Fully vaccinated have the lowest risk., iStockphoto.com  | Bihlmayer Fotografie © iStockphoto.com | Bihlmayer Fotografie

Important Patient Information

Vaccination is the best protection

Even with CHD, the benefits outweigh the risks

Since the first months of 2021, the corona variant delta has displaced the variant alpha in Germany and spread strongly. The available vaccines against COVID-19, when fully vaccinated, offer a high level of protection even against severe disease caused by this virus variant.

Nevertheless, vaccination progress to date has been slow. Many parents of children with congenital heart defects, as well as adults and adolescents with congenital heart defects, are understandably concerned.

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    Slow increase in vaccination rates

    Fully vaccinated have the lowest risk. © iStockphoto.com | Bihlmayer Fotografie
    Fully vaccinated have the lowest risk.

    Since August, the Ständige Impfkommission (STIKO) has also been urgently recommending vaccination of all children over the age of twelve. By the beginning of October, slightly more than one in three (as of 08.10.2021: 37 percent) between the ages of twelve and 17 had received a complete vaccination. The overall rate of those fully vaccinated is 65.3 percent. According to calculations by the Robert Koch Institute (RKI), however, this figure must be 85 percent for those aged twelve to 59 and 90 percent for those aged 60 and older. Only then could the transmission 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.


Self-protection and consideration for the youngest

The unwillingness of people to be vaccinated is a major burden and challenge, especially for at-risk patients under 12 years of age, their parents and their environment. This is because an appropriate vaccination solution is just beginning to emerge for the youngest. Until then, they are highly dependent on the general population's willingness to vaccinate and consideration for their safety if they are to participate equally in social life in daycare, school and leisure.

How safe is vaccination even in severe AHF?

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 getting vaccinated with the mRNA vaccine from BioNTech or Moderna from the age of twelve, especially in cases of congenital heart defects: "Like the STIKO, we base our recommendations on what has been scientifically proven. The risks of vaccination, even for children and adolescents with severe congenital heart defects, are vanishingly small compared to the high risks of infection." 

Responsibility for society as a whole

Pediatric cardiologists also observe with great concern the consequences of contact, kindergarten, after-school and school restrictions. "Many children with heart disease were and are extremely protected from contact. Even in the Corona pandemic, children have a right to be able to participate in their familiar daily lives to the best of their ability. Here we have a responsibility to society as a whole. Everyone who gets vaccinated protects themselves and others, saves lives and helps to ensure that children who are particularly at risk are not restricted in their right to a self-determined life," says Professor Dietmar Schranz, pediatric cardiologist and emeritus professor at Justus Liebig University in Giessen.

Vaccination under twelve

He also firmly expects that the necessary scientific data will soon be available for a vaccination recommendation for children under twelve. Until that time comes, pediatric cardiologists still advise against general vaccination under twelve. "In terms of tolerability and side effects, but also with regard to the vaccination dose, one cannot simply orient oneself on the data from children over 12 years of age or even adults; all this must first be clarified by reliable studies," says Professor Hans-Heiner Kramer, explaining the restraint.

Delta variant carries higher risks for at-risk patients from 6

However, the experts make an exception for high-risk patients among younger 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. According to the current state of knowledge, the pediatric cardiologist would therefore affirm the vaccination of high-risk patients in the group of 6- to 12-year-olds even now: "The delta variant has a much higher 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." Parents of children under twelve with severe congenital heart defects should therefore consult with their treating pediatric cardiologist about possible vaccination.

For more information on vaccination of children and adolescents, see the German Heart Foundation's fact check with Professor Dietmar Schranz.

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