Covid-19 HSE Clinical Guidance and Evidence

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Interim Guidance on Medically Vulnerable Children during the Coronavirus (COVID-19) pandemic (CD19-191-001 / 09.02.22)

• Introduction

• Recommendations

• Conclusion

• Guidance Development Group

• Contributors

Content

• This guidance has been developed by Consultant Paediatricians across a variety of specialities to provide guidance and reassurance for parents and healthcare professionals caring for medically vulnerable children and is subject to change with emerging evidence
• Endorsed by the Paediatric Clinical Advisory Group, RCPI
• Target audience : parents and healthcare professionals
   

Introduction

• Many children have underlying health problems which may make them prone to more severe illness with any infection, so the question arises as to whether these children should be cocooned from SARS-CoV-2 infection. Typically, these children and their families already exercise extra caution around avoiding exposure to colds and flus etc. and they receive the annual seasonal flu vaccine
• It is clear now that fortunately the vast majority of children who get SARS-CoV-2 infection do not develop severe COVID-19 illness. This also appears to be the case for children with underlying health problems, these children may get an infection with very few symptoms at all or they may experience an illness like, but usually no worse than, the seasonal flu. Some children e.g. with complex severe neurodisability and complex medical disorders are at a higher risk of the consequences of COVID-19 disease. Evidence to date suggests that COVID-19 vaccination is safe and effective in preventing severe disease. Vaccination is therefore strongly recommended for medically vulnerable children. 
• It should be noted that the widely reported but very rare multisystem inflammatory response (Kawasaki- like syndrome, also called PIMS, Paediatric Inflammatory Multisystem disorder) linked to COVID-19 occurs in children who are otherwise well without pre-existing medical conditions, and as such it is unpredictable as to who will get it
• Given current knowledge about COVID-19 disease in children it is now difficult to justify cocooning in most children with underlying conditions. Long-term cocooning of children with complex medical needs is likely to adversely affect them and may outweigh the potential risk of infection. 
   

Recommendations

• All eligible medically vulnerable children (and their household members) should avail of the COVID-19 vaccination. This vaccine is currently recommended for those aged 5years+. Further information is available at:
  • https://www.rcpi.ie/policy-and-advocacy/national-immunisation-advisory-committee/advice-on-covid-19-vaccinations-provided-by-niac-to-the-department-of-health/
  • https://www2.hse.ie/screening-and-vaccinations/covid-19-vaccine
• We advise that for children with profound immunodeficiency (e.g. a very recent transplant) it is best that individual risk (including the possible necessity of avoiding school) should be discussed with your specialist team.
• For all other children, care should be taken to reduce transmission through the measures promoted by the HPSC (https://www2.hse.ie/conditions/coronavirus/protect-yourself-and-others.html) by all household members etc. 
• Schools have mitigation systems in place according to government policy https://www.gov.ie/en/publication/b264b-roadmap-for-the-full-return-to-school/ Excluding a child from school for prolonged periods is not in their best interest but please discuss this with your doctor if concerned
• If a child with pre-existing health condition acquires COVID-19-parents should make contact early with their GP and specialist as recommended with other infectious illnesses.
• We also wish to highlight that all efforts are being made in GP surgeries and in hospitals to reduce the risk of infection to anyone attending, so be reassured that your child can continue to access medical services as needed during this pandemic
• Children can develop illnesses, specifically non COVID related illnesses at any time, and as such, if unwell, should attend the GP or ED, as appropriate
• Please avail of all usual vaccinations as recommended and don’t forget to get the seasonal flu vaccine for yourself and your children  – it is available to all medically vulnerable children and is now also available free of charge to all children aged 2-18 years. 

Conclusion

• We make the recommendations above (1-8) in the best interests of all children and of medically vulnerable children, in particular. Knowledge of COVID-19 disease in children continues to expand and as information comes to light, this guidance will be updated. For the most up to date information and guidance on national restrictions and recommendations please consult https://www2.hse.ie/coronavirus/

Guidance Development Group

• Dr. Jean Donnelly - Consultant Paediatrician General and Community Paediatrics
• Dr. Terry Prendiville - Consultant Paediatrician, Cardiology
• Prof. Karina Butler - Consultant Paediatrician, Infectious Diseases
• Dr. Ellen Crushell - Consultant Paediatrician Metabolic Disorders, National Clinical Lead for Children

Contributors

• Dr. Ronan Leahy - Consultant Paediatrician, Immunology
• Dr. Atif Awan - Consultant Paediatrician, Nephrology
• Dr. Cormac Owens - Consultant Paediatrician, Oncology
• Dr. Desmond Cox - Consultant Paediatrician, Respiratory Medicine
• Dr. Corrina McMahon - Consultant Paediatric Haematology
• Dr. John Murphy - Consultant Neonatologist, Clinical Neonatology Lead
• Dr. Declan O’Rourke - Consultant Paediatrician, Neurology
• Prof Billy Bourke - Consultant Paediatrician, Gastroenterology
• Dr Elizabeth Nolan - Clinical Child Psychologist

Endorsed by: Paediatric Clinical Advisory Group, RCPI
Target Audience: Parents and Healthcare Professionals