Omicron worries spur some Alberta parents to book early 2nd doses for their kids

As concerns about Omicron mount, and with schools expected to reopen on Monday, some Alberta parents are opting to get their younger children a second dose of the COVID-19 vaccine earlier than officially recommended.

While the Pfizer pediatric formulation is approved for a three-week interval in Canada, both the province and the National Advisory Committee on Immunization recommend waiting at least eight weeks before giving 5- to 11-year-olds their second shots.

NACI issued its guidance in November, prior to the Omicron-driven surge, stating it landed on the eight-week interval because "emerging evidence in adults suggests that compared to shorter intervals, longer intervals between the first and second doses result in a stronger immune response, higher vaccine effectiveness that is expected to last longer, and may be associated with a lower risk of myocarditis and/or pericarditis in adolescents and young adults."

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While Alberta Health Services was rebooking appointments made earlier than eight weeks apart, it has stopped that practice. And many Alberta parents are now weighing the benefits and risks of getting their child's second dose early.

"I'm not super comfortable with them returning to school," said Calgary mother Breffney Kreitner, who agonized over the decision.

She had her two youngest children, ages five and nine, vaccinated as soon as they became eligible in late November. Under Alberta's guidance, they aren't supposed to get their second dose until later this month.

"I'm very anxious that they will get COVID and they won't be fully vaccinated when they do," said Kreitner a few hours before she took her youngest kids in for their second doses on Tuesday — three weeks earlier than the official recommendation.

Kreitner hopes this will offer her children better protection when they are back in school.

'A tough decision'

"I'm hearing a lot of people saying that that's what they're doing," said Dr. Raj Bhardwaj, a Calgary urgent care physician who also teaches in the Cumming School of Medicine at the University of Calgary.

"It absolutely is a tough decision and it should be. And that's OK. It's OK to agonize over it because you want to do the best thing for your kids. And unfortunately we have some blind spots in our knowledge."

Bhardwaj said there is still uncertainty around the potential risks and benefits of shortening the interval.

"We think that the payoff is that you will have better immunity sooner, which is important with Omicron. And then the cost might be that that immunity might not be as long lasting as when we separate the doses by a longer period of time."

With third doses likely coming for children, he said, giving children a second shot earlier could be beneficial as Omicron cases spike. The hope is, though, that if their immunity wanes earlier, it comes when transmission rates have dropped and third doses are at hand.

"It is a gamble, but it's a gamble that I'm hearing a lot of patients are deciding to take."

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According to Dr. Daniel Gregson, an infectious disease physician and medical microbiologist at the University of Calgary's Cumming School of Medicine, the pediatric vaccine trials were conducted with a three-week interval between doses.

"The evidence we have in adults is that prolonging that interval out to six weeks or longer results in a better level of antibodies and immune response than you get with a shorter interval. That being said, the three-week interval was efficacious in terms of reducing COVID infections in children between the ages of five and 11," he said.

According to the Alberta Health website, more than 15,000 kids ages five to 11 in the province now have two doses. 

"It's not unreasonable to go early given what's going on in the country," Gregson said.

"If we were back in November here in Alberta, I would say probably wait. But that's not where we are today.… Omicron has changed this recommendation. The vaccine was approved in Canada a while back with the understanding that things weren't exploding and we had fairly good control over spread within schools."

Gregson noted Alberta offered second doses to health-care workers after a shorter period earlier in the pandemic.

"We were doing four weeks back this time last year with health-care workers, and I don't think it's a huge mistake to go a little bit shorter given what's going on at the current time."

Alberta's chief medical officer of health, Dr. Deena Hinshaw, said in a news conference on Tuesday that she is watching for updated guidance from NACI and has spoken with her counterparts in other provinces.

Alberta, though, is standing by the eight-week interval.

"Ultimately, I would say that the general recommendation continues to be that protection is important, not just right now but for the long term, which is why we continue to recommend that eight-week interval. And … it is a decision that I've made for my own children," she said.

In an email to CBC News, a government spokesperson said parents can book a shorter interval through AHS if their child is immuno-compromised or if the second dose is needed for travel.

The province also confirmed AHS is no longer rebooking appointments if parents wish to have the second dose done earlier "after hearing about the benefits of the longer interval."

Timing will be determined on a case-by-case basis, spokesperson Christa Jubinville said in the email.

"Current evidence suggests a longer interval of eight weeks between doses can result in higher vaccine effectiveness that may last longer, as well as reducing the risk of any adverse events. We continue to align our approach with NACI recommendations but are continuing to monitor the evidence and will recommend changes to this interval if needed."