Children With Inflammatory Bowel Disease in the COVID-19 Main Endemic Focus: The Lombardy Experience

Sansotta, Naire; Norsa, Lorenzo; Decorti, Giuliana; Panceri, Roberto; Dilillo, Dario; Pozzi, Elena; Giacomo, Costantino De; Moretti, Chiara; Celano, Rosaria; Nuti, Federica; Sgaramella, P; Stefano, M. Di; Salvatore, Silvia; Arrigo, Serena; Motta, Valentina; D’Antiga, Lorenzo

doi:10.3389/fped.2021.607285

Cited by 9 publications

(15 citation statements)

References 20 publications

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“…The main source of SARS-CoV-2 infection in our patient group was close contact with a SARS-CoV-2 PCR-positive patient. Similar findings were reported in previous studies; Yuksel et al [ 10 ] reported that among patients liver transplant recipients, the main source of infection was parents/siblings, and Sansotta et al [ 9 ] reported that among patients with inflammatory bowel disease, the source of infection was close contact with a positive patient. It is important to inform patients with chronic disease in close contact with a positive patient about the virus transmission risk.…”

Section: Discussionsupporting

confidence: 88%

“…Literature on the clinical features and outcomes of SARS-CoV-2 infection in children with chronic gastrointestinal and liver diseases has mainly focused on three diseases: CLD, liver transplantation recipients, and inflammatory bowel disease [ 8 9 10 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Exacerbation/flare of chronic diseases during the COVID-19 pandemic was first reported at the beginning of the pandemic owing to delayed or interrupted treatment in patients with inflammatory bowel disease. The treatments were mainly modified because of the increased risk of severe infection [ 9 11 ]. According to current scientific data, patients receiving biological agents do not have an increased risk of infection or severe disease course.…”

Section: Discussionmentioning

confidence: 99%

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SARS-CoV-2 Antibodies in Children with Chronic Disease from a Pediatric Gastroenterology Outpatient Clinic

Kaya

Issi

Güven

et al. 2022

Pediatr Gastroenterol Hepatol Nutr

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Purpose At the beginning of the Coronavirus disease (COVID-19) epidemic, physicians paid close attention to children with chronic diseases to prevent transmission or a severe course of infection. We aimed to measure the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody levels in children with chronic gastrointestinal and liver diseases to analyze the risk factors for infection and its interaction with their primary disease. Methods This cross-sectional study analyzed SARS-CoV-2 antibody levels in patients with gastrointestinal and liver diseases (n=141) and in healthy children (n=48) between January and February 2021. Results During the pandemic, 10 patients (7%) and 1 child (2%) had confirmed COVID-19 infection ( p =0.2). The SARS-CoV-2 antibody test was positive in 36 patients (25.5%) and 11 children (22.9%) ( p =0.7). SARS-CoV-2 antibody positivity was found in 20.4%, 26.6%, 33.3%, and 33.3% of patients with chronic liver diseases, chronic gastrointestinal tract diseases, cystic fibrosis, and liver transplantation recipients, respectively ( p >0.05, patients vs. healthy children). Risk factors for SARS-CoV-2 antibody positivity were COVID-19-related symptoms (47.2% vs. 14.2%, p =0.00004) and close contact with SARS-CoV-2 polymerase chain reaction-positive patients (69.4% vs. 9%, p <0.00001). The use, number, and type of immunosuppressants and primary diagnosis were not associated with SARS-CoV-2 antibody positivity. The frequency of disease activation/flare was not significant in patients with (8.3%) or without (14.2%) antibody positivity ( p =0.35). Conclusion SARS-CoV-2 antibodies in children with chronic gastrointestinal and liver diseases are similar to that in healthy children. Close follow-up is important to understand the long-term effects of past COVID-19 infection in these children.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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SARS-CoV-2 Antibodies in Children with Chronic Disease from a Pediatric Gastroenterology Outpatient Clinic

Kaya

Issi

Güven

et al. 2022

Pediatr Gastroenterol Hepatol Nutr

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“…This seems to be consistent with other studies, showing good adherence to biological treatments ( 21 – 24 ) and in this unprecedented context, in comparison to patients with other chronic non-respiratory pathologies treated with immunosuppressors, JIA patients seems to be compliant with their treatment. In fact, children with inflammatory bowel disease did not discontinue their immunomodulatory treatments ( 25 ), patients with rheumatoid arthritis declared a modification in their treatment in 11% of cases ( 26 ), and patients with systemic lupus modified their treatment in 10% of cases ( 27 ). Of course, these data must take into account the self-report aspect of our study and the difficulty of measuring therapy adherence.…”

Section: Discussionmentioning

confidence: 99%

Juvenile Idiopathic Arthritis and COVID-19 Pandemic: Good Compliance With Treatment, Reluctance to Return to School

et al. 2021

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Objective: The SARS-CoV-2 pandemic has induced an exceptional sanitary crisis, potentially having an impact on treatment continuation, for juvenile idiopathic arthritis (JIA) patients receiving immunosuppressive therapies. After national lockdowns, many patients were also concerned about their safety at school. We evaluated the impact of the pandemic on the optimal continuation of treatment and on the return to school in JIA patients.Methods: JIA patients under 18 years of age, usually treated with disease-modifying anti-rheumatic drugs (DMARDs) were prospectively included during their outpatient visit and completed a standardized questionnaire. The primary outcome was DMARD treatment modification in relation to the context of the pandemic but we also evaluated the pandemic's impact on the schooling.Results: One hundred and seventy three patients from 8 different expert centers were included between May and August 2020. Their mean age was 11.6 years (± 4.1 years), and most of them 31.2% (54/173) had a rheumatoid factor-negative polyarticular JIA. Fifty percent (86/172) were treated with methotrexate, and 72.5% (124/171) were treated with bDMARDs. DMARD treatment modification in relation to the pandemic was observed in 4.0% (7/173) of participants. 49.1% (81/165) of the patients did not return to school due to a personal/parental decision in 69.9% (55/81) of cases. Two patients were diagnosed positive for SARS-CoV-2 infection.Conclusion: This study suggests that JIA patients treated with DMARDs continued their treatment during the pandemic and were rarely affected by symptomatic COVID-19. In contrast, parents' reluctance was a major obstacle for returning to school. Therefore, more solidified school reopening strategies should be developed.

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“…A study by Sansotta et al [ 34 ] highlights that, although all patients were instructed to continue therapy, none had a severe course and there were no cases of hospitalization. During this period, two patients experienced fever and gastrointestinal symptoms.…”

Section: Inflammatory Bowel Diseases Covid-19 and Childrenmentioning

confidence: 99%

Risk, Course, and Effect of SARS-CoV-2 Infection in Children and Adults with Chronic Inflammatory Bowel Diseases

et al. 2021

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Susceptibility and disease course of COVID-19 among patients with inflammatory bowel diseases (IBD) are unclear and epidemiological data on the topic are still limited. There is some concern that patients with immuno-mediated diseases such as IBD, which are frequently treated with immunosuppressive therapies, may have an increased risk of SARS-CoV-2 infection with its related serious adverse outcomes, including intensive care unit (ICU) admission and death. Corticosteroids, immunomodulators, and biologic drugs, which are commonly prescribed to these patients, have been associated with higher rates of severe viral and bacterial infections including influenza and pneumonia. It is not known whether these drugs can be so harmful as to justify their interruption during COVID-19 infection or if, on the contrary, patients with IBD can benefit from them. As shown by recent reports, it cannot be excluded that drugs that suppress the immune system can block the characteristic cytokine storm of severe forms of COVID-19 and consequently reduce mortality. Another cause for concern is the up-regulation of angiotensin converting enzyme-2 (ACE2) receptors that has been noticed in these patients, which could facilitate the entry and replication of SARS-CoV-2. The aim of this narrative review is to clarify the susceptibility of SARS-CoV-2 infection in patients with IBD, the clinical characteristics of patients who contract the infection, and the relationship between the severity of COVID-19 and immunosuppressive treatment.

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Children With Inflammatory Bowel Disease in the COVID-19 Main Endemic Focus: The Lombardy Experience

Cited by 9 publications

References 20 publications

SARS-CoV-2 Antibodies in Children with Chronic Disease from a Pediatric Gastroenterology Outpatient Clinic

SARS-CoV-2 Antibodies in Children with Chronic Disease from a Pediatric Gastroenterology Outpatient Clinic

Juvenile Idiopathic Arthritis and COVID-19 Pandemic: Good Compliance With Treatment, Reluctance to Return to School

Risk, Course, and Effect of SARS-CoV-2 Infection in Children and Adults with Chronic Inflammatory Bowel Diseases

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