Clinical manifestations and outcome of SARS-CoV-2 infections in children and adolescents with rheumatic musculoskeletal diseases: data from the National Paediatric Rheumatology Database in Germany

Sengler, Claudia; Eulert, Sascha; Minden, Kirsten; Niewerth, Martina; Horneff, Gerd; Kuemmerle‐Deschner, Jasmin; C, Siemer; Berendes, R.; Girschick, Hermann; Hühn, Regina; Borte, Michael; Hospach, Anton; Emminger, W; Armann, Jakob; Klein, Ariane; Kallinich, Tilmann

doi:10.1136/rmdopen-2021-001687

Cited by 35 publications

(24 citation statements)

References 23 publications

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“…48 Conversely, other authors reported a similarly favorable course, compared to healthy children, in patients undergoing immunosuppressive treatment for inflammatory bowel diseases, rheumatic diseases, and kidney diseases. [49][50][51] Table 1 summarizes the major risk factors for severe COVID-19 in pediatric patients.…”

Section: Sars-cov-2 Infection and Covid-19 In Children Andmentioning

confidence: 99%

Covid-19 in Children and Adolescent: Characteristics and Specificities in Immunocompetent and Oncohematological Patients

Mercolini¹,

Cesaro²

2022

Mediterr J Hematol Infect Dis

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SARS-CoV-2 pandemic affected less children and adolescents, morbidity and mortality figures being inferior to that reported for adults. In this review we focused on the clinical course, risk factors for severe COVID-19, mortality, treatment options and prevention measures in the pediatric and adolescent setting with special attention to the pediatric oncohematological patients. In this subgroups of patients, SARS-CoV-2 infection was often asyntomatic but 47 to 68% of patients require hospitalization and 9-10% of those hospitalized needed intensive care with a COVID-19 attributable mortality of about 4%. The multisystem inflammatory syndrome associated to Coronavirus 2019 was less frequent than that reported in the non-oncohematological pediatric population. Noteworthy, the course of COVID-19 was more severe in low-middle income countries. The key measures to prevent SARS-CoV-2 infection are the reduction of patients exposure to the SARS-CoV-2 and vaccination, now available fore care givers and parents and for patients and siblings > 12 years old. The treatment of COVID-19 in pediatric patients was mainly based on supportive care with dexamethasone and heparin prophylaxis for severely ill patients. Other measures, such as convalescent plasma, remdesivir and monoclonal antibodies have been used in limited case or within experimental protocols. Further studies are needed on the risk factors and outcome of SARS-CoV-2 infection in the pediatric immunocompromised patients.

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Section: Sars-cov-2 Infection and Covid-19 In Children Andmentioning

confidence: 99%

Covid-19 in Children and Adolescent: Characteristics and Specificities in Immunocompetent and Oncohematological Patients

Mercolini¹,

Cesaro²

2022

Mediterr J Hematol Infect Dis

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“…In line with our findings, their results suggest that associated comorbidities and treatment with glucocorticoids increase the risk of hospital admission [ 12 ]. Results from the national paediatric rheumatology database in Germany show similar results, with 76 cases of COVID-19 in children with rheumatic diseases, with mild outcome and good recovery in the majority of cases, and no relevant impact on disease activity [ 13 ].…”

Section: Discussionmentioning

confidence: 90%

Clinical course and seroprevalence of COVID-19 in children with rheumatic diseases—cross-sectional study from a reference centre in Spain

et al. 2022

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SARS-CoV-2 infections in children are frequently asymptomatic or mild and can go unnoticed. This study aimed to describe the seroprevalence and clinical course of SARS-CoV-2 in a cohort of children with rheumatic diseases in a real-life setting and assess possible risk factors. A cross-sectional study was performed in a paediatric rheumatology unit (September 2020 to February 2021). At inclusion, a specific questionnaire was completed and SARS-CoV-2 serology was performed. Demographics, treatment and disease activity of patients with and without laboratory-confirmed SARS-CoV-2 infection were compared. A total of 105 children were included. SARS-CoV-2 infection was demonstrated in 27 patients (25.7%). The mean age was 11.8 years, and most patients were females (72.4%). The most frequent underlying condition was juvenile idiopathic arthritis (70.3%; 19/27). Patients received immunosuppressive treatment in 78% of cases (21/27). Overall, 44.4% (12/27) of infected patients were asymptomatic. A total of 66.7% (18/27) of patients did not require medical assistance. Three patients required hospital admission because of COVID-19. Children with confirmed SARS-CoV-2 infection were less frequently in remission (52% vs 72%; p 0.014). Moderate disease activity and treatment with oral corticosteroids were associated with higher risk for SARS-CoV-2 (OR 5.05; CI 95%: 1.56–16.3 and OR 4.2; CI 95%: 1.26–13.9, respectively). In a cohort of Spanish paediatric patients with rheumatic diseases, clinical course of COVID-19 was mild, with more than one third of asymptomatic cases. Higher disease activity and oral corticosteroids appear to be risk factors for SARS-CoV-2 infection. Key Points • We aimed to investigate the seroprevalence of SARS-CoV-2 infection in a cohort of Spanish paediatric patients with RD, testing both symptomatic and asymptomatic patients. We also compared treatment and disease activity of patients with and without laboratory-confirmed SARS-CoV-2 infection. • In our cohort of 105 paediatric patients with rheumatic diseases, the clinical course of COVID-19 was mild and 44% of cases were asymptomatic. Three cases required hospital admission with no complications. Seroprevalence was 20%. • No association was found between disease activity or treatment with corticosteroids and symptomatic or asymptomatic infection. Higher disease activity and treatment with oral corticosteroids appeared to be risk factors for laboratory-confirmed SARS-CoV-2 infection.

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“…In a study from Germany, the clinical manifestations, course, and outcome of SARS-CoV-2 infection in 76 children with rheumatic diseases (44 with JIA) from April 2020 to February 2021 were analyzed. In 76% of patients under various immunosuppressive medications, SARS-CoV-2 infection was mild with good outcome in the majority of cases and did not have a relevant impact on rheumatic disease activity [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Programmed Cell Death Protein-1 Upregulation in Response to SARS-CoV-2 in Juvenile Idiopathic Arthritis: A Case-Control Study

Opoka-Winiarska

Grywalska

Korona-Głowniak

et al. 2022

JCM

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Currently, data regarding the impact of COVID-19 disease (caused by SARS-CoV-2) on patients with childhood rheumatic diseases are significantly limited. To assess the possible connection, we measured levels of IgA and IgG anti-SARS-CoV-2 antibodies in children with juvenile idiopathic arthritis (JIA) and a control group during the pandemic, prior to the introduction of anti-COVID-19 vaccination. We assessed levels of PD-1 suppressive molecule and inflammatory markers in patients and correlated those results with serological response to SARS-CoV-2. In JIA patients, the activity of the disease was assessed using the Juvenile Arthritis Disease Activity Score 71 (JADAS 71) scale. The study consisted of 96 children, 65 diagnosed with JIA, treated with antirheumatic drugs, and 31 healthy volunteers. In patients with JIA, significantly higher levels of SARS-CoV-2 antibodies in the IgA and IgG were demonstrated compared to the control group. We also found significantly higher serum PD-1 levels in JIA patients and control volunteers who were seropositive for SARS-CoV-2 IgA or IgG antibodies compared to those who were seronegative. The humoral immune response to SARS-CoV-2 infection is associated with the persistent upregulation of PD-1 expression in both JIA patients and healthy children. The clinical significance of the detected disorder requires further careful observation.

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Clinical manifestations and outcome of SARS-CoV-2 infections in children and adolescents with rheumatic musculoskeletal diseases: data from the National Paediatric Rheumatology Database in Germany

Cited by 35 publications

References 23 publications

Covid-19 in Children and Adolescent: Characteristics and Specificities in Immunocompetent and Oncohematological Patients

Covid-19 in Children and Adolescent: Characteristics and Specificities in Immunocompetent and Oncohematological Patients

Clinical course and seroprevalence of COVID-19 in children with rheumatic diseases—cross-sectional study from a reference centre in Spain

Programmed Cell Death Protein-1 Upregulation in Response to SARS-CoV-2 in Juvenile Idiopathic Arthritis: A Case-Control Study

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