CHLA expert offers update on the latest COVID-19 vaccine information and precautions

The coronavirus pandemic is no longer a national emergency, but the virus that causes COVID-19 isn't gone-;and neither is the risk of getting the disease. For parents, navigating when to get their child vaccinated and knowing how to best protect their child from COVID-19 can be complicated. We spoke to Michael Smit, MD, MSPH, Hospital Epidemiologist and Medical Director of Infection Prevention and Control at Children's Hospital Los Angeles, to get an update on the latest COVID-19 vaccine information and precautions.

Who is eligible for the bivalent COVID-19 vaccine that was approved last fall?

Everyone who is 6 months and older should get a bivalent booster dose as long as it has been at least two months since they received a monovalent vaccine dose, which was the original COVID vaccine. People who are 6 years and older and who are immunocompromised can also receive a second dose of bivalent vaccine at least two months after their first dose of the bivalent. If you have questions about the eligibility of you or your child to get the booster, you should check with your medical provider.

For children who are getting their first COVID-19 vaccine shot, will they receive the original monovalent series or the bivalent vaccine?

The current COVID-19 vaccine guidelines from the Centers for Disease Control and Prevention (CDC), which were updated in May 2023, recommend that unvaccinated children 6 months and older get the bivalent vaccine.

Are children who received the original COVID vaccine series eligible for the bivalent booster?

Yes. Children who already received the original vaccine series are eligible for the bivalent vaccine. The guidelines can be complicated if your child has previously received the original vaccine, so I recommend consulting public health guidelines and your medical provider.

Coronavirus cases are waning in most places in the U.S. Do you recommend getting the bivalent vaccine if you haven't gotten it?

I recommend following vaccine guidelines provided by U.S. public health agencies such as the CDC and the California Department of Public Health. Although COVID-19 cases are currently low, it is still a serious disease that can cause illness, hospitalization and death.

What does the research show about side effects of the COVID-19 vaccine in children?

Side effects of the COVID-19 vaccine tend to be mild and temporary. The most common side effects for children ages 6 months to 3 years include pain on the leg or arm where the shot was given, swollen lymph nodes, irritability or crying, sleepiness and loss of appetite. For children 4 to 17 years of age, side effects also include pain at the site where the shot was given, swollen lymph nodes and fatigue. This age group can also experience headaches, chills, muscle aches and loss of appetite. In some rare cases, adolescent boys have been found to experience myocarditis, a rare inflammation of the heart, after vaccination. However, the risk of this condition is higher for children who get infected with COVID-19 than for those who have received the vaccine.

The CDC has indicated that people will get a COVID-19 vaccine shot once a year. Is that for everyone?

Currently people ages 65 years and older can receive a dose of the bivalent vaccine at least four months after the first dose. I recommend that people discuss whether to get the additional booster with their medical provider. Currently, the CDC has not announced a second booster shot for groups other than those who are 65 and older or people who are immunocompromised.

Can children get long COVID? Is there a way to protect against long COVID in kids or adults?

Yes, children get long COVID. The best way to protect anyone against long COVID is to remain up to date on COVID-19 vaccinations. If you do not get COVID-19, you will not get long COVID. If you do get COVID-19 after being vaccinated, you are less likely to develop long COVID.

Are there medications available for adults or children if they get infected with COVID-19?

Yes, there are medications available for both adults and children if they get COVID-19. These medications can have interactions with other medications or have specific indications for use based on an individual's health status. I recommend discussing taking any COVID-19 medications with your medical provider.

What are the isolation rules today if someone is infected with COVID-19?

If you test positive for COVID-19, current isolation guidelines from the CDC depend on whether or not you have symptoms. Regardless of symptoms, if you test positive you should isolate for five days. If you must be around others, you should wear a high-quality mask and avoid contact as much as possible. If you do not have symptoms, isolation is completed after day five, with day zero being the day you had a positive test.

If you do have symptoms, then you may end isolation after day five as long as you are fever-free and your symptoms are improving. If you are experiencing moderate symptoms, including shortness of breath, you should isolate for 10 days. For moderate or severe cases, you should discuss specific isolation details with your medical provider.

What are the best ways to avoid COVID-19 at this point?

The best way to avoid COVID-19 is to stay up to date on your vaccines. This decreases your chances of catching COVID-19, which, in turn, greatly decreases your chances of developing long COVID. You can also decrease your chances of getting COVID-19 by avoiding crowded situations where you cannot maintain physical distancing of about 3 feet-;arm's length-;from others. If crowded situations cannot be avoided, then wearing a well-fitting mask may decrease your chances of getting COVID-19, but only if the mask is worn correctly and consistently.