Important Patient Information
Vaccination is the best protection
Even with CHD, the benefits outweigh the risks
In the first months of 2021, the Corona variant Delta displaced the Alpha variant in Germany and spread rapidly. Since December, the Omicron variant, which is even more contagious, has increasingly determined the course of the infection. The available vaccines against COVID-19 offer a high level of protection against severe corona after complete vaccination plus booster.
This is particularly true for children, adolescents and adults with congenital heart defects, and even more so if they belong to one of the risk groups identified so far. Nevertheless, the vaccination rate in Germany is increasing unsatisfactorily slowly.
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Slow increase in vaccination rates
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Fully vaccinated have the lowest risk. In August 2021, the Ständige Impfkommission (STIKO) also urgently recommended vaccination of all children aged twelve and older for the first time. By the end of December, slightly more than one in two (as of Jan. 06, 2022: 53.6 percent) children between the ages of twelve and 17 had been fully vaccinated. The overall rate of fully vaccinated is 71.5 percent. 40.9 percent have also received a booster vaccination by Jan. 06, 2022. However, according to calculations by the Robert Koch Institute (RKI), 85 percent of those aged 12 to 59 and 90 percent of those aged 60 and older should have been fully vaccinated. Only then could the spread of SARS-CoV-2 be kept below the critical threshold of 50 infected persons per 100,000 per week. The Robert Koch Institute (RKI) provides information on the current status of vaccinations.
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Vaccination is especially important for children with previous illnesses and for children who have a lot of contact with people with previous illnesses, such as siblings with congenital heart defects or adults with previous illnesses. BioNTech's Comirnaty mRNA vaccine is administered in a dose suitable for children.
How Safe is Vaccination Even in Severe CHD?
The Kiel pediatric cardiologist Professor Hans-Heiner Kramer, chairman of the expert panel and member of the steering committee of the Competence Network for Congenital Heart Defects, together with his colleagues, strongly recommends following the recommendations of the Ständige Impfkommission (STIKO) and to have children five years and older vaccinated with BioNTech's Comirnaty mRNA vaccine if they are in a high-risk group: "Like the STIKO, we base our recommendations on what has been scientifically proven. The risks of this vaccination, even for children and adolescents with severe congenital heart defects, are vanishingly small compared to the high risks of infection."
Rare Complications in Children
The very rare but severe complications observed in connection with Covid 19 infection in children under the age of twelve include pediatric inflammatory multisystem syndrome (PIMS or MIS-C for multisystem inflammatory syndrome in children) and associated vasculitis, which then also leads to myocarditis.
"The target of Covid-19 viruses is primarily the vascular endothelium, which are the cells that line the inside of blood vessels as a thin layer. They have the highest ACE-2 receptor occupancy, the docking site for the Covid-19 virus. So vasculitis is more likely to be behind the myocarditis observed more frequently with Covid-19," explains Professor Dietmar Schranz. "The delta variant has a more significant binding to the ACE-2 receptors and especially in the severe vasculitis in the context of a PIMS/MIS-C, a conspicuously large number of eight-year-old children were affected."
Children under twelve with severe congenital heart defects should definitely be vaccinated for this reason as well. Little is yet known about the long-term course of infection when comparing the different virus variants.