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Impact of COVID-19 in Immunosuppressed Children With Neuroimmunologic Disorders
Gemma Olivé-Cirera1, Elianet Fonseca1, Verónica Cantarín-Extremera1
1From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain.
Insights
Children on immunosuppressive therapy for neuroimmunologic disorders did not have increased COVID-19 risk. Key risk factors for coronavirus infection included household COVID-19 exposure and low vitamin D levels.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Immunology
Background:
- Neuroimmunologic disorders affect children, often requiring immunosuppressive therapies.
- The COVID-19 pandemic raised concerns about infection susceptibility and severity in these vulnerable populations.
Purpose of the Study:
- To assess SARS-CoV-2 infection risk in children with neuroimmunologic disorders on immunosuppressants.
- To evaluate COVID-19 severity, relapse rates, and autoimmune complications.
- To examine changes in healthcare delivery during the pandemic.
Main Methods:
- Retrospective survey of 153 children (March 2020-March 2021).
- Comparison between patients on immunosuppressive treatment and those not.
- Data collected on demographics, clinical features, COVID-19 status, and care delivery.
Main Results:
- COVID-19 occurred in 11% of patients, with similar rates in treated and untreated groups (14% vs 8%).
- Infections were mild; no increased neurologic relapses or autoimmune complications were observed.
- Household COVID-19 exposure and low vitamin D levels were significant risk factors.
Conclusions:
- Immunosuppressive therapies did not increase COVID-19 susceptibility or severity in children with neuroimmunologic disorders.
- Healthcare delivery shifted to remote consultations, with high patient satisfaction.
- Maintaining adequate vitamin D levels may be important for this patient group.
Background And Objectives:
To investigate whether children receiving immunosuppressive therapies for neuroimmunologic disorders had (1) increased susceptibility to SARS-CoV2 infection or to develop more severe forms of COVID-19; (2) increased relapses or autoimmune complications if infected; and (3) changes in health care delivery during the pandemic.
Methods:
Patients with and without immunosuppressive treatment were recruited to participate in a retrospective survey evaluating the period from March 14, 2020, to March 30, 2021. Demographics, clinical features, type of immunosuppressive treatment, suspected or confirmed COVID-19 in the patients or cohabitants, and changes in care delivery were recorded.
Results:
One hundred fifty-three children were included: 84 (55%) female, median age 13 years (interquartile range [8-16] years), 79 (52%) on immunosuppressive treatment. COVID-19 was suspected or confirmed in 17 (11%) (all mild), with a frequency similar in patients with and without immunosuppressive treatment (11/79 [14%] vs 6/74 [8%], p = 0.3085). The frequency of neurologic relapses was similar in patients with (18%) and without (21%) COVID-19. Factors associated with COVID-19 included having cohabitants with COVID-19 (p < 0.001) and lower blood levels of vitamin D (p = 0.039). Return to face-to-face schooling or mask type did not influence the risk of infection, although 43(28%) children had contact with a classmate with COVID-19. Clinic visits changed from face to face to remote for 120 (79%) patients; 110 (92%) were satisfied with the change.
Discussion:
In this cohort of children with neuroimmunologic disorders, the frequency of COVID-19 was low and not affected by immunosuppressive therapies. The main risk factors for developing COVID-19 were having cohabitants with COVID-19 and low vitamin D levels.
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