Australia’s trusted independent immunisation experts

Children aged 12 years and older are recommended to get COVID-19 vaccine and vaccination roll out for this age group is underway in Australia. 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.

You can view the PDF version of these FAQs here. (You will need an Adobe Reader to view the PDF file.)

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

 

Severity of COVID-19 in children

  • Are children at risk of getting COVID-19?

    Children, particularly under the age of 10 years, are at a lower risk of getting COVID-19 than adults, but adolescents, especially older teenagers, seem to have the same risk of getting COVID-19 as young adults.1-3 Studies show both children and adolescents can play a role in spreading the SARS-CoV-2 virus – the virus that causes COVID-19, but this also depends on age. Spread between young children or from young children to adults in many settings, other than the household, is relatively uncommon.4

    The Delta variant of COVID-19 is more transmissible and is causing higher number of cases in children compared with the original strain.5 Household or close family contact from unvaccinated adults poses the greatest risk of spread to children.4,6

  • How serious is COVID-19 in children?

    COVID- 19 is usually milder in children than in adults but can still very rarely cause severe illness. Around 98% of children and adolescents either get mild infection or have no symptoms at all.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 Hospitalisation rates in adolescents are higher with COVID-19 than with influenza.5 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. 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):9 type 1 diabetes (about 4.5-fold higher risk), obesity (about 3-fold higher risk); a history of prematurity (about 2-fold higher risk); heart disease, including some congenital conditions (about 2-fold higher risk); immunocompromising conditions (3.5-fold higher risk); and complex and chronic illnesses (about 2–8 times higher risk).

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

    Yes, children can spread COVID-19 to other children and adults.14 Most children who get infected with the virus have no symptoms or have only mild symptoms4 but they can still pass on the virus to unvaccinated adults who can become very ill.

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

    A significant proportion of children who get COVID-19 may not have any symptoms at all (some studies estimate this will be between 16–45% of children).7 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 a runny nose and tiredness. Less commonly, some children may have gastrointestinal symptoms like abdominal pain, diarrhoea or vomiting.

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

    When a person, including children and adolescents, is diagnosed with COVID-19, they are linked with a hospital or community service from their state or territory health system that monitors their progress. The majority of children have mild symptoms and remain safe at home. Parents and carers are advised on what symptoms and signs to monitor for. If children feel unwell and have difficulty breathing or keeping fluids in, they may need to be reviewed in hospital and sometimes require oxygen and medical treatment. Healthy children rarely need intensive care treatment – this is more likely to be needed for 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’15 and in NSW currently represents the reason for hospital admission in half of paediatric patients.

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

    The condition of ‘long COVID’ in children is not well defined. It usually refers to the persistence of COVID-19 symptoms such as fatigue and breathlessness, for over 3 months, long after the infection first occurs and the initial illness is over. Studies show that although children can get ‘long COVID’, it is uncommon.2,16 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.

COVID-19 vaccines for children

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

    It is recommended that adolescents 12 years of age and older get a COVID-19 vaccine in Australia.17 This is to protect them from getting severe sickness from COVID-19, reduce the spread of virus between themselves and to adults, prevent other complications such as ‘long COVID’ and importantly, to reduce disruptions to schooling and other learning.18-21 

  • 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 12 years in Australia.

    A recent press release on the Pfizer vaccine (Comirnaty) trial suggests that children aged 5–11 years vaccinated with one third of the dose of the Pfizer vaccine used in those aged 12 years and older have similar antibody responses to vaccinated young people aged 16–25 years.22 The data on safety and efficacy as well as the risk and benefit of vaccinating young children against COVID-19 will need to be formally reviewed by regulators before the vaccine can be registered and/or recommended for use in children under 12 years of age. In Australia this is done by the Therapeutic Goods Administration (TGA) and the Australian Technical Advisory Group in Immunisation (ATAGI), respectively. 

    Moderna is also trialling the use of its mRNA COVID-19 vaccine Spikevax in children under 12 years of age. The AstraZeneca COVID-19 vaccine (Vaxzevria) is not registered for use in children under 18 years of age. 

  • Which vaccines are available for children aged 12 years or older in Australia?

    Comirnaty (Pfizer vaccine) and Spikevax (Moderna vaccine), both mRNA vaccines, are registered for use by the TGA, recommended by ATAGI and are now available for use in children 12 years of age and older. Bookings for vaccination can be made using the COVID-19 vaccine eligibility checker, through the GPs, eligible pharmacies and state/territory vaccination hubs.

    Around one third of those aged 12–15 years have already received a first dose of the Pfizer or Moderna vaccine in Australia and coverage in this age group is climbing rapidly. For more information on COVID-19 vaccine coverage in Australia, refer to the Australian Government Department of Health website.

  • 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.

  • How many doses of COVID-19 vaccine do children need?

    Children 12 years of age or older are recommended to receive 2 doses of the Pfizer vaccine (Comirnaty) or Moderna vaccine (Spikevax), and the dose used (30 ug) is the same as for older teenagers and adults. The two doses of the Pfizer vaccine are given 3–6 weeks apart and the two doses of the Moderna vaccine are given 4–6 weeks apart.

  • Are COVID-19 vaccines safe in children?

    Clinical trials and real-world studies23,24 have shown that COVID-19 vaccines approved for adolescents are very safe. Adolescents may experience mild side effects after vaccination, but these usually resolve within 48 hours. In the clinical trials, the most common adverse events following immunisation were injection site pain (80–90%), headache (30–50%) and fatigue (30–60%).25,26

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

    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.

  • What are the side effects of COVID-19 vaccines in children?

    Children can experience mild side effects after COVID-19 vaccination.27 These can include swelling, redness, and pain at injection site, fever, headache, tiredness, muscle pain, chills and nausea. These side effects usually resolve within 24–48 hours. Consult your medical practitioner if you are worried about any of the side effects. Serious side effects such as anaphylaxis or myopericarditis after COVID-19 vaccination are very rare. See also "What is myocarditis and pericarditis, and can Pfizer or Moderna vaccine cause it?"

  • Are COVID-19 vaccines effective in children?

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

    There are also ‘real world' studies (also called observational or post-market vaccine effectiveness studies) in adults25,26,28-32 from vaccination programs in countries like the USA, the UK and Israel that show strong protection for both vaccines and some indicate effectiveness against transmission.  

  • 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 12 years of age and older, who have had the Pfizer Comirnaty vaccine or the Moderna Spikevax vaccine. It is more common after dose 2 and in males. In the USA, from data reported through to 11 June 2021,23 the rate of myocarditis/pericarditis in female adolescents aged 12–17 years was 9.1 per million doses, and in male adolescents aged 12–17 years 66.7 per million doses of an mRNA COVID-19 vaccine given.

    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.

    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.

    If a child or adult experiences any of these symptoms, 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 approximately 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 than after a COVID-19 vaccine.33

  • 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. The vaccines 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 give them protection in the future.

  • Can a child get COVID-19 vaccine if they have already had COVID-19?

    Yes, children can be vaccinated (with the usual two-dose schedule) as soon as they have recovered from their illness. However the risk of reinfection is reduced for at least 6 months after infection, so vaccination can be deferred for up to 6 months.17

  • 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.

  • 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.

     

    Children and adults taking other medications should continue their regular treatment before and after 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 and AstraZeneca 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.34

  • Is COVID-19 vaccination compulsory for adolescents?

    COVID-19 vaccination is not mandatory for adolescents in Australia (refer to the question “Is the COVID-19 vaccine mandatory” in NCIRS COVID-19 vaccines: Frequently asked questions). However, adolescents 12 years of age and older are strongly 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.

COVID-19 and attending school

  • Can children get COVID-19 in school?

    Yes, children can get COVID-19 in schools. An ongoing study of the transmission of COVID-19 in educational settings in New South Wales, Australia shows that although the risk of child-to-child spread of the Delta variant is lower (1.6%), infected school staff members can pass on the virus to children (7.0%).

    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 the population aged 12 years and older and where transmission of the virus in the community remains contained, the likelihood of spread of the virus in school settings the severity of any associated infections 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 wearing masks, 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 12 years of age and older will protect people from severe disease and decrease spread to younger children.

References

  • List of references

    1.   European Centre for Disease Prevention and Control. Interim public health considerations for COVID-19 vaccination of adolescents in the EU/EEA. 2021. Available from: https://www.ecdc.europa.eu/en/publications-data/interim-public-health-considerations-covid-19-vaccination-adolescents-eueea (Accessed 29 September 2021).

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

    3.   Götzinger F, Santiago-García B, Noguera-Julián A, et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. The Lancet Child & Adolescent Health 2020;4:653-61.

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

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

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

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

    8.   Poline J, Gaschignard J, Leblanc C, et al. Systematic Severe Acute Respiratory Syndrome Coronavirus 2 Screening at Hospital Admission in Children: A French Prospective Multicenter Study. Clinical Infectious Diseases 2021;72:2215-7.

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

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

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

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

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

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

    15. Sydney Children's Hospitals Network (SCHN). Caring for children with COVID-19. 2021. Available from: https://www.schn.health.nsw.gov.au/news/articles/2021/08/caring-for-children-with-covid-19 (Accessed 29 September 2021).

    16. Radtke T, Ulyte A, Puhan MA, Kriemler S. Long-term Symptoms After SARS-CoV-2 Infection in Children and Adolescents. Jama 2021;326:869-71.

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

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

    19. SF Government. Updated data on COVID-19 cases among San Francisco children and in schools. 2021. Available from: https://sf.gov/information/updated-data-covid-19-cases-among-san-francisco-children-and-schools (Accessed 29 September 2021).

    20. Delahoy MJ, Ujamaa D, Whitaker M, et al. Hospitalizations Associated with COVID-19 Among Children and Adolescents - COVID-NET, 14 States, March 1, 2020-August 14, 2021. MMWR Morbidity and mortality Weekly Report 2021;70:1255-60.

    21. Centers for Disease Control and Prevention (CDC). Delta variant: What we know about the science. 2021. Available from: https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html (Accessed 29 September 2021).

    22. Pfizer. Pfizer and Biontech announce positive topline results from pivotal trial of COVID-19 vaccine in children 5 to 11 years. New York and Germany: 2021. Available from: https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-positive-topline-results.

    23. Shimabukuro T. COVID-19 Vaccine safety updates, June 23, 2021. Vaccine Safety Team, CDC COVID-19 Vaccine Task Force,. Available from: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-06/03-COVID-Shimabukuro-508.pdf (Accessed 29 September 2021).

    24. Centers for Disease Control and Prevention (CDC). COVID-19 Vaccine Safety in Adolescents Aged 12–17 Years — United States, December 14, 2020–July 16, 2021. 2021. Available from: https://www.cdc.gov/mmwr/volumes/70/wr/mm7031e1.htm (Accessed 29 September 2021).

    25. Ali K, Berman G, Zhou H, et al. Evaluation of mRNA-1273 SARS-CoV-2 Vaccine in Adolescents. New England Journal of Medicine 2021.

    26. Frenck RW, Jr., Klein NP, Kitchin N, et al. Safety, immunogenicity, and efficacy of the BNT162b2 Covid-19 vaccine in adolescents. New England Journal of Medicine 2021;385:239-50.

    27. National Centre for Immunisation Research and Surveillance (NCIRS). AusVaxSafety COVID-19 vaccine safety data. 2021. Available from: https://www.ausvaxsafety.org.au/safety-data/covid-19-vaccines (Accessed 29 September 2021).

    28. Sheikh A, McMenamin J, Taylor B, Robertson C. SARS-CoV-2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness. The Lancet 2021;397:2461-2.

    29. Lopez Bernal J, Andrews N, Gower C, et al. Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant. New England Journal of Medicine 2021;385:585-94.

    30. Grannis SJ, Rowley EA, Ong TC, et al. Interim Estimates of COVID-19 Vaccine Effectiveness Against COVID-19-Associated Emergency Department or Urgent Care Clinic Encounters and Hospitalizations Among Adults During SARS-CoV-2 B.1.617.2 (Delta) Variant Predominance - Nine States, June-August 2021. MMWR Morbidity and mortality Weekly Report 2021;70:1291-3.

    31. Scobie HM, Johnson AG, Suthar AB, et al. Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Status - 13 U.S. Jurisdictions, April 4-July 17, 2021. MMWR Morbidity and mortality Weekly Report 2021;70:1284-90.

    32. Andrews N, Tessier E, Stowe J, et al. Vaccine effectiveness and duration of protection of Comirnaty, Vaxzevria and Spikevax against mild and severe COVID-19 in the UK. 2021. Available from: https://doi.org/10.1101/2021.09.15.21263583 (Accessed 29 September 2021).

    33. Barda N, Dagan N, Ben-Shlomo Y, et al. Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting. New England Journal of Medicine 2021;385:1078-90.

    34. Safrai M, Reubinoff B, Ben-Meir A. BNT162b2 mRNA Covid-19 vaccine does not impair sperm parameters (pre-print). 2021. Available from: https://doi.org/10.1101/2021.04.30.21255690 (Accessed 29 September 2021).