Sri Lanka to vaccinate children, youth under 20 in October

Sri Lanka will vaccinate children and youth under 20 against COVID-19 starting October, with priority given to kids with comorobidities and teenagers over 15, State Minister Channa Jayasumana said.

The State Minister of Production, Supply and Regulation of Pharmaceuticals told reporters on Monday (13) that health authorities will begin vaccinating children with weak immunity or other comorboidities next week. These children will receive the Pfizer-BioNTech jab.

A proposal to vaccinate school students sitting their GCE Ordinary Level and Advanced Level exams is also being discussed, he said.

“Discussions are still under way, and a committee has been appointed to look into it. The committee will also decide for which grades schools should be reopened. We have requested that opening preschools also be discussed,” said Jayasumana.

Children below 15 who do not have comorbidities will not be vaccinated as they have a lower infection rate, he added. However, a decision will be made on that regard after the committee discussions.

According to the Census and Statistics department’s population and housing report for 2012 – the stats referred by health authorities in categorising age groups in Sri Lanka’s vaccine rollout, 1,644,249 of the country’s population are in the age group 15 to 19.

Government Medical Officers Association (GMOA) member Dr Nalinda Herath said, according to the committee chaired by Health Services Director General Dr Asela Gunawardena, vaccination of this age group will most likely begin in October.

“A committee has been appointed under the DG of Health Services to provide recommendations and guidelines to reopen schools,” Herath told the media on Monday.

“According to the committee discussions held, employees of school canteens, student transport services and teachers will be also vaccinated.”

Herath said the committee’s recommendations and guidelines regarding reopening schools and the vaccination of under-20s will be issued this Friday (17).

According to the Sri Lanka College of Pediatricians (SLCP, compared to adults, the number of cases and the proportion of severe COVID-19 disease among children are significantly low. In most instances, the proportion of childhood cases are approximately 10% or less of all COVID-19 positive patients. However, with the acute surge of the total number of cases, the number of reported cases among children has risen.

Therefore, a high possibility of children with severe disease is expected along with the increased number of cases. The following hypotheses have been proposed on why children are less susceptible to acquire COVID-19 infection or develop severe disease compared to adults.

Differences in the number and the distribution of ACE2 receptors and their affinity to SARS CoV-2, the virus that causes COVID-19
Differences in the endothelium and clotting function (make children less susceptible to developing endothelial damage, activation of coagulation pathways, and formation of microthrombi)
The presence of more cross-reactive and neutralizing antibodies after infections with other coronaviruses in children
“In contrast, adults have more non-neutralising antibodies that lead to antibody-dependent enhancement”, the SLCP said.

The college further said strong and protective innate immune response in children compared to immunosenescence and dysfunctional or over-active innate immune response in adults, differences in the microbiota (oropharyngeal, nasopharyngeal, lung, and gastrointestinal), higher levels of melatonin which has anti-inflammatory and anti-oxidative properties, lower prevalence of comorbidities that leads to severe disease and less intense exposure to SARS-CoV-2 in children due to less social mobilisation are also reasons for fewer cases.

Meanwhile SLCP member Channa De Silva said the college has proposed a priority list for vaccinating children.

“According to our recommendations, priority should be given to children with weak immunity and children under special medical treatment,” De Silva told reporters on Sunday (12).

“There are around 30,000 children with comorbidities. They will also be given priority under medical supervision.”

Children with underlying medical conditions are at increased risk for severe illness than children without underlying medical conditions.

Those with the following kids should be prioritsed:

Complex medical conditions with genetic, neurologic, or metabolic in origin
Haemodynamically significant congenital heart diseases
Chronic lung diseases
Immunocompromised children (Primary immune deficiencies, solid-organ/bone marrow transplant recipients on immunosuppressive therapy, cancer patients undergoing treatment)
Those on long-term immunosuppressants/corticosteroids for any cause
HIV-infected children
Obese children
Children with diabetes mellitus
Significant chronic ill health due to any other organ involvement, including chronic kidney or liver failure
Silva added that parents whose kids have healthy immunity levels or do not have other conditions should not panic, as those kids too will be vaccinated after the priority list has been exhausted.

“Other children will be vaccinated step by step,” he said.

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