key: cord-0876543-z832uqsb
authors: nan
title: NASPAG Position Statement on COVID-19 Vaccines and Gynecologic Concerns in Adolescents and Young Adults
date: 2021-07-07
journal: J Pediatr Adolesc Gynecol
DOI: 10.1016/j.jpag.2021.05.008
sha: ccf3d06050de209c501339e5a90eb4f3f9c96795
doc_id: 876543
cord_uid: z832uqsb

nan

This NASPAG Position Statement was created by Hina Talib With COVID-19 vaccine eligibility expanding into the adolescent age group, many teens, families, and health care providers have thoughtful questions about the vaccine that are particular to this stage of development. Importantly, parents who accepted and even received the vaccine for themselves, have taken pause when approaching the vaccine for adolescents in their care citing specific concerns related to vaccine interactions with puberty, menstrual cycles, birth control, and fertility. The North American Society for Pediatric and Adolescent Gynecology (NASPAG) offers guidance herein, on the basis of available data as well as expert opinion, for those who might be seeking gynecologic information related to COVID-19 vaccine use in adolescents and young adults. COVID-19 vaccines that are approved by the rigorous Federal Drug Administration Emergency Use Authorization (EUA) and recommended by subsequent Centers for Disease Control and Prevention Advisory Committee on Immunization Practices as well as Health Canada and the National Advisory Committee on Immunization have been determined to be safe and effective, and NASPAG supports their use in approved and eligible populations, which currently includes adolescents and young adults. [1] [2] [3] NASPAG advocates for the use of COVID-19 vaccines for children, when approved, and adolescents who are eligible now to protect them from COVID-19 infection and its sequelae, as well as to reduce the spread of the virus in the community and to vulnerable people. The American Academy of Pediatrics has reported that since the start of the pandemic, and as of April 2021, 3.85 million children have been infected with COVID-19, 303 have died, and children are now making up a greater proportion of all COVID-19 infections. 4 Beyond the physical toll including hospitalizations, unpredictable courses with multisystem inflammatory syndrome in children and long COVID-19 symptoms, the emotional, social, and educational effects are farreaching. 

• COVID-19 vaccines can be used during puberty. Currently there are several routine recommended vaccines during adolescence including those directed against tetanus, diphtheria, pertussis, human papillomavirus, and bacterial meningitis. There is no plausible biological mechanism or evidence to support concerns that puberty or growth would be altered by COVID-19 vaccines. • Anecdotal and media reports of irregular menstrual cycles, including skipped periods, prolonged periods, and spotting after COVID-19 vaccines in adult menstruators have been shared, and similar changes in menstrual cycles have been shared after COVID-19 infection. This is not surprising because infections, immune reactions, and fevers are understood to cause short-term, self-limited changes in cycles. However, further studies are needed to verify and characterize these changes in relationship to COVID-19 vaccines. In teens, it is also important to note the natural variability in cycles due to hypothalamic-pituitary-ovary axis maturation and the large range of normal menstrual cycles in the first few years after the onset of menses. 5 Stress and weight changes, which have also occurred in many adolescents during the pandemic, can themselves cause these changes in menstrual cycles. Regardless of vaccine use, youth should be encouraged to track their menstrual cycles to become familiar with their own menstrual function and to discuss any concerns about their cycles with their gynecologists, pediatricians, or adolescent medicine physicians or other health care providers. • Adolescents and young adults who are using hormonal birth control may continue to do so when considering any of the approved COVID-19 vaccines. In April 2021, the Food and Drug Administration added a warning to the Janssen COVID vaccine's EUA because of the extremely rare occurrence of thrombosis with thrombocytopenia syndrome; approximately 7 of every million doses of Janssen COVID-19 vaccine administered to women aged 18-49 years. 6 An association with COVID-19 vaccine-related thrombosis with thrombocytopenia syndrome and hormonal contraceptives has not been found. Accordingly, continuation of hormonal contraceptive use and COVID-19 vaccination is recommended for eligible young persons. • Although teenage pregnancy rates have declined over the past few decades, the United States has a high adolescent pregnancy rate (57 per 10 0 0 of 15-to 19-yearold teens) compared with other developed countries. 7 Pregnancy increases the risks of significant vaccine has an effect on cycles, it is likely short-term and self-limited. 4. Adolescents and young adults who are sexually active and/or using hormonal or nonhormonal contraceptive methods should be offered the COVID-19 vaccine. 5. Pregnant adolescents should be offered the COVID-19 vaccine because they are a group at high risk of COVID complications. A pregnancy test is not indicated before vaccine administration. 6. There are no scientific data that demonstrate a link between COVID-19 vaccine and fertility.

Food and Drug Administration: Coronavirus (COVID-19) update: FDA authorizes Pfizer-BioNTech COVID-19 vaccine for emergency use in adolescents in another important action in fight against pandemic

CDC. Centers for Disease Control and Prevention: COVID-19 vaccines for children and teens

Recommendations on the use of COVID-19 Vaccines

American Academy of Pediatrics: Children and COVID-19: state-level data report

ACOG Committee Opinion No. 651menstruation in girls and adolescents: using the menstrual cycle as a vital sign

Vaccinating pregnant and lactating patients against COVID-19. Practice Advisory

Guttmacher Institute: Teen pregnancy rates declined in many countries between the mid-1990s and 2011

Society of Obstetricians and Gynaecologists of Canada: SOGC statement on COVID-19 vaccination in pregnancy

joint statement: medical experts continue to assert that COVID vaccines do not impact fertility