In addition to navigating parenting three children in a pandemic, Jennifer Su, M.D., is pediatric cardiologist and director of heart failure and cardiomyopathies with the Heart Institute at Children’s Hospital Los Angeles. While she and her husband were happy to see their children return to campus after the shutdown, they recently had to take off work to quarantine with their son, whose preschool announced a COVID-19 exposure. “Navigating between the unpredictability of parenting and the busy hospital setting has been quite a challenge,” she says.
In the middle of it all, Su is also working to alleviate misconceptions about the COVID-19 vaccination, including a belief some parents hold that their children will develop myocarditis (an inflammation of the heart muscle) after receiving the vaccine.
How is L.A. County doing with its rate of vaccinated children?
To date [late January], over 80% of adolescents have been vaccinated with at least one dose. In younger children between 5-11 years old, however, the vaccination rate is much lower, with about 30% of these kids having received at least one dose of the COVID vaccine. Particularly in this younger age group, we know that the vaccine has much fewer side effects and is highly effective in preventing COVID complications such as MIS-C, or multisystem inflammatory syndrome in children, a rare but serious condition that is seen a few weeks after COVID infection and includes fever with inflammation of multiple body parts (such as the heart, lungs, kidneys, brain, and intestines).
What is causing hesitancy in parents when it comes to getting their eligible children vaccinated against this virus?
There are three common reasons that come up in terms of vaccine hesitancy. First is the perception that the vaccine doesn’t work. When this comes up, parents often share a story about someone close to them who has gotten vaccinated and subsequently got COVID. I have seen these cases happen as well. We are observing that the COVID vaccine is not completely effective at preventing transmission of this current (Omicron) variant. However, we do see that it is incredibly effective at minimizing the symptoms of COVID. You may have heard that Omicron is a milder variant of COVID-19 – this is in part because many people have now been vaccinated and are experiencing milder symptoms because of their vaccine immunity.
Another reason for vaccine hesitancy that comes up is concern that the mRNA vaccine technology is “too new,” and long-term effects of the vaccine are not fully understood. Even though COVID-19 is the first virus in which the general public has heard of mRNA vaccine technology, mRNA vaccines have actually been around for almost 30 years. This technology was first studied in mice back in 1993. It has been studied and found to be effective in humans since 2013, being used to vaccinate against rabies.
Most commonly, parents are hesitant to get their children vaccinated because of concern for potential vaccine side effects. Specifically, the mRNA COVID vaccine has been linked to myocarditis, most frequently seen after the second vaccine dose in adolescents and young adults.
What is myocarditis? And what is the relationship between it and the vaccine?
The heart is basically one big muscle. Myocarditis is inflammation of the heart muscle as the immune system reacts to the vaccine. Just like how some people might develop soreness in arms or body after receiving a vaccine, occasionally some people will develop inflammation of the heart muscle after the COVID mRNA vaccine.
What is the severity of the risk and what symptoms are usually present?
Myocarditis after the COVID mRNA vaccine is incredibly rare, affecting about 1 in every 10,000 teenagers who receive the vaccine. After observing this side effect for a few months now, we know that in addition to being rare, vaccine-associated myocarditis also tends to be mild. In most cases, symptoms completely resolve after a few days and heart function remains normal. Most common symptoms related to myocarditis are chest pain, difficulty breathing or funny heartbeats that develop within one week after receiving the vaccine.
How do these risks compare to risks associated with contracting COVID, especially in kids and teens?
The short answer is that the risk of myocarditis with the vaccine is much smaller than the risk of getting myocarditis from COVID. In fact, in 2020, an estimated 40% of all diagnosed myocarditis in children was related to COVID. The story doesn’t stop here. In addition to myocarditis, COVID can cause many other complications as well, ranging from mild to life-threatening (pneumonia, heart arrhythmias, MIS-C). Although less than in adults, kids and teens may also experience “long COVID” in which symptoms last for months and can lead to mood changes, trouble concentrating and physical difficulties. Compared with side effects of the vaccine, the risk of complications with COVID is much higher, more severe and can potentially last longer.
What should parents do if they suspect myocarditis in their children, and what is the treatment?
If your child complains of symptoms [such as] chest pain, difficulty breathing, abnormal heartbeats within one week of receiving the vaccine, you should go to the doctor to check it out. There are easy and fast ways to check if your child has myocarditis. In most cases that have been reported across the nation, resting and treating the pain with ibuprofen has been the main treatment for mild myocarditis. Myocarditis usually improves completely on its own.
How is CHLA addressing the vaccine hesitancies?
Empowering families with accurate and up-to-date information about COVID and the vaccine is the most important way to begin a conversation about keeping their kids safe during the pandemic. Sharing information through articles such as this one is a valuable way to reach parents and address concerns. We also have an extensive website dedicated to providing families with updated COVID and vaccine related information at chla.org.