COVID-19 in Immunosuppressed Children

Abstract

Following the spread of the SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) to a global pandemic, concerns have arisen for the disease impact in at-risk populations, especially in immunocompromised hosts. On the other hand, clinical studies have clarified that the COVID-19 clinical burden is mostly due to over-inflammation and immune-mediated multiorgan injury. This has led to downsizing the role of immunosuppression as a determinant of outcome, and early reports confirm the hypothesis that patients undergoing immunosuppressive treatments do not have an increased risk of severe COVID-19 with respect to the general population. Intriguingly, SARS-CoV-2 natural reservoirs, such as bats and mice, have evolved mechanisms of tolerance involving selection of genes optimizing viral clearance through interferon type I and III responses and also dampening inflammasome response and cytokine expression. Children exhibit resistance to COVID-19 severe manifestations, and age-related features in innate and adaptive response possibly explaining this difference are discussed. A competent recognition by the innate immune system and controlled pro-inflammatory signaling seem to be the pillars of an effective response and the premise for pathogen clearance in SARS-CoV-2 infection. Immunosuppression—if not associated with other elements of fragility—do not represent per se an obstacle to this competent/tolerant phenotype in children. Several reports confirm that children receiving immunosuppressive medications have similar clinical involvement and outcomes as the pediatric general population, indicating that maintenance treatments should not be interrupted in suspect or confirmed SARS-CoV-2 infection.

Safety of administration of BNT162b2 mRNA (Pfizer‐BioNTech) COVID‐19 vaccine in youths and young adults with a history of acute lymphoblastic leukemia and allergy to PEG‐asparaginase

“…1 , 2 Those with a malignant diagnosis are at risk of poor outcome following COVID‐19 infection. 3 , 4 , 5 , 6 , 7 …”

Kidney involvement and histological findings in two pediatric COVID-19 patients

“…The novel coronavirus (SARS-CoV-2) infection has rapidly become a pandemic, with an aggressive and even fatal course in adults with comorbidities, and milder clinical manifestations in children [1]. Children with chronic kidney disease (CKD) or on immunosuppression for nephrotic syndrome, glomerular diseases, or transplantation show neither a more severe clinical course nor an increased risk of infection, compared to healthy peers [2][3][4][5]. SARS-CoV-2 nephropathy has been reported in both healthy adults and children.…”

Prevalence and Course of SARS-CoV-2 Infection among Immunocompromised Children Hospitalised in the Tertiary Referral Hospital in Poland

“…Although the pandemic has lasted for a year and a half, reports of cases concerning immunocompromised children are still relatively scarce. This population may be less frequently exposed to SARS-CoV-2 due to the increased isolation that is crucial to their therapies, and as a result, may not become a part of regular studies [ 10 ]. Even in the Children’s Memorial Health Institute in Warsaw, Poland’s biggest tertiary referral hospital, we were only able to collect data on 55 immunocompromised, SARS-CoV-2-infected patients during the six-month observation period.…”