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Vaccination rates are low among children, but health officials are warning of a likely winter surge of COVID-19.

PMG FILE PHOTO - Felipe receives a dose of the COVID-19 vaccine at a vaccination clinic hosted by Virginia Garcia Memorial Health Center at Beaverton's Aloha-Huber Park Elementary School in November 2021.Updated COVID-19 booster shots for children as young as 5 have been approved in Oregon as officials urge people to get vaccinated ahead of an expected winter surge.

Bivalent boosters targeting the original strain of COVID-19 and the omicron variant, which has been dominant locally and nationally for months, were rolled out for people 12 and older last month.

Federal and state health officials approved the updated vaccine for elementary school-age kids on Wednesday, Oct. 12, making an estimated 343,000 children in Oregon eligible for doses at least two months after their primary series of COVID-19 vaccinations or a monovalent booster dose.

People should schedule appointments for bivalent booster because it offers protection against the highly contagious omicron variant as immunity from previous doses has waned and infections are likely headed for a seasonal uptick, said Dean Sidelinger, health officer and state epidemiologist at the Oregon Health Authority, during a press conference Thursday, Oct. 13.

The updated boosters "are our best protection as we move into the fall and winter, as respiratory viruses like COVID-19 typically spread at higher rates," Sidelinger said. He added that people should schedule their annual flu shots as well.

While children tend to have less severe infections than adults, cases and hospitalizations for the age group have increased during prior waves of the virus.

Pediatricians have been trying to make it clear that COVID-19 can have a harsh impact on children, said Dr. Eliza Hayes Bakken, associate professor of pediatrics at OHSU and medical director of the general pediatric and adolescent clinic at the OHSU Marquam Hill campus.

"While children are proportionately less affected, they're not unaffected," Bakken said in an interview with Pamplin Media Group last month. "There are deaths and long-term complications in children that make us concerned. We have a lot of conversations around the fact that COVID is impacting children at much higher rates right now in terms of complications and even death than even other things that we routinely vaccinate for."

The bivalent boosters protect against the most common strains because they're made with the genetic recipe for the COVID-19 spike protein components of the omicron BA.4 and BA.5 subvariants.

Similar to the process for annual changes to flu vaccines, federal officials approved the updated boosters without requiring human test results. They relied on safety and effectiveness data from the original COVID-19 vaccines and trials of the new formulation in mice. Also, human trials for a similar vaccine targeting a prior omicron subvariant found it safely elicited a strong immune response.

The bivalent boosters for children are no different than they are for adults, except they're a smaller dose. The booster made by Pfizer-BioNTech, which is available to kids aged 5 to 11, will be administered at one-third of the dose of the booster for anyone older than 12. The booster made by Moderna, which is available for kids aged 6 to 11, will be administered at half the dose for older age groups.

To pediatricians' disappointment, the uptake of the vaccine among children has been low.

Statewide, 37% of kids aged 5 to 11 have received two primary doses of the COVID-19 vaccine, making them eligible for a booster. In Multnomah County, the rate is higher, but still low at 53%.

Among children under 5, who received approval for their first doses of the vaccine in June, the numbers are far lower. Only 9.5% of the youngest kids in Oregon have completed their primary vaccination series. Eighteen percent of kids in the age group have completed the primary series in Multnomah County.

It will take months for regulators to decide whether the youngest children should be eligible for boosters using the currently available vaccine recipe.

State health officials recommend people check with their medical providers to schedule doses or use the Get Vaccinated Oregon tool to find available appointments.

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