Coronavirus Disease 2019 Infection and Vaccination in Pediatric Demyelinating Diseases

As compared to adults, less is known about the effects of SARS-CoV-2 infection in children with neuroinflammatory diseases, such as multiple sclerosis (MS), anti-myelin oligodendrocyte glycoprotein associated disease (MOGAD), and neuromyelitis optica spectrum disorder (NMOSD). Moreover, the effects of SARS-CoV-2 vaccination on pediatric demyelinating diseases is also lesser known. Here, we examine the effects of SARS-CoV-2 infection and vaccination on children with demyelinating diseases.

Retrospective chart review was performed at a single tertiary pediatric center, including 116 children with demyelinating diagnoses (MOGAD, MS, NMOSD, transverse myelitis-TM, and acute disseminated encephalomyelitis). Descriptive statistics and logistic regression were used.

The diagnoses included: MS: 56/116 = 48%, MOGAD: 32/116 = 28%, NMOSD: 15/116 = 13%, acute disseminated encephalomyelitis: 12/116 = 10%, and TM: 1/116 = 1%. The known COVID infection rate was 26% = 30/116. Three of 30 (10%) of those with known infection were hospitalized. None of those hospitalized required intubation or ICU admission. Of the 30 with known infection, two (7%) had neuroinflammatory events that occurred within four weeks of infection, both of which were their first clinical events for MS. SARS-CoV-2 vaccination was not associated with any new onset or relapse neuroinflammatory events in our cohort. Demyelinating diagnosis and anti-CD20 mAbs were associated with known SARS-CoV-2 infection.

Two participants had an initial clinical MS event associated with infection. However, we found no association with SARS-COV-2 vaccination or infection with relapses and no long-term adverse outcomes with SARS-CoV-2 vaccination or infection. Future larger multicenter studies should prospectively compare how infection and vaccination affects children and adults with demyelinating diseases.