key: cord-0846809-w89avkjl authors: Bird, Paul W.; Riff, Roger; Folwell, Andrew; Holmes, Christopher W.; Tang, Julian W. title: Increased incidence of COVID‐19 in younger patients (May–July 2021)—An argument for extending vaccination? date: 2021-10-06 journal: J Med Virol DOI: 10.1002/jmv.27363 sha: 2881a54d7722fffa031a149f6862fe93f737ada3 doc_id: 846809 cord_uid: w89avkjl The decision on whether or not to vaccinate young children against COVID-19 is causing significant controversy in the UK This article is protected by copyright. All rights reserved. Increased incidence of COVID-19 in younger patients (May-July 2021)-An argument for extending vaccination? To the Editor, The decision on whether or not to vaccinate young children against coronavirus disease 2019 (COVID-19) is causing significant controversy in the UK. Ladhani 1 outlines the pros and cons of vaccinating school children, and we agree that it is not an easy decision. However, with a potentially difficult winter ahead, including the backlog of non-COVID-19 medical cases to care for and the return of seasonal respiratory viruses in the absence of COVID-19 restrictions, 2 expanding vaccine coverage for both influenza and COVID-19, would seem prudent. Another aspect that needs to be considered is the impact that increased numbers of sick children (even if not requiring hospitalization) will have on working parents, who will need to take time off work to care for them. Although the COVID-19 vaccine rollout in the UK has been a remarkable success, the last phase of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) versus vaccine race is being hampered by a reduced vaccine uptake in the younger population (18-30 years old). This is likely due to individual risk-benefit selfassessment, based on some widely publicized data, 3 Unfortunately, what these low vaccine update figures do not show is the potential impact on the older adult contacts of these potentially delta variant-infected younger populations (e.g., parents, grandparents, teachers), where the delta variant has effectively broken through fully vaccinated individuals, some of whom need hospitalization. 4, 5 The increasing numbers of hospitalized cases infected with the delta variant are likely partly due to some degree of the waning of vaccine immunity over time. 6, 7 Not only this, a recent US study has suggested that delta variant SARS-COV-2 viral loads are similar between newly diagnosed COVID-19 cases that have been vaccinated (mainly with the messenger RNA vaccines) and the unvaccinated, 8 indicating that even fully vaccinated adults can potentially still transmit the virus to unvaccinated children. Local data (Table and Figure 1 ), during May-July 2021, confirm this UK trend of a higher incidence of hospitalized COVID-19 cases in the younger population, in whom vaccine coverage is generally lower. Table 1 shows increasing numbers of COVID-19 cases presenting to hospital-now mostly due to the delta variant 9 -in the younger groups, but also in the more vulnerable older adult and elderly populations. Yet, although the absolute numbers of COVID-19 cases are rising in these populations, COVID-19 cases are rising at similar rates across all the age groups, so the overall proportion of COVID-19 cases across these different age groups remains more or less con- Abbreviations: PCR, polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; UHL, University Hospitals of Leicester. Crossing the Rubicon: a fine line between waiting and vaccinating adolescents against COVID-19 Weekly national influenza and COVID-19 surveillance report week 29 report (up to week 28 data) Winton Centre for Risk and Evidence Communication Public Health Scotland and the EAVE II Collaborators. SARS-CoV-2 delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness SARS-CoV-2 variants of concern and variants under investigation in England. Technical briefing 20. Public Health England Correlation of SARS-CoV-2 breakthrough infections to time-from-vaccine Six month safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine Shedding of Infectious SARS-CoV-2 Despite Vaccination when the Delta Variant is Prevalent -Wisconsin Written statement: COVID-19 vaccination-JCVI announcement on vaccinating children & young people. Welsh Government Expert expresses fears over Covid outbreaks at Bristol schools. The Guardian Factbox: countries vaccinating children against COVID-19. Reuters