The European Medicines Agency (EMA) recommended this Thursday to authorize the booster dose with the Pfizer vaccine in young people between 12 and 17 years old and supported the use of Moderna in children between 6 and 11 years old, with a lower dose than recommended in adults and an interval of four weeks.
Estepa Sports Center (Seville) with a mass vaccination point. EFE/Raul Caro
After analyzing interim data from a clinical trial in people over 16 years of age and real-world evidence of Pfizer booster use in young people in Israel, the EMA believes that “the available evidence is sufficient to conclude that the immune response to a booster dose in adolescents it would be at least equal to that of adults.
It assures that “no new safety problems were identified from the available data”, although it stresses that more information from studies and analyzes in adolescents is expected in the coming months.
However, the agency does not indicate a specific time interval between the second and third doses of Pfizer in adolescents and stresses that “the decision about whether and when to offer boosters in this age group” will have to take into account certain factors.
“Such as the spread and likely severity of the disease (especially with the omicron variant) in younger people, the known risk of side effects (particularly the very rare but serious complication of myocarditis), and the existence of other protective measures and restrictions ”, he details.
Therefore, the EMA recommends “the authorization” of the booster dose in this age group, in a decision aimed at “supporting national campaigns in those Member States that offer booster vaccines to adolescents”, but this does not imply that EMA encourage or urge all youth ages 12-17 to inject a Pfizer booster.
Modern for children from 6 to 11 years old
On the other hand, the agency recommended the use of Moderna (Spikevax) in children aged 6 to 11 years after reviewing a study that showed that the immune response – in antibody levels – to the lowest dose of Spikevax (50 µg) was “comparable” to that seen with the highest dose in 18-25 year olds.
“The evidence indicates that the efficacy and safety of Spikevax in children 6 to 11 years of age are similar to those in adults (…) Its benefits in this age group outweigh the risks, especially in those with conditions that increase the risk of developing Severe COVID-19,” he explained.
The most common side effects observed have been similar to those in those over 12 years of age, including pain and swelling at the injection site, tiredness, headache, chills, nausea, vomiting, fever, and muscle pain, among others, which They improve within a few days of the injection.
Moderna’s vaccine is the second supported by the EMA in children under 11 years of age, since the agency already approved last November the use of Pfizer (Comirnaty) in children between 5 and 11 years of age, also with a lower dose than that used in those older than 12 and with an interval of three weeks between the first and the second.
In adolescence, children “are in that moment of tireless search for their personal, sexual, ideological and intellectual identity. To the whirlwind of hormones is added the whirlwind of emotions that they feel with the intensity of their age. This is how the pediatrician and disseminator Lucía Galán describes it in her new book “La vida va de esto” (Planeta), in which she takes off her medical gown, speaks like a mother and tells us some of her keys to dealing with teenagers
PHOTO EFE/Alejandro Garcia
Member of the UNICEF Advisory Council and award from the Spanish Collegiate Medical Organization for the best disseminator, Lucía Galán is concerned about the impact of Covid on adolescents, and more specifically on their mental health.
In an interview with EFEsalud, he cannot help but remember that psychiatric emergencies in children and adolescents have increased by 50 percent during the pandemic.
“Self-harm has increased alarmingly and at the consultation we have seen more cases of eating disorders, anorexia and bulimia, and anxiety disorders, depression and phobias.”
The most tremendous fact, he adds, is that suicide is the first cause of mortality between 15 and 29 years old.
Every day ten people commit suicide in Spain; of them, one is a young man under thirty years of age or an adolescent.
“This is a real drama, a silent and silenced drama”, which must be faced with plans and more resources, he defends.
In her book, Lucía Galán explains that “being sad does not justify in any case having the desire to end your own life, but if you have suicidal thoughts, you should talk to a professional.”
Talking to a professional “is a symptom of strength and not weakness as popular imagination believes,” says the pediatrician.
“Everything is in our mind: resilience, optimism and sense of humor, as well as the attitude towards life, struggle, sacrifice or hope and peace that we all seek after a storm.”
Life “is about accepting that death is part of the journey and that losses, absences and abysses are mourned, and, once you have mourned them, life is also about getting up and moving forward, always moving forward.”
For this reason, he adds, we must know the difference between being sad and having depression, since they are completely different things.
As for depression, he insists, it is a disease and, as such, must be treated.
In his opinion, it is natural to be afraid, “but if it overwhelms us and limits us, that fear can become a phobia and we necessarily have to seek professional help.”
Pediatrician Lucía Galán: dealing with adolescents
In relation to the initial topic of dealing with adolescent children, the pediatrician Lucía Galán invites calm, reflection and listening, and especially to work on the difficult art of communication:
“As they grow up, communication with our children will decrease, and it is completely normal that when they are adolescents they seek refuge in the solitude of their room and in the complicity of their friends.”
And he adds that our adolescent children “need to isolate themselves, to spend more time in their room alone in search of answers that only they have to find.”
Lucia Galan Bertrand
The author invites us not to miss those windows of opportunity that they grant us, such as, for example, when leaving school or institute, and they come home for a snack “and it seems that they have been wound up, they talk and devour in equal parts” .
Or when when picking them up from training, and due to the endorphins released by exercise, our children let go of the reel and there is no one to shut them up.
When that happens, he advises, we should not judge, criticize or question, becauseAutomatically the adolescent will feel attacked and will close his mouth. Maybe he’ll even give up trying to tell us anything again.
In his new book, Lucia Galan also dedicates a chapter to parents who have had a baby and haven’t slept for months, to girls who have had their first period, to the mothers of mothers, to the traveling companion, to life, to death, to enterprising woman and those who do not give up.
Because life, he concludes, «is about looking at his kind and pretty face, which there is, of course there is, and it is beautiful. Life is looking for those refugee people to whom you can always return, no matter what happens.
Chlamydia and gonococcus are the most frequent sexually transmitted infections in adolescents, one of the few population groups worldwide in which a decrease in new HIV diagnoses has not been achieved.
They also point out that more than 50% of minors between the ages of 14 and 17 regularly consume porn on the internet and consider that the role of paediatricians, family members and educational centers is crucial to guarantee responsible sexual behavior among the youngest.
The incidence of sexually transmitted infections (STIs) follows an upward trend in practically all population groups, including adolescents.
According to the latest report from the National Epidemiology Center, between 2016 and 2019 the incidence of gonococcus, chlamydia and syphilis has doubled in young people aged 15 to 19 in Spain.
A worrying reality that pediatricians warn of coinciding with the European Day of Sexual Healthwhich is commemorated every February 14.
for the doctor Cristina Epalza Ibarrondomember of the working group on HIV and sexually transmitted diseases of the Spanish Society of Pediatric Infectious Diseases (SEIP), the data “are especially alarming” in other sexually transmitted infections without a cure today, such as HIV infection.
According to this specialist, adolescents constitute one of the few population groups worldwide in which a decrease in new diagnoses has not been achieved. In them also, late diagnosis is a worrying reality that already affects 30 percent.
Leaving aside the human papillomavirus, which is the most prevalent sexually transmitted infection worldwide – and whose prevalence is estimated to be between 50% and 60% in the first two years after the start of sexual intercourse -, the most common sexually transmitted diseases (STIs) in adolescents are chlamydia and gonococcus.
Epalza points out that around 30% of chlamydia diagnoses and 25% of gonococcus correspond to young people under 19 years of age, in the United States, according to data from the Centers for Disease Control and Prevention (CDC). , for its acronym in English).
Teenagers demonstrate for “real sex education” outside Parliament in London, UK in 2012/Andy Rain
Sexual health and adolescents
For pediatricians it is clear that the esexual education is the pending issue of the health system and schools.
One aspect that worries pediatricians is how little is said about STIs and sexual health among adolescents, taking into account that the age of onset of sexual relations decreases more and more and access to inappropriate sexual content increases.
As the doctor explains Talia Sainz Costaa pediatrician specializing in Infectious and Tropical Diseases and a member of the SEIP, adolescents, who are more vulnerable and easily influenced, “receive sexual references that do not favor global sexual education, where respect for themselves and others is transmitted.”
In this sense and according to Félix Notario, president of the Spanish Society of Adolescent Medicine (SEMA), more than 50% of adolescents between 14 and 17 years old regularly watch porn on the internet.
Something that familiarizes them with risk practices and contributes to a decontextualization of sexuality:
“Adolescents have more information than ever, but between their knowledge and their behavior there is a great contradiction. They lack legitimate information from family, school and health professionals, they do not feel comfortable talking about sexuality with their environment and this does not favor responsible behavior”.
Risky sexual behaviors not only cause an increase in STIs, but also unwanted pregnanciesabuse and frustration in relationships.
For this reason, and taking into account that sexual health forms an important part of the development of individuals, and more especially of adolescents, specialists insist on the fundamental role played by paediatricians, families and schools in this regard and They warn that sexual education continues to be the great pending subject in Spain.
The president of the EMS proposes that in all schools there be at least one sex educator who can give specific guidelines and adapt sex education programs for each of the cycles, as well as the creation of spaces designed for them where they can be attended free of charge and personally by part of trained professionals and without the presence of their tutors.
“Paediatricians for our part, we must open the door to a broader consideration of health that includes sexual health, incorporating, for example, questions about sexuality in our routine clinical interviews,” concludes Dr. Notario.
Poverview: what the WHO says
According to information available to the World Health Organization (WHO), More than 30 different bacteria, viruses, and parasites are transmitted through sexual contact today.
Eight of these pathogens have been linked to the highest incidence of sexually transmitted diseases (STIs).
Four of these diseases can currently be cured: syphilis, gonorrhea, chlamydia and trichomoniasis.
The other four are incurable viral infections: Hepatitis B, herpes simplex virus (HSV or herpes), HIV, and human papillomavirus (HPV).
STIs are spread predominantly through sexual contact, including vaginal, anal, and oral sex. Some STIs can also be passed from mother to child during pregnancy, childbirth, and breastfeeding.
A person can have an STI without showing symptoms. The most common symptoms of STIs are: vaginal discharge, urethral discharge or burning in men, genital ulcers and abdominal pain.
Magnitude of the problem
According to this United Nations organization, every day, more than a million people contract an STI.
And it is estimated that, in 2020, there were about 374 million new infections of one of these four STIs: chlamydia (129 million), gonorrhea (82 million), syphilis (7.1 million) and trichomoniasis (156 million).
The number of people with genital HSV (herpes) infection was estimated to exceed 490 million in 2016, and more than 300 million women are infected with HPV, the leading cause of cervical cancer.
About 296 million people have chronic hepatitis B. Both genital herpes and hepatitis B can be prevented by vaccination. Beyond the immediate effect of the infection, STIs can have serious consequences.
Some STIs, such as herpes, gonorrhea, and syphilis, can increase the risk of becoming infected with HIV.
Transmission of an STI from mother to child can cause prenatal or neonatal death, prematurity and low birth weight, sepsis, pneumonia, neonatal conjunctivitis, and congenital anomalies.
It is estimated that more than one million pregnant women had active syphilis in 2016, which caused complications in around 350,000 births, including 200,000 deaths of the fetus or newborn.
HPV infection causes cervical cancer. Globally, cervical cancer is the fourth most common type of cancer among women, with an estimated incidence for 2018 of 570,000 new cases and more than 311,000 deaths from the disease each year.
In 2019, hepatitis B caused an estimated 820,000 deaths, mainly from cirrhosis or hepatocellular carcinoma (primary liver cancer).
Some STIs, such as gonorrhea and chlamydia, are important causes of pelvic inflammatory disease and female infertility.
A doctor holds a woman’s HIV test during a health campaign in Tegucigalpa, Honduras. EFE/Gustavo Amador
Prevention of sexually transmitted diseases
When used correctly and consistently, condoms are one of the most effective methods of protection against STIs, including HIV infection.
According to the same source, condoms also protect against unwanted pregnancy in consensual sexual relations.
Although highly effective, condoms do not offer protection against STIs that cause extragenital ulcers (ie, syphilis or genital herpes).
Whenever possible, a condom should be used for all vaginal and anal sexual activity.
There are safe and highly effective vaccines to prevent two of the viral STIs: hepatitis B and HPV infection. These vaccines have brought important prophylactic advances against these infections.
By the end of 2020, the HPV vaccine had been introduced into routine immunization programs in 111 countries, mostly high- and middle-income countries.
In low- and middle-income countries, where the majority of cervical cancer cases are concentrated, this vaccination could prevent the death of millions of women in the next decade if vaccination coverage of more than 80% is achieved in girls from 11 to 15 years old.
Research on herpes and HIV vaccination is well advanced, and clinical trials are beginning with several experimental vaccines.
There is increasing evidence that the vaccine to prevent meningitis (MemB) confers cross-protection against gonorrhea.
It is necessary to continue investigating chlamydia, gonorrhea, syphilis and trichomoniasis, points out the aforementioned organization.
Finally, he points out that there are other biomedical interventions to prevent some STIs, such as circumcision in adult men and the use of microbicides.
