COVID-19 vaccinations declined in grade school children over the last month, leaving thousands unprotected in Minnesota as the omicron pandemic wave took hold.

Vaccine hesitancy, holiday breaks and appointment hassles reduced first-dose vaccinations in children 5-11 from 7,300 per day in mid-November to 1,200 last week, federal data showed. While Minnesota has almost reached a 40% first-dose rate in this group, ranking 10th among states, health officials lamented missed opportunities.

"The surge ... has already been put into the history books in terms of the role vaccine will play," said Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, because the omicron wave is peaking and new vaccine recipients won't reach full immunity for five weeks.

Omicron's spread has been stunning, producing fewer severe COVID-19 cases than previous waves but record infections that filled up hospitals and disrupted schools and businesses. In 2021, weekly infections per 10,000 children 5-11 yo-yoed from 84 in mid-November to 26 in mid-December to 112 at year's end, according to the Minnesota Department of Health.

Kirsten Grupa heeded the risks, canceling plans to see "Annie" at the Children's Theatre Company with her twin 8-year-old daughters, and asking their grandparents to test negative for COVID-19 before visiting. Grupa has home-schooled the girls during the pandemic, partly because one has Type 1 diabetes and is at risk for severe illness. But the Maplewood mother hasn't gotten them vaccinated.

"We are not around a lot of other people and we're very like COVID aware," said Grupa, who is vaccinated and runs a photography business with her husband. "We mask, we generally don't go out to restaurants to eat, and so for me I just felt like our risk was lower."

Minnesota expanded its pediatric vaccinations at the Mall of America on Nov. 3, the day after the director of the Centers for Disease Control and Prevention OK'd the two-dose Pfizer COVID-19 vaccine in children 5-11. The age group's first-dose vaccination rate reached 23% by Thanksgiving.

The subsequent decline was expected, said Dr. Gigi Chawla, chief of general pediatrics at Children's Minnesota, which operates hospitals in Minneapolis and St. Paul. The first third of parents are eager to pursue new pediatric vaccines to protect children, but the next third takes convincing and needs to hear from people they trust.

"We're really in that middle third where people are ... thinking more about their individual children and [the infection risk in] their family," she said.

Vaccine progress has been slower in children 5-11 than it was when children 12-15 were approved last spring, and that was expected as well because parents tend to be more cautious with younger children, state infectious disease director Kris Ehresmann said.

The problem is the slower rollout occurred at a higher-stakes time last fall when the fast-spreading omicron variant was emerging to replace delta as the dominant coronavirus strain. Minnesota's first omicron infection was announced Dec. 2 but occurred Nov. 22, days before the variant was discovered in South Africa, Ehresmann said. "To say we were going to have had a chance to be prepared is probably not fair."

Holiday breaks also disrupted vaccination progress, but the Health Department has restarted school-based vaccination clinics and plans to provide clinics in popular places for young families. The state also responded with a $200 vaccine incentive for new recipients 5-11 and drawings for five $100,000 Minnesota college scholarships. Signup begins Monday.

The risk of severe COVID-19 is lower in children. Minnesota has reported nearly 12,000 COVID-19 deaths, and 82% have been seniors. Last week's report of a COVID-19 death in a Dakota County child was the eighth involving a Minnesotan younger than 20.

However, pediatric hospitalizations have increased in the omicron wave. Minnesota hospitals through Wednesday reported 239 confirmed pediatric inpatient COVID-19 cases in January, according to federal data. That exceeded the previous record of 145 admissions in December and the 154 admissions last February through April combined during the alpha wave.

Some are children needing care for other issues who have mild or asymptomatic COVID-19, but even they demand extra attention and infection control measures, Chawla said.

"The hospitals are full. They're full with kids who are sick right now, and as more and more kids get infected with omicron, we will probably see ... more kids getting hospitalized."

More than 71% of adults 18-49 have received first doses of COVID-19 vaccine, according to Minnesota data, indicating that many parents are vaccinated even if their children are not.

Stephanie Canfield said she had COVID-19 in March 2020, suffering shortness of breath and other symptoms for three months after an outbreak at her husband's workplace. The Lakeville mother is vaccinated but said she isn't in a hurry to get shots for her 7- and 9-year-old children, partly because her 4-year-old twins aren't eligible.

Breakthrough infections in her brother's family were a deterrent, she added. "They were all vaccinated and still picked up COVID and still got sick."

Minnesota hasn't provided breakthrough data for the 5-11 age group yet, but infection rates from May 2 to Dec. 18 were three times higher in 12- to 17-year-olds who were unvaccinated vs. vaccinated. The rate of COVID-19 hospitalizations was eight times higher in the unvaccinated.

Osterholm said families shouldn't assume they are risk-free just because omicron produces fewer severe COVID-19 cases and the wave is peaking. Infection rates have plateaued for weeks since the initial wave subsided in South Africa.

"Some parents, they refuse to do it at all," he said. "Their sense is it's not going to happen to me or my family. Or it will be mild in our kids and the vaccines pose some risks."

Side effects include rare allergic reactions and common short-term symptoms such as arm pain, fever and body aches. Rare risks include a form of heart inflammation called myocarditis, but Osterholm said the risks are higher from COVID-19.

"You greatly reduce your risk of having severe myocarditis by being vaccinated," he said.

Limited appointments have contributed to sluggish vaccination progress because omicron infected nurses and other vaccine providers. Canfield had appointments for her two older children last month but had to reschedule when one had a fever and then they got bumped by the clinic because it was short-staffed.

Jessica Kearns of Falcon Heights said appointments are so scarce that she drove her two boys to separate clinics in different cities. The U sociology student lamented the plight of low-income parents with limited transportation.

"It was hard enough trying to find appointments for my kids even though I have a working car and a very flexible job," she said.

Grupa said the $200 incentive nudged her and she searched Friday and found appointments for her girls this week. Outdoor activities at a recreation center have been great, and they toured a library Friday. But she has delayed swimming lessons because of infection risks.

"Not having them vaccinated yet," she said, "I've had to make choices."