We read with interest the review by Gabis et al. about the association between SARS-CoV-2 vaccines and autism-spectrum disorders(ASD) in children.[1] It was concluded that SARS-CoV-2 vaccines are safe in children, that SARS-CoV-2 vaccines do not cause ASD, and that the myth that SARS-CoV-2 vaccines cause ASD still persists and affects parental attitudes towards vaccination and increases vaccination refusal rates.[1] The study is appealing but raises concerns.
We do not agree that fear from autism is the reason for parents’ hesitancy to immunise their children. According to a search in PubMed not a single pediatric patient with autism triggered by a SARS-CoV-2 vaccination has been reported. More likely than fear from autism, is fear from severe adverse events (SAE) that is responsible for the parent’s hesitancy. SAE of SARS-CoV-2 vaccinations that have been described in children include MIS-C,[2], myocarditis,[3] peri-myocarditis,[4], Guillain-Barre syndrome (GBS), [Finsterer, submitted] thrombocytopenia,[5] facial palsy,[6], vulvar aphthous ulcer,[7], and hypersensitivity reactions.[8],
Parents’ fear from vaccinating their children may be supported by the complications of SARS-CoV-2 infections in children, which include stroke, intracerebral bleeding, subarachnoid bleeding, micro-hemorrhages, venous sinus thrombosis, immune encephalitis, reversible splenial lesions, ADEM, MIS-C, transverse myelitis, GBS, cranial nerve lesions, meningo-encephalitis, encephalopathy, benign intracranial hypertension, and myositis.[9]
A further reason for concerns of parents about SARS-CoV-2 vaccinations in their children is the limited knowledge about the safety profile of SARS-CoV-2 vaccinations in children, which results from the fact that only few children were vaccinated so far compared to adults.
Following the preliminary results available about side effects of SARS-CoV-2 vaccines in children, it is comprehensible why parents have reservations against immunising their children. In addition to medical reasons hesitancy may originate from disinformation through social media. Health care authorities, scientists, and media are obliged to provide valid and reliable data about the pros/cons of SARS-CoV-2 vaccinations in children.
Gabis, L.V., et al. “The Myth of Vaccination and Autism Spectrum.” European Journal of Paediatric Neurology, vol. 36, January 2022, pp. 151–158. https://doi.org/10.1016/j.ejpn.2021.12.011.
Abdelgalil, A.A., and F.A. Saeedi. “Multisystem Inflammatory Syndrome in a 12-Year-Old Boy After mRNA–SARS-CoV-2 Vaccination.” Pediatric Infectious Disease Journal, vol. 41, no. 3, March 2022, pp. e93–e94. https://doi.org/10.1097/INF.0000000000003442.
Dionne, A., et al. “Association of Myocarditis With BNT162b2 Messenger RNA COVID-19 Vaccine in a Case Series of Children.” JAMA Cardiology, vol. 6, no. 12, December 2021, pp. 1446–1450. https://doi.org/10.1001/jamacardio.2021.3471.
Snapiri, O., et al. “Transient Cardiac Injury in Adolescents Receiving the BNT162b2 mRNA COVID-19 Vaccine.” Pediatric Infectious Disease Journal, vol. 40, no. 10, October 2021, pp. e360–e363. https://doi.org/10.1097/INF.0000000000003235.
Underdown, M.J., and R. Nuss. “Thrombocytopenia in a Teen With Sickle Cell Disease Following COVID-19 Vaccination.” Pediatric Blood & Cancer, vol. 68, no. 12, December 2021, p. e29271. https://doi.org/10.1002/pbc.29271.
Ahsanuddin, S., et al. “Facial Paralysis and Vaccinations: A Vaccine Adverse Event Reporting System Review.” Family Practice, vol. 39, no. 1, January 2022, pp. 80–84. https://doi.org/10.1093/fampra/cmab068.
Popatia, S., and Y.E. Chiu. “Vulvar Aphthous Ulcer After COVID-19 Vaccination.” Pediatric Dermatology, vol. 39, no. 1, January 2022, pp. 153–154. https://doi.org/10.1111/pde.14881.
Caffarelli, C., et al. “Hypersensitivity Reactions to Vaccines in Children: From Measles to SARS-CoV-2.” Pediatric Allergy and Immunology, vol. 33, suppl. 27, January 2022, pp. 58–60. https://doi.org/10.1111/pai.13631.
Siracusa, L., et al. “Neurological Complications in Pediatric Patients With SARS-CoV-2 Infection: A Systematic Review of the Literature.” Italian Journal of Pediatrics, vol. 47, no. 1, June 2021, p. 123. https://doi.org/10.1186/s13052-021-01066-9.
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