The COVID-19 pandemic began in late 2019 and has now become a global endemic infection like influenza. That means it will continue to re-occur regularly throughout the globe. Furthermore, like influenza, the COVID-19 virus cleverly mutates into new variants that may or may not be more infectious or virulent. Therefore, like influenza, periodic re-vaccination against COVID-19 and its prevalent variants will become standard practice.
Although children with cancer generally have better outcomes with COVID-19 infection than adults with cancer, their risks of hospitalization, intensive care unit admission, and death are still greatly increased compared to the general pediatric population.
A North America-wide study from August 2021 found that about 20 percent of pediatric cancer patients who tested positive for COVID-19 experienced a severe infection, compared to 1-6 percent of children in the general population. Additionally, there are socio-economic and ethnic disparities present in these effects.
Waiting to see how COVID-19 effects long-term childhood health outcomes
It has yet to be seen how delays in cancer diagnosis, delays and interruptions of cancer treatment, and direct toxicities (to the heart and lungs especially) caused by the COVID-19 virus itself may affect long-term outcomes in children.
The Children’s Oncology Group (COG), an NIH-funded consortium including 100% of pediatric cancer centers in North America, has released advice for childhood cancer survivors and parents of children with cancer. Parents are advised that in most cases, treatment for children continues as planned: “Do not stop chemotherapy without talking to your child’s treatment team first.” If your child develops a fever, “you should continue to follow the usual instructions for fever that you have received from your health care team.”
The COG advises cancer survivors to take extra precautions regarding social distancing and good hygiene. For survivors who suspect they may have the coronavirus, COG emphasizes that any healthcare providers they may see for COVID-19 testing or care must be informed: that they are a cancer survivor; of any chronic health conditions; and if their cancer treatment places them at high risk for lung or heart problems (such as chest radiation therapy or certain chemotherapies).
The Children’s Oncology Group strongly recommends that children in treatment and cancer survivors receive the COVID-19 vaccine as soon as they are eligible.
For children in treatment who are age-eligible for the vaccine (aged over six months), the timing of vaccination may depend on treatment considerations, so talk to your oncology team. COG notes that “a small number of people are allergic to one of the vaccine components. If your child has had a severe allergic reaction to polyethylene glycol (PEG) or to polysorbate, check with their health care provider to determine which formulation of the vaccine is best for your child.”
Risk may be elevated for those with lowered immunity to viral infections
Current information suggests that a cancer history alone does not increase the risk of developing COVID-19. But, according to the COG, the risk may be elevated for those with lowered immunity to viral infections, such as survivors with chronic graft-versus-host disease; survivors taking certain medications like corticosteroids, immunosuppressants, or medications that prevent or treat graft or organ rejection; and those who are currently receiving chemotherapy or have been treated with chemo within the past six months.
Bone marrow transplant recipients are at increased risk of severe infection and mortality if they develop COVID-19. COVID-19 survival is currently about 95-99 percent in the general population but drops to 68 percent among transplant recipients. This risk applies even to those whose transplants took place more than a year ago.
Survivors with chronic health conditions affecting the heart or lungs, such as pulmonary fibrosis or cardiomyopathy, may be at higher risk of complications from a COVID-19 infection, according to the COG. Furthermore, “it is also possible that survivors who received treatments that may damage the heart or lungs may be at increased risk for complications if they develop COVID-19 infection. These treatments include: Anthracycline chemotherapy (such as doxorubicin and daunorubicin); Bleomycin, busulfan, carmustine, or lomustine chemotherapy; or irradiation involving the heart or lungs, including total body irradiation (TBI) and irradiation to the chest, axilla, abdomen, or spine.”
Vaccination offers the best protection
For children in treatment who are age-eligible (six months and up) and for childhood cancer survivors and their families, receiving the COVID-19 vaccination offers the best possible protection against severe impacts of the virus.
Should you have additional questions or concerns, the specialist physicians in our MORE Health for Kids provider network would be pleased to discuss them with you through our expert second opinion process.
About the Author
Jonathan Finlay, MD, ChB, FRCP, is the Pediatrician-in-Chief of MORE Health for Kids. He is an Emeritus Professor of Pediatrics at The Ohio State University College of Medicine and is Principal Investigator of NEXT / Head Start 4 Consortium Trial at Nationwide Children’s Hospital. Among his many awards, he is the first pediatric specialist to receive a Lifetime Achievement Award from the Society of Neuro-Oncology.