We appreciate the positive comments of the author regarding the recommendations of the Indian Academy of Pediatrics Advisory Committee on Vaccines and Immunization Practices (IAP ACVIP) on the subject of vaccination during the COVID-19 pandemic [1]. We would like to allay the apprehension of the author about immunization of children with the COVID-19 vaccine.

In certain situations, as in the present COVID-19 times, with limited availability of vaccines, the priority at this stage is to protect those at highest risk. There is unanimity in the view, that the priority groups for vaccination are the frontline healthcare workers, to ensure the optimal functioning of the health care system, followed by those over 65 years of age and those with co-morbid medical conditions [2,3].

As of now, studies have shown that Covid-19 is relatively uncommon in children and when infected, typically have milder symptoms and the rate of complications are lower [4,5]. The role of children in transmission of the disease is uncertain and contact tracing studies have shown that children are rarely the index case in family outbreaks [6]. Nevertheless, outbreaks of Covid-19 have been reported in schools and school camps [7]. The temporal association of a novel Kawasaki disease–like multisystem inflammatory syndrome in children with past Covid-19 infection, underlines the need for continued surveillance in pediatric patients [8].

ACVIP is a sub-committee of the IAP, which has the mandate to evaluate evidence on available vaccines and make recommendations primarily for members of IAP. In the case of COVID-19 vaccines, we do not have a vaccine licensed　for use in India nor are we expecting a Covid-19 vaccine for children in the very near future. None of the Covid-19 vaccines in phase 3 trials have included young children. The BNT162b2 mRNA Covid-19 vaccine trial has included adolescents 16 years and older and studies in the 12-15 year olds and subsequently the younger age groups are planned [9].

The ACVIP is following the developments very closely and will make recommendations, at the appropriate time, when more robust data is available about the efficacy, safety and availability of Covid-19 vaccines in children.

1. Kasi SG, Dhir SK, Verma S, et al. Immunization During the COVID-19 Pandemic: Recommendations From Indian Academy of Pediatrics Advisory Committee on Vaccines and Immunization Practices. Indian Pediatr. 2020; 57:1147-52.

2. Nguyen LH, Drew DA, Graham MS, et al. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Health. 2020; 5:e475-83.

3. Velavan TP, Meyer CG. The COVID-19 epidemic. Trop Med Int Health. 2020;25:278-80.

4. Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020;145:e20200702.

5. Ding Y, Yan H, Guo W. Clinical characteristics of children with COVID-19: A meta-analysis. Front Pediatr. 2020;8:431.

6. Lee B, Raszka WV. COVID-19 transmission and children: The child is not to blame. Pediatrics. 2020;146: e2020004879.

7. Szablewski CM, Chang KT, Brown MM, et al. SARS-CoV-2 transmission and infection among attendees of an overnight camp - Georgia, June, 2020. Morb Mortal Wkly Rep. 2020;69: 1023-25.

8. Jiang L, Tang K, Levin M, et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis. 2020;20:e276-88.

9. Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. 2020;10.1056/NEJMoa2034577.