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How to talk to children about getting their vaccine: U of T's Jean Wilson shares advice – News@UofT



With kids age five to 11 now eligible for COVID-19 vaccines in Ontario, Jean Wilson of the University of Toronto’s Lawrence S. Bloomberg Faculty of Nursing has some tips to help lessen children’s fear of needles – and ease parents’ anxiety, too. 

Jean Wilson

“Well before their child’s first scheduled vaccinations, I start by talking to parents about the importance of vaccinations,” says Wilson, an assistant professor, teaching stream and nurse practitioner at St. Michael’s Hospital. “Every parent wants to do what is best for their child, so the more information they have the more comfortable they will be with their decision.”

Wilson was part of a panel of experts from the Leslie Dan Faculty of Pharmacy, Faculty of Nursing, Centre for Addiction and Mental Health and Niagara Region Public Health who shared insights last week in a talk titled “How to Talk to Your Children About Vaccines.” The event aimed to provide parents and caregivers with helpful information to prepare their kids for vaccines including Health Canada-approved COVID-19 shots.

The line-up of speakers also featured Anna Taddio, a pharmacy professor who developed the CARD system to reduce pain and fear of needles among kids. CARD (Comfort, Ask, Relaxation and Distract) is an evidence-based system that invites students to choose a coping strategy to improve the vaccination experience (such as playing with their phones to distract them from getting a shot.)  

Wilson, who has worked for the Public Health Agency of Canada on communicable disease outbreak management, discussed how the mRNA vaccines work and the importance of vaccination.

She recently spoke with U of T’s Rebecca Biason about how to help kids cope with needle phobia and how nurse practitioners can reduce vaccine hesitancy. 

How can parents help kids feel comfortable with getting vaccinated?

One of the first things I ask parents is whether they are afraid of needles. If the parent is anxious, the child can often pick up on this energy. I suggest that parents try to get as much information as possible about the decision they are making, appear calm and normalize the situation when discussing vaccines and needles with their children. Being honest with their child is very important. It is important to say, “We are going to get your needle today, it will pinch for a few seconds, but right after we will go to the store [or some other positive experience for the child].” Making it a part of a normal day helps the child feel more at ease and doesn’t make the vaccine experience feel so momentous.

This is also where parents and practitioners can utilize Professor Anna Taddio’s Comfort, Ask, Relax, Distract (CARD) system. I will often ask parents to help the child feel comfortable. Maybe that’s lying down or maybe that’s sitting on the parent’s lap. For babies who are breastfeeding, I would encourage mom to breastfeed before and after the vaccine as it has been shown to comfort, distract and manage pain.

Parents and practitioners can adapt the CARD system depending on the developmental age of the child as well. For older kids or teenagers, we might suggest they put headphones on and listen to their favourite song.

In my practice, I have liquid bubbles on hand to blow after a vaccine that works really well for children six months and up. Sometimes, we clap hands and/or sing songs after the vaccination – all of which can distract the child from any pain they might feel. I might also ask the child to wiggle their toes on the count of three before giving the shot. This distracts the brain/pain pathway physiologically, and can also help minimize pain.

The CARD system is an important part of the toolbox and I encourage practitioners and parents to try and utilize it to help make the vaccination process for their children more comfortable, less anxiety provoking and empowering for parents too.

How are the common misconceptions about the vaccine that you have encountered?

I get questions about the vaccine being rushed to market and whether it is safe. While the pandemic has required a more expedited process to help us get a vaccine, I discuss with parents that we have a comprehensive and robust vaccine approval process in Canada, and this continues even with the COVID-19 vaccines. While the vaccine manufacturer information and research data is coming in on an ongoing basis, experts at Health Canada, the Public Health Agency of Canada and provinces have been working hard to review the information in detail, strictly adhering to all the safety checks and balances that have always been in place to ensure that vaccines used in Canada are effective and safe.

The Pfizer-BioNTech COVID-19 vaccine approved for use in children by Health Canada shows side-effects that are very mild and similar to what we have seen with children 12 years and older receiving the vaccine. There were no severe allergic reactions or complications (such as myocarditis/pericarditis, multi-system inflammatory syndrome or deaths). This safety profile has also been seen in the 2.5 million children vaccinated in the United States where the vaccine was approved earlier this fall.

Another question I often get is does the mRNA change our DNA and/or interfere with fertility? The answer is no.

I tell parents how the vaccine works in the body. The mRNA in the vaccine is a small blueprint for only the spikes on the outside of the virus that causes COVID-19. When the person gets the vaccine, the mRNA goes into the cell but never goes into the nucleus where our DNA is stored. The mRNA stays in the cell liquid outside the nucleus and that is where the mRNA is read, processed and protein pieces move to the outside of the cell surface, so the person’s immune system starts to create protection called antibodies against COVID-19. The body destroys all the vaccine mRNA shortly after it is read. Once antibodies are created, if the person is ever exposed or infected with the actual COVID-19 virus, their immune system identifies the spikes and immediately starts to attack the virus and stops or minimizes the infection.

Why should parents vaccinate their children against COVID-19?

Parents want to make the best decisions for their children. This is where the “Ask” part of the CARD system comes into play. A parent’s hesitancy around vaccinations can be the result of a variety of things including their own experiences with vaccinations, mistrust of the health-care system as a whole or misinformation they have gleaned from the internet. Providers can often alleviate hesitancy by providing trusted information and online resources.

I often get questions about why children should get vaccines if they don’t get symptoms or only a very mild case of COVID-19. While this is true, unfortunately in the third and fourth COVID waves, we have seen more children becoming sick with COVID. While the risk of severe illness and hospitalization is less for children compared with adults, this still occurs and can happen to children who were otherwise healthy.

I discuss with parents the possible complications of COVID. Some children might develop multi-system inflammatory syndrome and require hospitalization. We also know from newly published research about children with COVID, regardless of the severity, can develop complications such as long COVID, a condition in which COVID symptoms remain with the child for months after the initial illness. We are still learning more about this.

Finally, I talk to parents about the social and psychological aspects of the pandemic on children. The faster we get as many people protected from this virus, the sooner we can get back to normal life for both parents and children. We know that children have been impacted by the change in routine, social isolation, disruption to school and extracurricular activities and the stressful impact COVID has had on their parents, family and friends. Part of the vaccination process is to assist in making the child’s environment stable again for their well-being. I encourage parents who are talking to their children about the COVID vaccine to explain that this will help us get back to activities they love such as going to school, sports activities, sleepovers, visiting grandparents and other elderly loved ones and taking family trips.

When I sit with people who have been hesitant, it takes such a short amount of time to answer their questions in a non-judgmental, respectful way. It doesn’t take much to reassure them. As practitioners, we must be able to take that time to listen and answer questions knowledgably and most of the time, parents are reassured and feel better informed to make this important decision for themselves and their children. Nurses are a highly trusted profession and viewed as being knowledgeable. Using that gift and skill is vital to helping people make evidence-based decisions.

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Omicron subvariant appears more contagious, but not more severe, Denmark says



The BA.2 subvariant of the Omicron coronavirus variant, which is dominant in Denmark, appears more contagious than the more common BA.1 sub-lineage, Danish Health Minister Magnus Heunicke said on Wednesday in a national address.

“There is no evidence that the BA.2 variant causes more disease, but it must be more contagious,” Heunicke told a news conference.

The BA.1 lineage currently accounts for 98% of all cases globally but in Denmark has been pushed aside by BA.2, which became the dominant strain in the second week of January.

The UK Health Security Agency has designated BA.2 a variant under investigation, saying it could have a growth advantage.

Preliminary calculations suggest BA.2 could be 1.5 times more infectious than BA.1, Denmark’s top infectious disease authority, Statens Serum Institut (SSI), said in a note on Wednesday.

However, an initial analysis by the institute showed no difference in the risk of hospitalisation for BA.2 compared to BA.1.

“There is some indication that it is more contagious, especially for the unvaccinated, but that it can also infect people who have been vaccinated to a greater extent,” SSI’s technical director Tyra Grove Krause said at the briefing.

This could mean the peak of Denmark’s epidemic will extend a bit further into February than previously forecast, Krause said.

BA.2 cases have also been registered in Britain, Sweden and Norway, but to a much lesser extent than in Denmark.

Denmark on Wednesday announced plans to scrap the last of its COVID-19 restrictions by Feb 1, the latest country in Europe to do so despite record high daily infection numbers.

(Reporting by Nikolaj Skydsgaard and Stine Jacobsen;Editing by Alison Williams, Kirsten Donovan)

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Pfizer, Moderna shots safe during in vitro fertilization; healthy gut bacteria may help prevent long COVID



The following is a summary of some recent studies on COVID-19. They include research that warrants further study to corroborate the findings and that has yet to be certified by peer review.

mRNA vaccines safe during in vitro fertilization

COVID-19 vaccines using mRNA technology do not affect fertility outcomes during in-vitro fertilization (IVF), researchers have found.

They compared rates of fertilization, pregnancy, and early miscarriage in IVF patients who had received two doses of the vaccines from Pfizer with BioNTech or ModernaO> with those in unvaccinated patients. The 222 vaccinated and 983 unvaccinated patients who underwent ovarian stimulation – medical treatment to stimulate development of eggs – had similar rates of eggs retrieved, fertilization, and embryos with normal numbers of chromosomes. The 214 vaccinated and 733 unvaccinated patients who underwent frozen-thawed embryo transfer – where their eggs were collected from the ovaries and fertilized by sperm in a laboratory, creating embryos that were frozen and later thawed and transferred to the womb – had similar rates of pregnancy and early pregnancy loss, according to a report published on Tuesday in Obstetrics & Gynecology.

“Our findings contribute to the growing body of evidence regarding the safety of COVID-19 vaccination in women who are trying to conceive,” the researchers concluded.

Healthy gut bacteria may protect during COVID

The bacteria living in your small intestine may contribute to the risk for long COVID after infection with SARS-CoV-2, new findings suggest.

Researchers analyzed the “gut microbiome” in 116 COVID-19 patients in Hong Kong in 2020, when regulations required that every infected person be hospitalized. More than 80% were mildly or moderately ill, but more than 75% had at least one persistent symptom. After six months, the most common symptoms were fatigue (reported by 31%), poor memory (28%), hair loss (22%), anxiety (21%) and sleep disturbances (21%), according to a report published on Tuesday in Gut. Analyses of stool samples obtained at hospital admission and over the succeeding months showed long COVID patients “had a less diverse and less abundant microbiome,” said Siew C. Ng of The Chinese University of Hong Kong. “Patients who didn’t develop long COVID had a gut microbiome similar to that of people without COVID-19.”

Lack of “friendly” immunity-boosting Bifidobacteria species was strongly associated with persistent respiratory symptoms, Ng noted. While the study cannot prove that healthy gut organisms prevent long COVID, the findings suggest “maintaining a healthy and balanced gut microbiota via diet, avoidance of antibiotics if possible, exercise and supplementing with depleted bacteria species including Bifidobacteria” might be helpful, she said.

New PCR test can identify variants

A new type of PCR test can quickly tell which variant of the coronavirus is causing infection, helping doctors choose the most effective antibody treatments, researchers said.

Most current PCR tests can check broadly for the presence of the virus but cannot identify specific variants. The new test uses special “probes” – fluorescently labeled molecules – called “sloppy molecular beacons” that glow in different colors when they attach themselves to DNA or RNA in the virus. When the sample from the patient is heated, the probes fall off their DNA or RNA targets and their color disappears. They fall off at different temperatures depending on the DNA or RNA sequence they were bound to. Because the variants each have some unique sequences, they can be identified based on the pattern of color changes at each temperature, explained Dr. David Alland of \?


“We have already performed a clinical study which showed that the assay was 100% sensitive and 100% specific for identifying variants of concern including Delta and Omicron,” Alland said. “We are asking the N.J. Dept of Health to clear our test” so that New Jersey labs can use it, he added. A typical hospital molecular laboratory would be able to perform it, his team reported on Friday on medRxiv ahead of peer review.

U.S. study finds slight myocarditis risk with mRNA vaccines

There is a small but increased risk for heart muscle inflammation, or myocarditis, following receipt of the mRNA COVID-19 vaccines from Pfizer/BioNTech and Moderna, researchers from the U.S. Centers for Disease Control and Prevention have found.

The 1,626 cases documented in the Vaccine Adverse Event Reporting System from December 2020 through August 2021 “exceeded the expected rates,” the researchers reported on Tuesday in JAMA. Overall, 73% of reported cases were in people under age 30, and 82% were males. The highest rates were found among adolescent and young adult males. For every million doses of Pfizer’s vaccine, there were roughly 71 cases of myocarditis in males ages 12 to 15 and 106 cases in males ages 16 or 17. In young men ages 18 to 24, the rate per million doses was roughly 52 with the Pfizer shots and 56 after Moderna shots. About 96% of patients with myocarditis were hospitalized. In 87%, symptoms were gone by the time they were discharged. Non-steroidal anti-inflammatory drugs were the most common treatment.

“This risk should be considered within the context of the significant benefits of COVID-19 vaccination in preventing COVID-19 infection and potential serious complications,” said a spokesperson for the authors, who noted that COVID-19 itself confers a 16-times higher risk for myocarditis. “The benefits of COVID-19 vaccination continue to outweigh any potential risks.”

Click for a Reuters graphic on vaccines in development.


(Reporting by Nancy Lapid; Editing by Bill Berkrot)

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A third of airline pilots still not flying as pandemic drags on -survey



More than one-third of airline pilots are still not flying as the pandemic continues to take its toll on aviation globally, according to a new survey, though the situation has improved from a year earlier when the majority were grounded.

A poll of more than 1700 pilots by UK-based GOOSE Recruitment and industry publication FlightGlobal, released on Wednesday, found 62% globally were employed and currently flying, up from 43% a year earlier.

The proportion of unemployed pilots fell from 30% to 20%, while 6% were on furlough, compared with 17% previously as air traffic began to bounce back from 2020 lows.

But in the Asia-Pacific region, the worst-hit globally by a drop in international travel due to tough border restrictions, the proportion of those unemployed rose from 23% to 25%. The region also had the lowest number that were employed flying at 53%.

“We have … seen some expatriates return home from the region due to concerns over quarantine or being stuck for long periods away from friends and family,” the report on the survey said.

Hong Kong’s Cathay Pacific Airways, a large expatriate employer in Asia, has lost hundreds of pilots through the closure of its Cathay Dragon regional arm as well as almost all of its overseas bases during the pandemic.

Pilot attrition at Cathay has also been rising amid strict layover rules that leave crew members locked in hotels when they are not flying.

Of the pilots still flying globally, 61% told the survey they were concerned about their job security.

“It appears only Northern America is back to post-COVID passenger numbers,” said an unnamed captain flying in the Middle East and Africa. “The rest of the world, especially developing nations, are still struggling to get vaccines, and are still not travelling.”


(Reporting by Jamie Freed in Sydney; Editing by David Gregorio)

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