus and severe cases of COVID-19.

These conversations take place at the pediatrician’s office because Dr. Terk wants families to make informed decisions. A parent’s choice to receive the COVID-19 vaccination helps protect young children in the home, he tells them. Sometimes, he said, a reluctant or undecided candidate for the vaccine just needs a little nudge.

“Most people who have not gotten the vaccination and don’t intend to are not militantly anti-vaccine people. They simply have real concerns and questions,” Dr. Terk said.

More than 170 million Americans have received at least one dose of the COVID-19 vaccine, according to the CDC. In rare instances, the Vaccine Adverse Event Reporting System has received reports of myocarditis (inflammation of the heart muscle) particularly in adolescents and young adults. But to Dr. Terk and other promoters, the overall benefit from the vaccine far outweighs the risks, which he called “infinitesimal.”

Plans are underway to pilot a COVID-19 vaccine clinic at two Cook Children's pediatrician offices later this month. Dr. Terk encourages his teenage and 12-year-old patients to access the vaccine at pharmacies, clinics or wherever it’s most convenient.

“We are seeing wonderful rates of protection,” Dr. Terk said. “We now are millions of doses down the road and seeing a very, very good safety record.”

With immunizations likely to begin for children ages 12 to 15 very soon, parents may be wondering if they should get their child vaccinated. Mary Suzanne Whitworth, M.D., medical director of pediatric infectious diseases at Cook Children’s Medical Center, answers some questions parents are likely asking themselves.

Why should my child get the COVID-19 vaccine?

While children typically have milder symptoms from COVID-19 infection, they can become very ill and require hospitalization. In rare cases, life-saving measures such as ventilators and extracorporeal membrane oxygenation (ECMO), which oxygenates a patient’s blood outside of the body, have to be used on young COVID-19 patients. Children can also experience long-term symptoms of COVID-19, a diagnosis known as ‘long COVID,’ as well as a disease called Multisystem Inflammatory Syndrome in Children (MIS-C). Both of these syndromes can occur weeks after a COVID-19 infection in which the child may or may not have shown any symptoms.

Children and teens can also spread COVID-19 to more vulnerable populations, such as the elderly and immunocompromised. Getting this population vaccinated is a key step in reaching herd immunity and defeating COVID-19.

How do I know the Pfizer-BioNTech vaccine is safe for my child?

Like the vaccines approved for teens ages 16 and up, as well as adults, Pfizer-BioNTech conducted research trials to examine the effectiveness and side effects for kids ages 12 to 15. According to a company press release, the vaccine was 100% effective in preventing COVID-19 in this group and did not trigger any different side effects than the older age groups.

Pfizer-BioNTech turned this data over to the FDA for review. The FDA thoroughly examined the research, just like they did for the other age groups, and issued the emergency use authorization after deeming it safe and effective.

What side effects will my child experience after receiving the Pfizer-BioNTech vaccine?

Hopefully none, but there are some minor side effects reported with this vaccine. The most common symptom reported in the Pfizer-BioNTech trials for kids age 12 to 15 is a sore arm, similar to receiving a flu shot or other vaccines. More than half of participants also reported feeling tired and/or having a headache. Less common symptoms include chills, muscle and joint pain, fever, swelling and redness at the injection site, nausea and swollen lymph nodes.

What if my child is scheduled for routine shots such as Menactra, HPV, TDAP?

Because the COVID-19 vaccine is new and we don’t yet know how it will interact with other vaccines, children cannot receive other shots within 14 days before or after their two-dose COVID-19 vaccine. This means your child will have a seven-week window when they cannot receive other vaccines.

If your child is entering 7^th grade in the fall, you may want to schedule an appointment with your pediatrician to discuss when to get the vaccines they will need for the upcoming school year.

When will younger children be able to get the COVID-19 vaccine?

Pfizer expects to apply for emergency authorization for children between the ages of 2 and 11 in September. If approved by the FDA for emergency use, these children could get the vaccine by the end of the year.

Where can I go to get the Pfizer-BioNTech vaccine for my child?

Due to the strict requirements for storing the Pfizer-BioNTech vaccine, Cook Children’s is not offering the COVID-19 vaccine to patients at this time. We are partnering with Texas Health Resources to make sure our 12+ patients have a place to get the vaccine as soon as possible. Cook Children’s patient families can visit TexasHealth.org/CookChildrens for more information.

Pfizer-BioNTech recently released information regarding their COVID-19 vaccine being safe and effective for children 12 to 15. The vaccine is currently available for use in those 16 and older based on previous trials and is approved for emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA). Pfizer is expected to apply for an EUA for this younger age group in the next few weeks.

We know many parents have questions ranging from how safe the vaccine is for your child down to when it will be available. Mary Suzanne Whitworth, M.D., medical director of infectious diseases at Cook Children’s Medical Center, and Nicholas Rister, M.D., a pediatric infectious diseases specialist agree it’s safe to get children vaccinated once it’s approved.

With this COVID-19 vaccine being available for children 16-18 in Texas, do you recommend them getting the vaccine?

Yes. Older children are more at risk and they are very social and aren’t always the best at social distancing. They are better at spreading the virus than younger children.

Should younger children get the vaccine when it’s available?

Yes. We thoroughly encourage vaccination when all the data is available and the FDA issues emergency use.

Should children still be wearing masks?

Yes, the downside to wearing masks is minimal and the upside could be lifesaving.

Is there anything still mysterious about the virus?

We don’t fully know the long-term effects of having the COVID-19 virus. We will be monitoring it for decades to come. Getting vaccinated is the best way to go to prevent contracting the virus.

Is there a possibility families can travel with their children this summer?

We aren’t quite out of the pandemic and you have to think about the risks. Make sure it’s worth going through the precautions and see if the risks are worth it for your family.

Are children good to go back to school in person once they’re vaccinated? Children have been going back to school in person, some of them for six or seven months. It's been shown that there's very little transmission in the schools when good precautions like wearing a mask and social distancing are followed. The CDC now says distancing only needs to be three feet in schools as long as everybody's wearing a mask. Children can go back to school safely, even if they're not vaccinated, but this has to be a decision families work out amongst themselves and their doctors. It depends on if your child has underlying medical problems, if your child lives with someone with underlying medical problems, or if your child is going to a school where they aren't doing social distancing and they're not masking. It’s an individualized decision, but once they're vaccinated, then it will be significantly safer at school.

When will children begin to be vaccinated?

According to the studies, teenagers should begin to be vaccinated in late summer. However, that is subject to change.

How do we know the vaccine is safe for children?Once the trials are done, the data will be reviewed by the FDA and then they will issue an emergency use authorization, just like they did for adults. The FDA will look at all the data to decide if it's safe. They won't approve the vaccine if it isn't.

Will higher-risk children be among the first to receive their vaccine?

That information is not yet available.

What is the age range for children once the vaccine is available?

Pfizer is currently approved for those 16 and older. The next group to get vaccinated will be 12 and older. They are currently doing ongoing studies on children as young as six months to 11 years of age. As that information gets evaluated by the FDA, they could approve it over time, all the way down to six months of age. This will all be done in phases. Twelve to 15-year-olds could be vaccinated in the fall. A couple of months after that, maybe 6 to 11-year-olds, and they'll keep adding and going down to younger ages.

What do I do if my child is scheduled for routine shots such as Menactra, HPV, TDAP, etc.?If your child has gotten their vaccines routinely, you would wait at least 14 days to do the COVID-19 shot. If they’ve got their COVID-19 shot, you would wait at least 14 days to do any other vaccines.

What do we know about the Pfizer study?

The study is shown to be as effective in teenagers as it is in adults.

How long should the Pfizer trial take for children 6 months to 11 years old children?

Those results will not be finished, evaluated, and presented to the FDA for several months. We are looking at late 2021 early 2022, and that is also subject to change.

Will Cook Children’s be providing vaccines once they’re approved and available?

Cook Children’s does plan to provide the vaccine to pediatric patients once it is approved and becomes available. More details will be available soon.

Will children still have to wear a mask after they’ve been fully vaccinated?

Yes, for the time being, but that could change with time. It's much less likely that children can give anybody COVID-19, and it's much less likely that children can catch COVID-19 infection once they’ve been fully vaccinated. The decision about when to stop wearing masks will be recommended by the CDC and we will follow their recommendation.

Will I get to choose which vaccine my child receives?

It is important to get your child vaccinated. The vaccinations that are available work well. It is not recommended to wait for any period to get a certain brand of vaccine if a different one is readily available for your child.

Are there any medical issues that would prevent my child from getting the COVID-19 vaccine?

The only thing that would keep your child from getting the COVID-19 vaccine would be is if they’re allergic to the vaccine components or if you have an allergic reaction to the first COVID-19 vaccine.

Is there anything else I should be aware of before vaccinating my child?

On April 6, Cook Children’s shared that suicide is now the leading cause of trauma death at the medical center. In March, a record 43 patients were admitted to Cook Children’s after attempting suicide. Getting our children vaccinated is important, as vaccinations are the only way we can put an end to this pandemic and have more sense of normalcy for children.

A recent Seton Hall Sports Poll shows 25% of Americans say they will hold or attend a party for the big game. According to Mary Suzanne Whitworth, M.D., medical director of infectious diseases at Cook Children's, it is important to avoid large gatherings, even if you’re vaccinated.

“The COVID-19 vaccine is not a green light to get together with people,” Dr. Whitworth said. “If you’ve had the immunization, you can still get an asymptomatic infection and transmit it to others.”

Cook Children’s Medical Center is finally seeing lower numbers of COVID-19 patients after record hospitalizations and positive test numbers in December and January. The percentage of COVID-19 tests administered by Cook Children’s that are coming back positive is under 10%, which is a great improvement.

Dr. Whitworth says more good news is on the horizon. Vaccine rates are going up, and community spread of the disease is declining.

“The more people do their part, the sooner everyone can have large gatherings and celebrate with loved ones,” she said.

COVID-19 can spread from people who are symptomatic or asymptomatic by secretions coming from the nose and mouth. As you exhale, talk, yell, etc., those secretions fall within six feet of you. This is why it’s so important to stay six feet apart from others, wash your hands and wear a mask. When people are yelling at the TV or taking a break to eat or drink, there is always a possibility of spreading COVID-19. Dr. Whitworth reminds everyone, “Cloth, paper or N95 masks keep secretions in so you don't share germs with others around you.”

Although we can’t celebrate like years past, there are alternatives for large indoor gatherings, such as hosting a virtual party or starting a group text thread. These options allow us to enjoy the action with other fans while keeping distance and remaining safe.

As more COVID-19 vaccinations become available, health officials urge everyone to take the same precautions whether fully vaccinated or not. Dr. Whitworth says if everyone gathering is vaccinated, it’s safer, however, the vaccine is only about 95% effective. There’s still a chance someone could get sick.

While some may argue having a gathering in their home is safer than going out in public, Dr. Whitworth says any gathering comes with risks.

“A public place could have an influx of people with no masks and closed doors, and that is a high-risk environment,” she said.

The best way to protect yourself is to celebrate with those you live with.

It is also important to understand COVID-19 testing does not predict the future. If everyone gets tested before a gathering, the risk is lower because you can exclude those who test positive. However, you can test negative one day and transmit the virus the next day. While taking a COVID-19 test could lower the risk, it’s not the best indicator for a gathering.

Dr. Whitworth urges everyone to remain hopeful and to remember that we are getting closer to celebrations like Super Bowl parties, holidays, and birthday celebrations.

“As I've heard one of our scientists say, ‘The months ahead look a lot better than the weeks ahead and vaccine rates are going up everywhere,’” Dr. Whitworth said.

For more information on safer ways to enjoy the Super Bowl, visit the CDC’s website.

What is mRNA, and how does it differ from other vaccines we are familiar with?

Messenger RNA is a new type of vaccine technology. It has been studied for a couple of decades and has been researched for things like cancer vaccines. Messenger RNA is a molecule that we all make billions of copies of in our bodies every day.

The way this vaccine works is that messenger RNA is in the syringe and is injected into your arm. That messenger RNA is taken up by muscle cells and other white blood cells in the area. The messenger RNA tells your body to make the spike protein from the virus. When your body makes the spike protein, that's recognized as foreign, it doesn't belong there. Your immune system learns what the spike protein from coronavirus is, makes a response and develops antibodies, while other parts of your immune system learn about the spike protein. The coronavirus has the spike protein, and if you're exposed to it later, your body says, “Oh, this is that spike protein, I know what to do about this,” and binds it and prevents infection.

How was the COVID-19 vaccine made so quickly and how does that timeline compare to the development of other vaccines? 

The speed of this vaccine is one of the real miracles of modern science. The difference between this vaccine’s development and other vaccines like Prevnar, Menactra or the hepatitis A vaccine is that the steps for those were done one at a time over about six years. For the COVID-19 vaccine, all the steps were all done simultaneously.

If you're developing a Prevnar or a hepatitis B vaccine, you:

• Figure out what kind of vaccine you want to make, a live virus vaccine or a bacterial protein.
• Develop the vaccine.
• Conduct a Phase I trial to look at the dose.
• Conduct a Phase II trial where you look at about 500 or a thousand people, and you give them the vaccine to see if it's safe. 
• Conduct a Phase III trial of 10,000 or 20,000 people to see if it works.
• Get FDA approval.
• Make the vaccine. That may take a year.
• Distribute the vaccine. That may take another six to 12 months.

For Operation Warp Speed, a couple of things worked in our favor. Messenger RNA technology was available and the machines and scientists were already in the labs. Normally, a Phase II trial would take a year or two to get a hundred or more volunteers to enroll. It could take three years to get another 10,000 or 15,000 volunteers. With there being an active pandemic going on, there were more than 30,000 volunteers overnight.

To see if the vaccine works, there has to be enough disease in the community to cause enough infection to see if the vaccine is better than the placebo, or if they're equal. Normally, that may take a couple of years. In this case, the pandemic was so bad that we could see right away that placebo recipients had a lot of COVID-19 and the vaccine recipients didn't. That endpoint was reached quickly and very safely.

Also through Operation Warp Speed, the vaccine was being tested at the same time it was being manufactured and while plans were being made for distribution. Operation Warp Speed also paid for vaccines to be developed by companies, even if they were determined to be ineffective or didn't work. You'd never get a vaccine company to make a hundred million doses of a vaccine and take that financial risk, but Operation Warp Speed paid for that. The fact that there was plenty of disease and that everything was done at the same time allowed for very safe development of the vaccine in about 10 months. I've gotten both of my doses now. I think it's a very safe vaccine.

Is it normal for a vaccine to be released while still in a clinical trial?

I'm not sure that a vaccine has ever been released for EUA (Emergency Use Authorization) before. The reason that is done is that when there's been a pandemic declared, the FDA is allowed to use a vaccine or monoclonal antibodies or an antiviral medication if it's believed that the benefit outweighs the risk and it's deemed to be safe from everything that's known about it. The Phase III trials are still ongoing, which means that for the 40,000 people in the trial for Pfizer that were vaccinated, they are still being watched and are still collecting data.

Would we know by this stage in the trial, if there were major side effects with the COVID-19 vaccine?

You cannot be 100% sure. They watched about 20,000 people who got the vaccine for two full months and looked at every adverse event that happened to those people. When you look at the side effects of all kinds of vaccines throughout history, all of the serious side effects happen within about six to eight weeks. It's very rare to have a side effect from a vaccine after that time if it happens at all. We know that influenza vaccine can cause Guillain-Barre syndrome, which is a temporary paralysis requiring hospitalization. It’s a terrible side effect that happens in about one out of a million doses of influenza vaccine. That happens within six weeks. We know that with the measles, mumps, rubella (MMR) vaccine, you can get low platelets that happens at about three weeks. We know that with any vaccine or medicine, you can have anaphylaxis, which is a severe life-threatening allergic reaction that happens within two hours. For the vaccines that are known throughout history, there's no significant major side effect that's long-term. The only one I can think of is measles vaccine. There can be chronic measles infection that can lead to problems even a decade later, but that's a live virus vaccine. The COVID-19 vaccine has no virus in the vaccine, that would not even be a consideration for this. 

Have there been studies specifically on the safety of the COVID-19 vaccine in children?

There have been some children, 12 years of age and older, in the vaccine trials, but it's not enough that it has been licensed for children yet. There are some trials currently enrolling pediatric patients with Pfizer and Moderna.

Do you know when the COVID-19 studies regarding children will be complete? 

I don't know for sure. I think everyone is hopeful that we'll have some results by the spring, in the next three or four months.

When will the COVID-19 vaccine be available for children? 

There will have to be trials that document safety in children, and document that it works. Then it will go through the FDA, just like it went through for the adult COVID-19 dosing in December 2020. Then the FDA will give a ‘yes’ or ‘no.’ The Advisory Committee for Immunization Practices (ACIP) will then give a recommendation for a time frame and which children should receive the vaccine. I hope it will be here before the summer, but I don't know.

What benefit is there in vaccinating a healthy child if the statistics show that 99% of children recover from COVID-19?

You could say that for chicken pox, and for a lot of things that kids get vaccinated for. I think when you look at a pandemic, and you look at the transmission of the virus, you have to stop transmission of the virus. Even though children are not great transmitters, they still do spread the virus. You would want to add them in safely if the vaccine is safe for children. You would want to immunize children to remove another place for the virus to land. You want as much of your population as possible to be immune to the virus, to slow down community numbers, and stop the pandemic spread. 

What should parents who have children with underlying health conditions know about the COVID-19 vaccine?

Parents should talk to their child’s pediatrician. They need to see if the underlying condition puts the child at increased risk for problems with the COVID-19 disease and make that decision with their doctors. There is not a tremendous amount of data in immunocompromised hosts or other conditions, but there's some data and they'll need to talk to their doctors about their child's specific situation. Keeping in mind that if their child catches COVID-19, that may be riskier than the vaccine, there's always a choice. If you decide that you don't want to get the vaccine, you are saying ‘yes’ to the ongoing risk of infection. Depending on your child’s condition, that may be a reasonable choice.

Are there any medical conditions that would prevent a child from getting the COVID-19 vaccine?

You don’t want to get the vaccine if you are allergic to the vaccine components. There's not a known, proven medical condition where the diagnosis would prevent getting the vaccine. You don't want to get the vaccine if you've had anaphylaxis to the ingredients in the vaccine. If you've had anaphylaxis to the first dose of the vaccine, you wouldn't get the second one. 

Do we know what ingredients in the COVID-19 vaccine causes allergic reactions?

It is thought that part of the allergic reaction may be the polyethylene glycol or the PEG that's in the vaccine. Some individuals are allergic to polysorbates, and that can cross-react with polyethylene glycol. People that are allergic to either of those two compounds would be a contraindication for them to get the vaccine.

It's a very small vaccine. It contains the messenger RNA and a fatty or a lipid capsule around that little piece of RNA. There is a list of what's in that capsule on the Pfizer, CDC and FDA websites. There are no adjuvants nor preservatives in the COVID-19 vaccines that are currently available.

One of the complications of COVID-19 in children is MIS-C. What is MIS-C? 

MIS-C stands for multisystem inflammatory syndrome due to COVID-19 disease. If you catch the SARS-CoV-2 virus, you can get an asymptomatic infection or a symptomatic infection with a cough, fever, and shortness of breath. There are some children who, about the third or fourth week after they start their infection, will develop an inflammatory syndrome. The first part of their initial infection may not have any symptoms at all, and they can still get this inflammatory syndrome. Children with MIS-C have high fevers and appear very ill. They have very abnormal blood values for inflammation, and they have evidence that multiple organ systems are involved. They may have inflammation of the heart, which we can pick up with lab tests. They may have inflammation of the kidneys or the liver. They often will have a rash on their skin, pink eye and/or red swollen lips. When these children are admitted to the hospital, they frequently require intensive care before they get better. 

How should MIS-C be considered when weighing the risk and benefit of the COVID-19 vaccine in children? 

MIS-C is a high morbidity rate, meaning children are terribly ill, often in the intensive care unit (ICU), and occasionally on life support. You don't want your child to get MIS-C, it's serious. For reasons that are not clear to me, the mortality rate is very, very low, which we're grateful for. There aren't very many diseases like that. These children are ill, and the huge majority of them live through that, but not always unscathed. Some will have ongoing damage to the coronary arteries or the heart. When the data comes out about children, the hope is that it will show that those who are vaccinated are not only are protected from COVID-19, but protected from getting MIS-C. That data should be forthcoming. 

What are the side effects and adverse reactions of the COVID-19 vaccine?

There are a group of side effects that are part of the reactogenicity or part of your system saying, “Hey, I need to do something with this new spike protein floating around my body.” These side effects occur within the first 48 to 72 hours after the vaccine and are typically headache, muscle aches, fever, chills, joint pains, and sometimes redness and swelling where they get their vaccine. This occurs in about 20% or 30% of people after the first dose, and it might even be 40% of the people after the second dose.

The other side effects from the vaccine include anaphylaxis where you have a life-threatening allergic reaction within two hours of the vaccine dose, and it often happens within 15 to 30 minutes. You're more at risk for that if you've had anaphylaxis to something else in the past. It's thought that anaphylaxis happens in about one out of 90,000 doses of the vaccine. I have read and have not seen any deaths from that. Everyone has recovered and gone home from the hospital, and they can't get their second dose. That's probably the most serious side effect. Then there are some things that we're not sure about whether or not they're from the vaccine.

If you watch 20,000 people for two months, you can expect some of them will have a heart attack. Some of them will have a stroke. Some of them will be killed in a car wreck. All of those things happen. When you watch a large group of people for two months, it's not always easy to tell if the vaccine triggered the problem that happens. We know that in the Pfizer trial, there were four cases of Bell's palsy, which is paralysis of one side of the face that almost always completely resolves, but not every time. There were no cases of Bell's palsy out of 17,000 people that got the placebo. But four cases out of 17,000 is not above the baseline rate that you'd expect. Nobody knows what to make out of that information. There were about 12 cases of appendicitis after the vaccine and eight cases after the placebo, a tiny difference, but not different than the background rate. There are some side effects that you'll read about that are hard to determine if they're related to the virus, but for sure the anaphylaxis is in some cases. For sure, the reactogenicity side effects can be seen from the vaccine. 

If a child has a history of allergic reactions, should they avoid the COVID-19 vaccine? 

If they have an allergic reaction to something not related to the vaccine, a food allergy, a penicillin allergy, a bee sting allergy, they can still get the vaccine once it's approved for children, but their 15 minute observation period will be 30 minutes instead. Any child who’s had an anaphylaxis type of reaction to anything, needs to talk to their doctor first before they sign up for the vaccine and go over that with them.

What research is going on to track long-term side effects of the COVID-19 vaccine? 

For the people that are in the Phase III trials, it's my understanding that those companies will follow those recipients for two years, and they've already been following them for six or seven months. One of the things that you have to keep in mind about long-term follow-up for these vaccines is that in the current pandemic, you can't justify waiting another year to release these vaccines. With 3,000 or 4,000 deaths a day in the country, it only makes sense for something that's been proven to be safe to be released because the benefit of the vaccine at this point outweighs the risk of getting COVID-19. 

Does the COVID-19 vaccine change your DNA?

No. The vaccine injects messenger RNA into your muscle cell, or your white blood cells nearby. It never enters the nucleus where the DNA is. It doesn't integrate itself into your DNA. The messenger RNA particle is very fragile and it's not even around for very long, it disintegrates and goes away very quickly. This is why the vaccine has to have a deep freeze, and if you thaw it out for too long, it doesn't work. If you open the freezer for too long, and it gets at the wrong temperature for too long, it's inactive. It's a pretty fragile particle, and there's no evidence that it integrates into your DNA. 

Does the COVID-19 vaccine cause infertility? 

No. There were pregnancies during the vaccine trials, and there's no reason to think that it would cause infertility. If you think about it, if you make antibodies to the spike protein from the vaccine, that's exactly what you're going to do if you catch the COVID-19 infection. Either way, you get antibodies to the spike protein. If the COVID-19 infection doesn't make you sterile, the vaccine wouldn't either. 

Is the COVID-19 vaccine safe for pregnant women? 

I recommend that pregnant women speak with their physicians and make their own decision about the vaccine. If pregnant women want the vaccine, they can get it. The American College of Obstetricians and Gynecologists has said there's not any reason not to vaccinate pregnant women. What is recommended is that pregnant women talk to their physicians and make their own decision. Pregnant women have to keep in mind that if they catch COVID-19 during the pregnancy, they fare worse than if they're not pregnant.

Are there any other common myths about the COVID-19 vaccine?

There's no government implanted chip. I've heard the rumor that you get implanted with a chip when you get vaccinated and that the government is going to track you. All I can say is if you have a smartphone, there's probably already someone tracking you.

“Everybody had to have a tan in those days,” Pit, now 95, recalls. “We had been swimming, and I went out on a rooftop. I laid there for two hours and didn’t even burn.”

After hours in the sun, Pit developed a terrible headache. She remembers returning to her home, a two-story estate in the grand Ryan Place neighborhood, and telling her mother about the pain.

“The polio headache is one of the worst headaches. You can’t talk. It’s like a hammer,” she explained in a recent interview. “My mother called the doctor and said ‘something’s wrong, Pit’s very ill.’”

At that time, Fort Worth was in the middle of a polio outbreak, though Pit does not remember people being afraid or even aware of what was going on. Her doctor, however, knew about the growing number of local cases and insisted she be taken to the hospital.

She was admitted to Texas Health Harris Methodist Hospital (formerly Harris Hospital) in downtown Fort Worth. A spinal tap confirmed her diagnosis and she was placed in an isolated area of the hospital reserved for children with polio.

“It was a great, big room with about 35 beds. There were old-fashioned washing machines everywhere,” she said. “The nurses put the pads in the machines in hot, hot water and rang them out. That’s how they got the hot pads to put on our bodies to stop the spasms. My father donated about 100 of these machines to the hospital.”

Much like COVID-19 today, polio was somewhat of a mystery to medical professionals. There was no medicine to treat its symptoms, nor a vaccine to prevent its spread. The only thing doctors and nurses knew to do was to apply heat.

“It was a lot like today, nobody knew a thing about it,” she said.

According to the Centers for Disease Control and Prevention (CDC), polio disabled more than 35,000 people a year in the 1940s. It mostly affected infants and children, and many who caught polio had no symptoms at all. But for those who did, muscle pain and paralysis were common. Some children needed help breathing from an “iron lung,” a negative pressure ventilator.

Pit remembers being the oldest patient in the polio wing and says she became somewhat of a mother figure to the younger children. After many weeks, Pit’s parents decided to bring her home to receive round-the-clock care. One of her caretakers was her great aunt, a nurse who had traveled to Boston to train to take care of children with polio.

Thankfully, Pit recovered from the virus and had no long-term effects. She says the COVID-19 pandemic reminds her of that period in many ways, but stresses that people back then were unified in fighting the disease.

“When the vaccine came out in 1955, people were excited, overjoyed,” she explained. “We could go swimming again. We could have parties again. We didn’t have to be isolated anymore.”

She worries that today’s media environment has played a role in our current division. In the early 1940’s, there was no television, much less internet, and social media. Newspapers and radio were the only way people received their news. Pit thinks that helped her generation trust doctors and science.

“Medical science today, thank goodness, is 10 times better than what we had,” she said, noting that she also had scarlet fever and diphtheria as a child. “People have got to realize that our doctors and nurses are trying.”

Thanks to the polio vaccine, zero cases have originated in the U.S. since 1979. Pit hopes the COVID-19 vaccine will do the same for the current pandemic.

“In life, there are phases, and I believe this is just a phase we are going through,” said Pit. “If you’re able to get the vaccine, you should. I’m 95 years of age, but I can’t wait to have it.”

She credits her excitement for the vaccine to her experience of living for nearly a century.

“Sometimes younger people don’t realize what people my age have lived through. We had wars and illnesses. This is just one more thing we have to work together to get through. And remember, we’re all in this together.”

Staff members share how it feels to be completely vaccinated. 

We know that you have many questions about the COVID-19 vaccine and when it will be available for children. Information is changing rapidly, but we want to do our best to answer your questions with what we know so far.

About the Vaccine

In December 2020, the Food and Drug Administration (FDA) authorized the emergency use of two COVID -19 vaccines developed by the drug companies Moderna and Pfizer-BioNTech. This means that the vaccines can be offered to individuals in the midst of the current public health emergency even though drug trials are ongoing.

When can my child get the COVID-19 vaccine from Pfizer or Moderna?

The FDA has authorized the Pfizer vaccine for individuals 16 years of age and older and the Moderna is for individuals 18 years of age or older.

The first supply of the vaccine is being offered to health care workers and the elderly living in long-term care homes.

The second wave (Phase 1B) is currently underway for people 65 years of age and people who are 16 and older with these health conditions.

At this time, Cook Children's is not vaccinating the general public or our patients and their families for COVID-19. Our focus is on our health care workers and others within our organization. We will update our website and share any relevant information with patients and families via our physician offices and social media in the near future.

To get vaccinated by Tarrant County Public Health for COVID-19, click here. To learn more about COVID-19, visit the TCPH website here.

So far, the vaccine has not been tested on anyone younger than 12. Kids aren’t just little adults, so more testing is needed before it can be approved for use in children. It could be several months before the vaccine is available for the general public, and it could be longer before it’s offered to anyone younger than 16.

We will continue to follow  CDC’s strict criteria about who should receive the COVID-19 vaccine and when that should happen.

Will my child need a COVID-19 vaccine every year like the flu shot?

We don’t yet know if the COVID-19 vaccine will be once and done or if it will be needed every year. More studies are needed to understand whether or not the protection it provides is long term.

Is the COVID-19 vaccine similar to other vaccines?

The result produced from both traditional vaccines and the new COVID-19 vaccine is the same—an immune system response that produces antibodies. Those antibodies protect an individual from illness if they come in contact with the virus. But, the way in which other vaccines versus the COVID-19 vaccine produce that response is different.

Traditional vaccines are made using a weakened or dead virus that triggers the immune system to make antibodies against the virus. The COVID-19 vaccine uses genetic material called messenger RNA (mRNA) to instruct the body’s immune cells to produce a protein also found in COVID-19 so that the body can recognize the virus and produce antibodies against it.

More information about how an mRNA vaccine works is here.

Is it true that the vaccine requires two shots?

Yes. The Pfizer vaccine requires two shots spaced three weeks apart, and the Moderna vaccine requires two shots spaced four weeks apart.

Is the vaccine safe?

Studies of the vaccine’s safety are still underway, even for those being distributed under the FDA’s emergency use authorization. Even though these vaccines were produced faster than ever before, the FDA says safety measures have not been compromised and the benefits provided by the vaccine outweigh any risks associated with it.

Most people who reported an adverse reaction to the vaccine said they experienced the same reactions commonly reported with other immunizations such as:

• injection site reactions
• fatigue
• headache
• muscle pain
• joint pain
• fever for a few hours to a few days following a shot

Some vaccine recipients experienced swollen lymph nodes briefly after being immunized, which is believed to be a result of the vaccine activating an immune system response.

Of 38,000 Pfizer trial participants, four cases of Bell’s palsy, a condition that causes weakness in facial muscles, have been reported so far. All four cases occurred in vaccine recipients and none in placebo recipients (people who are participating in the trial but did not receive the vaccine in their shots). This is a normal rate of occurrence of Bell’s palsy in general—with or without a vaccine—but scientists will continue to observe any incidences of this condition as the vaccine is distributed more widely. The same is true for eight cases of appendicitis in trial participants who received the vaccine and four in those who received a placebo. Study investigators do not believe the appendicitis was related to the vaccine.

Is the vaccine effective in preventing COVID-19 disease?

Current data shows that Pfizer’s vaccine is 95% effective in protecting against COVID-19, while Moderna reports a 94.5% rate of effectiveness.

My child has underlying health conditions. Will the vaccine be safe for them?

More studies are needed to determine the safety of the vaccine in children, particularly those with underlying health conditions. Currently, there are no known risks for those with compromised immune systems because the vaccine does not contain a live virus. If your child has a history of allergic reaction, you should consult their pediatrician before vaccinating.

If my child has already had COVID-19, do they need to be vaccinated?

We don’t know how long one is immune to COVID-19 after getting and recovering from the virus. We also don’t know if the virus itself or the vaccination does a better job in producing immunity. So, for now, adults who have had the virus can be vaccinated after they have recovered. Hopefully, there will be data answering this question for children in the months ahead.

Where can I go for the most up-to-date information about the vaccine and when it will be available for children?

Cook Children’s is closely monitoring the status of the vaccine’s availability for children. For the most current information about COVID-19, its impact on children and answers to frequently asked questions about the vaccine, go to checkupnewsroom.com.

You can also contact your local health department for more information: 

Tarrant County Public Health

Collin County Health Care Services 

Denton County Public Health

When I heard that the COVID-19 vaccine had received authorization for emergency use, I was happy, full of hope and anticipation. Last week, I began seeing many colleagues in other cities posting their comments while receiving the first dose. Then I anxiously waited to know when I should have the opportunity to receive my vaccination. I was able to receive the first dose of the vaccine on Friday. 

I felt so excited about it that I was hardly able to sleep the night before. Interesting enough that it occurred near the holiday season, because I would liken it to how I felt as a kid the night before Christmas.

The excitement came from the feeling of finally taking a step toward reducing the rising COVID-19 cases in our community and also for hope to begin to move toward the end of this pandemic. 

As a pediatrician, my work every day includes providing life saving vaccines to infants and children. So I was honored to be able to receive the COVID-19 vaccine. While I know there is skepticism surrounding the fast development of this vaccine, I hope that the community can see the excitement that the medical community has had for the release of this vaccine. I hope the example being set by doctors, nurses, and many other healthcare workers around the world will convince the public that we would not recommend a therapy which we aren't willing to take ourselves. 

We hope our community will keep an open mind and be accepting the COVID-19 vaccine.

I especially hope that the Hispanic community takes the vaccine in an effort to begin to somehow minimize the impact that COVID-19 has had on our community.

And what now? 

We must continue to practice social distancing, mask wearing, and good hand hygiene. We must not let our guard down. Until a large number of the population receives the vaccine then we cannot achieve herd immunity which will hopefully be the beginning of the end to the ongoing COVID-19 pandemic. 

“I thought participating was important,” Thornhill said. “Number one, we need a vaccine to be able to save people’s lives. I’m in health care, so I just felt like it was the right thing to do. I also have friends who have lost family members and people that I know personally that have had COVID, and they were scared because they had underlying health conditions and some of them had children that were scared.”

In August, Thornhill joined Moderna’s mRNA-1273 vaccine trial after volunteering through the COVID-19 Prevention Network (CoVPN). The trial, called the COVE study, is a cooperation between Moderna and the National Institutes of Health (NIH). Thornhill received the first of two shots on Sept. 18 following a multi-hour screening and medical workup. At that time she did not know if she received a placebo or the actual immunization. As part of the trial, Thornhill tracks her temperature, reactions, health changes and any symptoms she experiences in an online diary application.

“The night of my first shot I started my first entry into the online diary app,” Thornhill said. “That week I had about a day and a half of tenderness at the injection site. It was warm to the touch and tender, very much like my flu shot in some years.”

A member of the research team following Thornhill periodically calls her to check in on her post-shot status. It wasn’t until her second shot on Oct. 16 that Thornhill experienced symptoms that led her to believe she received the immunization, not a placebo.

“That night, about three hours after getting the second shot, I was having dinner with my husband and, all of a sudden, I just didn’t feel well,” she said. “It wasn’t overwhelming but my husband looked at me and knew something wasn’t right.”

Thornhill was experiencing pain in her arm, body aches, joint pain and a low-grade fever. The symptoms persisted the next day, a Saturday, so she took the weekend to rest. By Sunday, her symptoms were gone and she was back to feeling like herself.

“I think my symptoms were very similar to what we see when we give kids immunizations,” she explained. “They’re fussy and don’t feel well but usually within a day or two that resolves, and it did for me. I’m pretty sure I received the actual vaccine, because I don’t think a placebo would do that.”

Thornhill advises those who get the vaccine to consider getting the second shot just before a weekend or when they have a few days off to recover in case their reaction is similar to hers.

Novel Vaccine For A Novel Virus

One of the unknowns about the new vaccine is whether or not it provides long-term protection against the virus. It remains to be seen if a COVID-19 vaccine will be once and done or become an annual immunization, much like the flu shot. In March, Thornhill will return to the research center for tests to determine if her immune system created COVID-19 antibodies following her shots, and she’ll be followed for the next two years to see how long any produced antibodies persist. At some point in the study, she’ll know for sure if she was given the placebo or the immunization.

Some people question the safety of a novel immunization for a novel virus. Thornhill said she trusts the Food and Drug Administration (FDA) and their approval of the vaccine.

“I think it’s such an individual decision and you have to think about your own circumstances,” she said. “I trust the FDA is going to do the right thing. I believe in vaccinations. I understand herd immunity and the science behind it and why we do it.”

Unlike typical vaccines, the NIH-Moderna immunization is made of messenger ribonucleic acid (mRNA)—not a weakened or inactive virus-—so there is no risk of being infected with the coronavirus from the shots. To make the vaccine, scientists isolated a protein within COVID-19 and encoded it into the mRNA instruction molecule. Once injected into an individual, this genetic code instructs immune cells to make copies of the same protein so that they can recognize the virus should a person come in contact with it and produce antibodies to fight it. As of late October, more than 25,500 COVE Phase 3 study participants have received their second vaccination, according to Moderna’s website. The NIH reports that results for the vaccine show a 94.5 percent efficacy rate.

Pfizer and BioNTech are also conducting a vaccine trial using mRNA. Both the NIH-Moderna and Pfizer/BioNTech vaccines are awaiting approval by the FDA. If approved, distribution is expected to begin within weeks.

Thornhill has no regrets when it comes to her trial participation.

“I’m hoping the FDA gets these approved and gets them out there pretty quickly and that they’re effective so that we can have some semblance of normalcy back in our lives,” she said. “A vaccine would take away that fear of losing somebody or having long-term health issues from a virus that we still don't understand all the ramifications of or the long-term effects.”

For more information about vaccines and COVID-19, visit FDA.gov. For the latest on how COVID-19 is impacting kids and Cook Children’s work to protect them, visit the medical center’s newsroom at checkupnewsroom.com.

There is currently no vaccine available for COVID-19. Studies are currently underway, but they are in the very early stages and there is no clear timeline for when it will be available.

Treatment for COVID-19 in children is mostly supportive. Making sure that they are drinking well and not having trouble breathing are the two major things you can do to help your child. Novel treatments such as antivirals and other medications are being studied, but it is not clear when those will be available for treatment-especially in children.

As a pediatrician, I have been lucky to practice medicine in the post-vaccine era. Although I have watched kids struggle with whooping cough, meningitis, mumps and pneumonia, I am happy to say I have never seen many of the vaccine-preventable diseases. I rely upon my education and training to know about the diseases and recognize them should the need arise.

I do frequently wonder, ‘What was life like for families and children before vaccines were introduced?’ How did people manage the illnesses and anxiety that came with the disease?

For a firsthand answer, I only had to talk to the person sitting at my dining room table during a typical weekend family dinner – my mom.

It was the summer of 1949. While other children were skipping rocks and riding their bikes, my mom was lying in a hospital bed as one of many children struck down by polio.

The illness began as a fever with trouble swallowing and weakness in her left leg. The doctors quickly admitted her to the hospital for quarantine and treatment. Her most vivid memory of the time has to be of the spinal tap used to aid in her diagnosis. At the time, there were no child life specialists to comfort her. She was told to hold still and if she moved the test might kill her.

After 3 months in the hospital with only her mother allowed to stay, her symptoms seemed to be worsening. Her kind physician came into the room one day to visit and cheer up the family. His kindness unfortunately, resulted in him contracting the disease and being confined to a wheelchair for the remainder of his days. After all, back then doctors did not even realize the value of handwashing.

I asked my mom what people thought about polio in the pre-vaccine era. “Everybody was scared to death of catching it! They did not know how they got it but knew it was prevalent in the summer months. They tried to avoid the sun and swimming holes since those seemed to be related.”

We now understand the transmission of polio much better. Polio comes from a virus that is highly contagious. It is spread person to person through sneezing, coughing or contact with human feces. Before the successful introduction of the polio vaccine in the 1950s, the disease resulted in the paralysis of 15,000 people per year. Since 1979, no cases of polio have originated within the United States but cases can be brought in by travelers with the disease.

My mom was one of the lucky ones. Just as a conversation with her medical team was turning to placing her in an iron lung to support her breathing she began to recover. The impact of the illness, however, continues to this day with residual weakness in her legs that makes walking for her a constant challenge.

I asked her what she thought about vaccines as a mom and a grandmother. She responded, “I experienced polio and its effect on my life. I want all my kids and grandkids protected so they don’t have to go through what I did.”

Vaccine-preventable diseases such as polio and the re-emerging measles and mumps are not historically that far away from us. We cannot forget the tremendous impact these diseases have had on the lives of so many before the introduction of vaccines.

If you want to learn more, you can check out the CDC website on polio. 

Better yet, just look across the table on a sunny Saturday afternoon and if you are fortunate to do so, ask the folks who lived it. Their stories and experiences are powerful.

More Information On This Topic

• 'I'm Worried Too.' Pediatricians Concered As Texas' Nonmedical Vaccine Exemption Rates Hit All Time-High
• 5 Questions We Get Asked About Vaccines Answered
• Vaccines for Your Children: 9 Facts Parents Need To Know
• Vaccines and Immunizations
• Information for Parents