Children aged 5 years and older are recommended to get COVID-19 vaccine. On this page, we answer some of the most frequently asked questions (FAQs) about COVID-19 in children, vaccines available in Australia, vaccine safety and schooling. (Last updated date: 17 November 2022)

Refer also to NCIRS COVID-19 vaccines: Frequently asked questions.

 

Severity of COVID-19 in children

  • UPDATED - Are children at risk of getting COVID-19?

    Everyone, including children, is at risk of getting COVID-19. Studies show that like adults, both children and adolescents can play a role in spreading the SARS-CoV-2 virus – the virus that causes COVID-19. Spread between young children or from young children to adults in the household setting is just as common as the spread between adults.

    The Omicron variants of COVID-19 are more transmissible than the ancestral strain and earlier variants and are causing higher number of cases in children compared with the original strain and prior variants, but are not causing more severe disease.1-3 Household or close family contact from unvaccinated adults poses the greatest risk of spread to children.4,5 Children tend to get mild disease and the majority do not require hospitalisation, but rarely, around 1 in 3,500 children infected with SARS-CoV-2 may develop a post-COVID inflammatory syndrome, called PIMS-TS (also known as MIS-C).

    Vaccination is available for children aged 6 months and older and has been shown to protect against hospitalisation and severe disease, with new evidence suggesting it may also protect against PIMS-TS.6 Vaccination of adults will protect themselves against severe disease and is important in those who live and work among young children.

  • How serious is COVID-19 in children?

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

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

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

    Some of the conditions that increase the risk of being hospitalised with COVID-19 in children, compared with healthy children, include (but are not limited to): children with congenital heart disease, chronic pulmonary disease, neurological diseases, prematurity or obesity.8,14

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

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

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

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

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

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

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

    Some children are also admitted to hospital to be looked after while their parents are unwell – this has been termed ‘home in the hospital’16 and was a common reason for hospitalisation for children with COVID-19 in the Delta wave,8 but is now less frequently required as Australia has a high adult vaccination coverage against SARS-CoV-2.

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

    In children, the condition of ‘long COVID’, also known as the ‘Post COVID condition’, is not well defined. It usually refers to the persistence of COVID-19 symptoms such as fatigue and breathlessness, for over 3 months.17 There is no conclusive evidence that ‘long COVID’ exists in children, as similar symptoms have been revealed in children who are exposed to frequent lockdowns and the general unease created by the global pandemic.18,19 It also appears to occur less commonly in children than in adults. Some of the symptoms such as body aches, difficulty concentrating, changes to mood have been reported in children and teenagers without prior infection and may be a consequence of living in the pandemic and in lockdown. Longitudinal studies tracking the duration of symptoms in children with COVID-19 frequently find almost complete symptom resolution within a few days.20,21

COVID-19 vaccines for children

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

    There are benefits and risks associated with all medical products and procedures. Throughout these FAQ, we provide information about the benefits and potential safety concerns associated with vaccinating children against COVID-19. Below is a general summary of some of the key points:22

    Individual benefits/pros

    • Protection from COVID-19 disease
    • Protection from severe disease and death
    • Potential protection from PIMS-TS or MIS-C
    • Potential protection from uncertainty associated with new variants

    Individual risks/cons

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

    Community considerations

    • (Pro/Con) Contribute to the reduction in the transmission of the virus but the level of reduction in transmission offered by COVID-19 vaccination is unknown, especially against new variants
    • (Pro) Potential to contribute to a reduced need for lockdowns and disruptions to school and social activities
    • (Con) A universal COVID-19 vaccination program for children may use resources meant for other vaccine programs and impact the accessibility to routine childhood vaccinations. 

     

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

  • UPDATED - Why do children need to get a COVID-19 vaccine?

    It is recommended that all children aged 5 years and older, and some children with certain medical conditions aged 6 months to under 5 years get a COVID-19 vaccine in Australia for several reasons. These include:23-25

    To protect against severe COVID-19. COVID-19 is usually milder in children than in adults but can still very rarely cause severe illness, particularly in children with chronic medical conditions. Some children will require hospitalisation or intensive care.26,27

    To reduce the spread of virus between themselves and to adults. Household transmission between children and from children to adults is common.27 Vaccinated people are less likely to pass on the virus than unvaccinated people.28,29 Vaccinating children can reduce the spread of virus between themselves and to vulnerable adults.

    To prevent other complications such as ‘long COVID’ or PIMS-TS/MIS-C. Even after recovery from COVID-19, there is a chance of long-term complications. ‘Long COVID’ is a condition where people with COVID-19 experience persistent symptoms, such as fatigue, shortness of breath, cognitive dysfunction (‘brain fog’) and others, that continue for at least 2 months. There is limited evidence on the severity and duration of long COVID in children, yet it may be less severe and of shorter duration in children than in adults.18,20 PIMS-TS (also known as MIS-C) is a rare inflammatory condition that has been seen in children following COVID-19 infection. It normally occurs 2–6 weeks after infection and can be mild to life-threatening.

    To reduce school closures and disruptions to other social activities. Vaccinating children will help control the spread of infection. This may reduce the need for public health measures like school closures.

  • Why are vaccination policies for children different in different countries?

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

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

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

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

    The minimum age for children to get a COVID-19 vaccine is 6 months in Australia.25,30  All children aged 5 years and older can receive a COVID-19 vaccine and some children aged 6 months to under 5 years with certain medical conditions can receive a COVID-19 vaccine.

  • UPDATED - Which vaccines are available for children and adolescents in Australia?

    Some children aged 6 months to under 4 years with certain medical conditions can receive the paediatric Moderna COVID-19 vaccine (blue topped 25 ug) or the Paediatric Pfizer vaccine (maroon topped 3 ug). Children aged 5–11 years can receive the paediatric Pfizer COVID-19 vaccine (orange topped 10 ug). Children aged 6–11 years can receive the paediatric Moderna COVID-19 vaccine (red topped 50 ug). Adolescents aged 12 years and older can receive the adult Pfizer COVID-19 vaccine (purple topped 30 ug), Moderna COVID-19 vaccine (red topped 100 ug) or Novavax (blue topped 5 ug).

    For those children and adolescents who are recommended to receive a first or second booster dose, the Pfizer vaccine is recommended. Novavax can be used as a booster dose in adolescents aged 12–17 years if no other COVID-19 vaccine brand is suitable for that person.

    For those children and adolescents who are severely immunocompromised and require a third primary dose, this can be the same vaccine as their first two doses (i.e. either Pfizer COVID-19 vaccine, Moderna COVID-19 vaccine or Novavax COVID-19 vaccine).

    The AstraZeneca COVID-19 vaccine (Vaxzevria) and the Moderna COVID-19 vaccine and Moderna bivalent vaccine are currently not registered for use in people aged under 18 years.

    Bookings for vaccination can be made using the COVID-19 Vaccine Clinic Finder, through GPs, eligible pharmacies and state/territory vaccination hubs.

    As of 1 September 2022, in Australia, 79% of those aged 12–15 years had received two doses of the Pfizer vaccine or Moderna vaccine and 41% of children aged 5–11 years had received two doses of the paediatric Pfizer vaccine. For more information on COVID-19 vaccine coverage in Australia, refer to the Australian Government Department of Health website.

     

  • How many doses of COVID-19 vaccine do children aged under 12 years need? Do they need a booster dose?

    Children aged 6 months to under 5 years who have severe immunocompromise, disability and complex and/or multiple health conditions which increase the risk of severe COVID-19 are recommended to receive 2 doses of the paediatric Moderna vaccine, 8 weeks apart, shortened to a minimum of 4 weeks in special circumstances.

    Children aged 5–11 years are recommended to receive two doses of the paediatric Pfizer vaccine, 8 weeks apart, shortened to a minimum of 3 weeks in special circumstances. The paediatric Pfizer vaccine is one third of the dose of the Pfizer vaccine for people aged 12 years and older.

    Children aged 6–11 years can also receive two doses of the paediatric Moderna vaccine, 8 weeks apart, shortened to a minimum of 4 weeks in special circumstances, as an alternative to the paediatric Pfizer vaccine. The paediatric Moderna vaccine is half the dose of the Moderna vaccine for people aged 12 years and older. 

    Children aged 6 months to 11 years and older who are severely immunocompromised are recommended to receive a third primary dose of COVID-19 vaccine from 2 months after they have had their second dose, as part of their primary vaccination course. A list of the conditions which make children eligible for this third dose is provided here.

    Children aged 6 months to 11 years are not currently recommended a first or second booster dose (i.e. 4th or 5th dose).

    Adolescents aged 12–18 years are recommended to receive two doses of either the Pfizer or Moderna vaccines 8 weeks apart. 

    A longer dose interval of 8 weeks between dose 1 and 2 has been recommended for all ages as it may improve effectiveness of the vaccine and may reduce the risk of myocarditis and pericarditis after vaccination

    Certain adolescents aged 12–15 years are recommended to receive a first booster dose, including:

    • those who are severely immunocompromised
    • those who have a disability with significant or complex health needs
    • those who have complex and/or multiple health conditions that increase the risk of severe disease.

     

    The first booster dose for the above groups is likely to be their 4th dose overall.

    All adolescents aged 16–18 years are recommended to receive a first booster dose

    All first booster doses should occur from 3 months after completion of their primary course and this includes a 4th dose for severely immunocompromised people. 

    Certain adolescents aged 16–18 years are recommended to receive a second booster dose, including:

    • those who are severely immunocompromised
    • those who have a disability with significant or complex health needs which increases their risk of a poor outcomes
    • those who have complex and/or multiple health conditions that increase the risk of severe disease.

     

    The second booster for the above groups is likely to be their fifth dose overall and should occur from 3 months after the first booster dose. 

    Children 5 years of age and older who are severely immunocompromised are recommended to receive a third primary dose of COVID-19 vaccine, 2 to 6 months after they have had their second dose, as part of their primary vaccination course. A list of the conditions which make children eligible for this third dose is provided here. They are not currently recommended to receive a first or second booster (i.e. 4th or 5th dose).

  • How many doses of COVID-19 vaccine do adolescents aged 12 years and older need? Do they need a booster dose?

    Adolescents aged 12–18 years are recommended to receive two doses of either the Pfizer, Moderna or Novavax vaccines 8 weeks apart.

    A longer dose interval of 8 weeks between dose 1 and 2 has been recommended for all ages as it may improve effectiveness of the vaccine and may reduce the risk of myocarditis and pericarditis after vaccination.

    Certain adolescents aged 12–15 years are recommended to receive a first booster dose, including:

    • those who are severely immunocompromised
    • those who have a disability with significant or complex health needs
    • those who have complex and/or multiple health conditions that increase the risk of severe disease.

     

    The first booster dose for the above groups is likely to be their 4th dose overall.

    All adolescents aged 16–18 years are recommended to receive a first booster dose.

    All first booster doses should occur from 3 months after completion of their primary course and this includes a 4th dose for severely immunocompromised people.

    Certain adolescents aged 16–18 years are recommended to receive a second booster dose, including:

    • those who are severely immunocompromised
    • those who have a disability with significant or complex health needs which increases their risk of a poor outcomes
    • those who have complex and/or multiple health conditions that increase the risk of severe disease.

     

    The second booster for the above groups is likely to be their fifth dose overall and should occur from 3 months after the first booster dose.

    For children and adolescents aged ≥12 years who are recommended to receive a first or second booster dose, Pfizer COVID-19 vaccine is recommended. Novavax can be used as a booster dose in adolescents aged 12–17 years if no other COVID-19 vaccine brand is suitable for that person.

  • How do mRNA COVID-19 vaccines work?

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

  • What is Novavax and how does it work?

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

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

    People aged 12 years and older can receive 2 doses of Novavax, 8 weeks apart for the primary course. It is not approved for use as a booster dose.

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

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

    There is limited evidence on the efficacy of Moderna vaccine in infants and children aged 6 months to <5 years. A phase 2 clinical trial found 2 doses of Moderna vaccine were 51% effective in infants/toddlers aged 6 to 23 months and 37% in children aged 2 to 5 years against symptomatic infection from the Omicron variant. The clinical trial for the Pfizer vaccine in 1,456 children aged 6 months to 4 years estimated the vaccine to have an efficacy of 80% against COVID-19 infection.31  

    A clinical trial for the paediatric Pfizer vaccine in children aged 5–11 years revealed that the vaccine was 91% effective in preventing (earlier variants of) SARS-CoV-2 in children.32

    A clinical trial for the Moderna vaccine showed that one dose was 93% effective in preventing symptomatic infection, and after dose 2, there was only one case in the placebo group and zero cases in the vaccine group, so a vaccine efficacy estimate could not be calculated.33

    A clinical trial for the Pfizer vaccine found the vaccine to be 100% effective in preventing infection with (earlier strains of) SARS-CoV-2 in adolescents aged 12–15 years.34

    A trial for the Moderna vaccine found the vaccine to be 92% effective in preventing symptomatic SARS-CoV-2 infection in adolescents aged 12–17 years.35 In a trial of 1,799 participants aged 12–17 years without evidence of previous SARS-CoV-2 infection, the Novavax COVID-19 vaccine was found to be 79.5% effective in preventing COVID-19.36

    There are also ‘real world' studies (also called observational or post-market vaccine effectiveness studies) during the Omicron period.

    A study from the US found that the paediatric Pfizer vaccine was 68% effective in preventing hospitalisation in children aged 5–11 years and 40% effective in adolescents aged 12–18 years.6 A study from the UK found that the Pfizer vaccine was 83% and 76% effective in preventing COVID-19 infection in adolescents aged 12–17 years and 16–17 years, respectively.37 A study from Argentina found either the Pfizer or Moderna vaccine was 78% effective in preventing hospitalisation in adolescents aged 12–17 years.38

    Another study from the US found that in adolescents aged 12–17 years who received a third dose, the Pfizer vaccine was 87% effective against emergency department visits during the Omicron period.39

    A study from Singapore found that two doses of the paediatric Pfizer vaccine were 83% effective in preventing hospitalisation and 37% effective in preventing infection in children aged 5–11 years during the Omicron period.40

    There are currently no vaccine effectiveness studies for the Moderna vaccine for infants and children aged 6 months to <5 years.

    For adolescents who are now recommended a first or second dose booster (which is likely to be their 4th or 5th dose overall), there are currently no vaccine effectiveness data published. However, it may offer additional protection against severe disease and the benefits likely outweigh the risks.

  • Should children avoid any activities after COVID-19 vaccination?

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

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

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

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

    Yes, children can be vaccinated (with the usual two-dose schedule or first/second booster) from 3 months after testing positive for COVID-19.23 A COVID infection means you produce antibodies that can help protect against COVID-19, this is called natural immunity.

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

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

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

    Adolescents aged 12 years and older who are severely immunocompromised are recommended booster doses in addition to their three primary doses. See “How many doses of COVID-19 vaccine do children and adolescents need? Do they need a booster?”

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

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

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

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

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

    COVID-19 vaccination is not mandatory for children or adolescents in Australia (refer to the question “Is the COVID-19 vaccine mandatory” in NCIRS COVID-19 vaccines: Frequently asked questions.

    However, all children aged 5 years and older and some children aged 6 months to <5 years are recommended to receive a COVID-19 vaccine to protect themselves from serious disease and to prevent spread of the virus to other children and adults.

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

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

Safety of COVID-19 vaccines in children

  • UPDATED - Are COVID-19 vaccines safe in children?

    Clinical trials and real-world studies31,41-43 have shown that COVID-19 vaccines approved for children (6 months–11 years) and adolescents (≥12 years) are safe. Children are likely to experience mild side effects after vaccination, but these usually resolve within 48 hours.

    The safety profile of the Moderna vaccine in children aged 6 months to 5 years was similar to that of the Moderna vaccine in other age groups, with systemic events more frequently reported after dose 2. Rates of fever after dose 1 and dose 2 were higher than for other age groups. Young children are prone to febrile convulsions most frequently due to viral infection but these can also occur after vaccination. There was one case of febrile convulsion in the Moderna vaccine clinical trial involving children aged 6 months to 5 years. Local reactions were also more common post dose 2, with lymphadenopathy more frequently reported after Moderna vaccination than placebo, and more frequently reported in the cohort aged 6 to 23 months.

    Safety data from the United States, where over 890,000 doses of the Pfizer vaccine have been administered in children aged 6 months to 4 years, have found that the vaccine in children aged 6 months to 4 years is safe.44

    Information from the US shows that adverse events in children aged 5–11 years who received the paediatric Pfizer vaccine were milder and less frequently observed when compared to 16–25 year olds. The most common adverse events for both age groups were injection site pain, fatigue, headache, muscle pain, chills and fever. In some instances injection site redness and swelling were more common in children than young adults.33,35

    For the Moderna vaccine adverse events occurred at a similar rate in children aged 6–11 years as that in people aged 18–25 years . The most common adverse events for the Moderna vaccine for both age groups were injection site pain, fatigue and headache. In some instances fever was more common in children than young adults.33

    In the clinical trials for people aged ≥12 years, the most common adverse events following immunisation were injection site pain (80–90%), headache (30–50%) and fatigue (30–60%).33-35

    There are currently no studies directly comparing short-term adverse events for paediatric doses of Pfizer and Moderna vaccines, but results from the Moderna vaccine clinical trial indicate some adverse events were more common than those seen in the Pfizer vaccine clinical trial. For more information, refer to the ATAGI recommendations on the use of Moderna vaccine in children. Consult your medical practitioner if you are worried about any of the side effects. Serious side effects such as anaphylaxis or myocarditis/pericarditis after COVID-19 vaccination are very rare.

    In an ongoing phase 3 clinical trial of a primary series of Novavax in adolescents aged 12–17 years, the adverse reaction profile was generally similar to that among adult participants aged 18 years and older. However, fever was more common among adolescents aged 12–17 years than among adults.36

    In Australia, the Therapeutic Goods Administration (TGA), part of the Australian Government Department of Health, is responsible for approving medicines and vaccines for use in Australia. The TGA has a rigorous process for assessing vaccine safety, quality and efficacy before approving vaccines for use in the population.

    Australia’s national active vaccine safety surveillance system AusVaxSafety also monitors vaccine safety in real-time and provides detailed information on age-specific rates of adverse events, as well as adverse events in Aboriginal and Torres Strait Islander people and those with risk conditions.

    In addition, tens of millions of adolescents have been vaccinated in countries that are closely monitoring and reporting on safety, including the USA, Europe, Canada, Israel, Singapore and Japan. Similarly, over 10 million children aged 5–11 years and around 1.5 million children aged <5 years have received at least one dose of the COVID-19 vaccine in the US, which is more than the total population for these age groups in Australia.45 For the period 18 June 2022 to 20 July 2022, just over 544,000 children under 5 years of age have received at least one dose of Moderna (25mcg) in the USA.46

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

    As with any medical product, including vaccines, there is a small risk of rare side effects. However there are much greater risks associated with the disease itself and the benefits of vaccination outweigh these risks. Only the Pfizer and Moderna vaccines are licensed for use in children to protect them against COVID-19. Both these vaccines have been associated with the small risk of the rare side effect of myocarditis or pericarditis. However, there is a risk of myocarditis or pericarditis from COVID-19 as well as a more severe condition called PIMS-TS/MIS-C. In a US study, 87% of those who experienced myocarditis after vaccination had their symptoms resolved by hospital discharge (average length of stay is around 1–2 days).47 In early data from the US, follow up of 12–15 year olds who experienced myocarditis following vaccination 92% had their symptoms resolved.48 Longer term follow-up of people who have had myocarditis or pericarditis following a COVID-19 vaccine or COVID-19 disease is ongoing.

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

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

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

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

    Clinical trials and real-world studies32,41-43 have shown that COVID-19 vaccines approved for children (6 months to 11 years) and adolescents (≥12 years) are safe. Both Pfizer and Moderna COVID-19 vaccines have now been administered to many millions of children aged ≥5 years and adolescents around the world.

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

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

  • What is myocarditis and pericarditis, and can Pfizer or Moderna vaccine cause it?

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

    Myocarditis and/or pericarditis occurs very rarely in younger people, including adolescents and children 5 years of age and older, who have had the Pfizer vaccine (Comirnaty) or the Moderna vaccine (Spikevax). It is more common after dose 2 and in adolescent males. Data from Canada, Australia and some Nordic countries suggest the rate is higher for the Moderna COVID-19 vaccine than for Pfizer.49

    Different rates of myocarditis have been reported from many countries as they have different ways of capturing information. The rates after dose 2 for males aged 12-17 years range from 71 to 136 per million doses for Pfizer and 237 per million doses for Moderna. For females, the rates after dose 2 range from 2 to 28 per million doses for Pfizer and 0-28 per million for Moderna.49

    Rates of myocarditis following a booster (third) dose have been observed to be lesser than after dose 2 but greater than after dose 1. Data from the USA and Israel suggest the rates in adults following a 4th dose are not above the expected background rates.49 There are currently no data on rates following a 5th dose.

    For children 5–11 years of age, there is currently no clear attributable risk of myocarditis and/or pericarditis from the COVID-19 vaccines. The symptoms typically appear within 1–5 days of vaccination and are usually mild. Most children and adults with myocarditis or pericarditis related to COVID-19 vaccination recover quickly after a short period of monitoring (usually in hospital) and no or simple treatment, such anti-inflammatory medication; however, occasionally children need to refrain from returning to sports for weeks to months.

    The symptoms of myocarditis or pericarditis can include chest pain, pressure or discomfort palpitations (irregular heartbeat, skipped beats or ‘fluttering’), syncope (fainting), shortness of breath, pain with breathing. It is important to note that this can present with atypical features, such as the absence of chest pain, or the presence of abdominal pain or other non-specific symptoms. If a child or adult experiences any of these symptoms in the weeks following vaccination, they should seek prompt medical attention. Further information can be found in the ATAGI guidance on myocarditis and pericarditis after mRNA COVID-19 vaccines. A tool has been developed by the Paediatric Research in Emergency Departments International Collaborative (PREDICT) to assess children and adolescents with chest pain following mRNA vaccination and evaluation of chest pain guideline in the emergency department.

    It is important to note that there could be other causes for these symptoms. Data indicate that in young adults around 3-8 cases of myocarditis and pericarditis that are not related to COVID-19 vaccination occur on average each week in Australia. The rate of myocarditis and pericarditis is higher in people with COVID-19 disease, than after a COVID-19 vaccine.50

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

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

    A study from the US51 investigated cases of PIMS-TS/MIS-C following vaccination and found that there were 21 potential reports as of 31 August 2021. However, of those cases, 71% had a previous infection with SARS-CoV-2. The study suggested that the rate of PIMS-TS/MIS-C in those who did not have prior SARS-CoV-2 infection was 0.3 cases per million vaccinated individuals). 

    In Australia, as of 8 September 2022,52 there have been no cases of PIMS-TS/MIS-C linked to COVID-19 vaccination.
     

  • Can COVID-19 vaccines lead to infertility?

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

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

    Studies from Israel and the US of mRNA vaccines in women undergoing in vitro fertilisation (IVF) comparing who had and had not been vaccinated or had COVID-19 in the past showed that Pfizer and Moderna vaccines did not affect fertility treatment.53 In studies conducted on healthy men, there were no significant impacts on sperm parameters after COVID-19 vaccination.54,55

COVID-19 and attending school

  • Can children get COVID-19 in school?

    Yes, children can get COVID-19 in schools. However, research shows they are more likely to catch COVID-19 in their own home environment or in gatherings outside of school. An ongoing study of the transmission of COVID-19 in educational settings in Australia shows that although the risk of child-to-child spread is low (0.3%), infected school staff members (adults) can pass on the virus to children (1.5%).56

    The virus that causes COVID-19 will continue to circulate in Australia as public health and social measures become less restrictive and in this context cases of COVID-19 will inevitably occur in students and/or staff who attend schools or childcare centres. However, with high vaccination rates in Australia, the likelihood of spread of the virus in school settings resulting in severe clinical consequences is anticipated to be low.

  • How can we keep children safe in schools?

    There are many relatively simple measures that can be taken to minimise COVID-19 spread in schools. These include regular hand hygiene, keeping adults and parents off school grounds and avoiding large crowds. The state, territory and Commonwealth governments are working with health and education sectors to implement guidelines that include these and other measures that can minimise the risk of COVID-19 spreading in schools.

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

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

    Yes, your child can go to school if they have not yet received a COVID-19 vaccine; however, vaccination is strongly recommended. COVID-19 is usually milder in children than in adults and since the vaccination rates in adults in Australia is high, over 90%, children are well protected from COVID-19. The spread of COVID-19 is also a lot less common in the school setting compared with the household setting.27,55

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

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