Article summary
Maximizing SARS-CoV-2 vaccination coverage in children, as central nervous system infections/demyelination account for a higher proportion of life-threatening infections in unvaccinated children and adolescents. , may reduce acute and long-term neurological complications.
Rates of neurological complications among children and adolescents hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or childhood multisystem inflammatory syndrome (MIS-C) will be the same in 2020 and 2021. However, the symptoms were mostly transient. research revealed.
Still, according to a study published online Nov. 7, central nervous system infections/demyelination accounted for a higher proportion of life-threatening infections, but most did not receive the COVID-19 vaccine. It has occurred in children who are not Department of Neurology, JAMA.
Lead author of the study, Kerri L. LaRovere, M.D., Ph.D., MMSc, and colleagues concluded that COVID-19 vaccination “prevents acute COVID-19 and MIS-C hospitalizations and reduces associated neurological complications.” It may be possible,” he said.
The authors noted that in 2020, it was common for children and adolescents hospitalized for SARS-CoV-2 in the United States to have associated neurological complications. We aimed to update the spectrum of coronavirus-related neurological involvement in children and adolescents in 2021 by accessing data from hospitals participating in the Public Health Surveillance Network.
Dr. LaRovere, assistant professor of neurology at Harvard Medical School and director of the Critical Care Neurology Consultation Service at Boston Children’s Hospital, said:
From March to mid-December 2020, 22% (365 of 1,695) of hospitalized pediatric patients had neurological involvement with severe acute COVID-19 or MIS-C at 52 centers in the United States. , 12% had severe complications. In 2021, the frequency of neurological involvement remained roughly the same, from mild to severe.
The B.1.617.2 (Delta) variant of SARS-CoV-2 became dominant in June 2021, causing another spike in pediatric hospitalizations in the United States. Adolescents will be eligible for the COVID-19 vaccine on May 12, 2021, and children aged 5 to her 11 years will be eligible on November 2, 2021.
Dr. LaRovere said: Neurology Today Clinicians should “look out for new or worsening neurological symptoms, cognitive problems, and overall fatigue levels after exposure to COVID-19 or a positive SARS-CoV-2 test, among other symptoms. You have to pay attention and pay attention.
“By maximizing vaccination coverage in children, we may be able to minimize acute and long-term neurological complications,” she added.
Dr. LaRovere said investigators, including a large national sample of hospitalized adolescents, relied on the same methodology for both surveillance periods (2020 and 2021), relying on expert judgment in neurological diagnostics. I pointed out that I went They were also able to confirm vaccination status in the 2021 cohort.
However, she acknowledged that, among study limitations, some sites in the registry may not have collected data for all patients. It was not standardized and was performed using clinical discretion.Both factors may lead to an underestimation of the frequency and nature of neurological involvement,” said Dr. LaRovere.
Furthermore, she added, researchers cannot study the immunobiology underlying severe complications involving the delta variant or assess the reasons for low vaccine uptake.
“The neurobiology that underlies early and long-term immune responses to SARS-CoV-2 infection, how this affects brain development and recovery, and how to intervene and provide effective therapeutics. We need to understand it better,” said Dr. LaRovere.
Survey details
The authors determined that between December 15, 2020 and December 31, 2021, 55 US hospitals in 31 states were hospitalized with illness associated with SARS-CoV-2 and followed up in hospital. We derived data on patient cases reported to public health surveillance. discharge. Analysis during the study period included 2,168 patients.
The study excluded 85 patients considered to have MIS-C who did not meet the criteria. Analyzes included anyone under the age of 21 who had a positive SARS-CoV-2 test result (reverse transcriptase polymerase chain reaction and/or antibodies) and met criteria for MIS-C or acute COVID-19. I was.
Patients with neurological involvement presented with acute neurological symptoms or illness at presentation or during hospitalization. Experts determined life-threatening neurological involvement according to clinical and/or neuroradiological features. They considered the type and severity of neurological involvement, laboratory and imaging data, vaccination status, and discharge outcome (death or survival due to new neurological impairment).
Of the 2,168 patients, 66% (58% male, median age 10.3 years) met MIS-C criteria, and 22% documented neurological involvement. Patients with neurological involvement had a median age of 12 years compared to those without (median 10 years).
Among patients with neurological involvement, 9% developed acute SARS-CoV-2-related life-threatening conditions. This includes infection/demyelination of the central nervous system. 11, stroke; 6, meningitis; 5, severe encephalopathy. 2, acute fulminant cerebral edema; One is transverse myelitis. One is non-hemorrhagic leukoencephalopathy. Another has Guillain-Barré Syndrome.
Of the 42 patients, 10 (24%) survived with new neurologic deficits at discharge, and 8 (19%) died. Among patients with life-threatening neurological conditions, 15 of 16 (94%) eligible for vaccination were not vaccinated.
Expert commentary
Marissa Vawter Lee, M.D., associate professor of pediatric neurology and pediatrics at Cincinnati Children’s Hospital Medical Center, combined data from 31 states and 55 separate children’s hospitals, including people from racially diverse groups. We commend researchers who have conducted strong pooled studies. Ethnic and socioeconomic background.
“The more centers involved, the more likely we are to capture the population of interest in our research, and the more we can generalize our findings to other children,” says Grace Gombolay, assistant professor of pediatrics. says MD. She is also the director of the Children’s Health Care of Atlanta and the Pediatric Neuroimmunology and Multiple Sclerosis Clinic at Emory University School of Medicine.
Dr. Gomborey also commended the researchers for confirming that the patients participating in the analysis had been diagnosed with COVID-19. “This is very important. Some studies have mentioned suspected neurological involvement, but there are no confirmed tests, so what was seen in that particular study could be related to COVID-19 or other It’s difficult to know if it’s related to infection,” she said.
Another strength of this study is that the data correspond to both children hospitalized with acute COVID-19 and MIS-C, says a pediatric neurologist and cardiologist at Boston Children’s Hospital. said Caitlin K. Rollins, MD, SM, Director of the Developmental Program.
“This study provides an important update on the frequency of neurological signs and symptoms in children with MIS-C or hospitalized with acute COVID-19,” said Dr. We have collected a very large national sample.” ”
She said, “Previous publications from this team covered the neurological involvement of patients with acute COVID and MIS-C from March to mid-December 2020, and the neurological implications associated with these two conditions. It has played an important role in raising awareness about the prevalence and severity of sexual involvement.”
Nonetheless, Dr. Vawter-Lee notes that a weakness of this type of study is its reliance on field-reported data, resulting in a lack of confidence in how to classify diagnoses such as acute disseminated encephalomyelitis. He said there could be a lack of standardization.
“One site may have a different definition than another site,” she said. “But the author clearly states this as a limitation.”
“Further updates are needed to determine whether the neurological features associated with the post-delta variant remain stable,” said Dr. Rollins. Recent variants such as Delta may be associated with neuroinflammatory diseases more generally, she added, but additional data are needed to confirm this association.
The fact that 22% of patients hospitalized with SARS-CoV-2 had neurological symptoms is significant, Dr. Vawter-Lee said.
“This is the same proportion reported in our 2020 cohort, so we are confident that at this time, approximately one-fifth of hospitalized pediatric patients with SARS-CoV-2 will have neurological involvement/symptoms.” I think you can say that with a sense of urgency,” she said.
“Thankfully, as this study points out, the vast majority of people with neurological symptoms are not life-threatening. deaths were reported.”
“This study provides an important update on the frequency of neurological signs and symptoms in children with MIS-C or hospitalized with acute COVID-19.” —DR. Caitlin K. Rawlins
Dr. Gomborey said: Some people develop central nervous system or brain infections, or demyelination, in which the immune system attacks parts of the brain. ”
These findings should lead pediatricians and critical care physicians to look for neurological conditions in children and adolescents. For example, Dr. Vawter-Lee said: Changes in mental status raise the level of suspicion of encephalopathy or ADEM. ”
The study also emphasized the importance of vaccination, as the majority of children who were eligible for vaccination and who had life-threatening neurological complications were not vaccinated. should discuss whether COVID-19 vaccination is appropriate when children are seen in the clinic, she said.
Although the study was not designed to assess whether a vaccine would prevent the neurological complications of COVID-19, Dr. Gomborey noted the intrinsic value of this observation.
“In this case, it is not surprising that vaccines can prevent the severe neurological effects of COVID-19 or MIS-C, because COVID-19 vaccination can prevent admission to ICU, other organ damage, and other organ damage. , and die,” she said.
Dr. Rollins added: Most patients may have been discharged without obvious neurological deficits, but more subtle deficits may go undetected until the children return to their normal lives. ”
Disclosure
No physicians reported disclosure.
