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Abdelhak A, Petermeier F, Benkert P, Schädelin S, Oechtering J, Maleska Maceski A, Kabesch M, Geis T, Laub O, Leipold G, Gobbi C, Zecca C, Green A, Tumani H, Willemse E, Wiendl H, Granziera C, Kappos L, Leppert D, Waubant E, Wellmann S, Kuhle J. Serum neurofilament light chain reference database for individual application in paediatric care: a retrospective modelling and validation study. Lancet Neurol 2023; 22:826-833. [PMID: 37524100 DOI: 10.1016/s1474-4422(23)00210-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/11/2023] [Accepted: 05/30/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Neurological conditions represent an important driver of paediatric disability burden worldwide. Measurement of serum neurofilament light chain (sNfL) concentrations, a specific marker of neuroaxonal injury, has the potential to contribute to the management of children with such conditions. In this context, the European Medicines Agency recently declared age-adjusted reference values for sNfL a top research priority. We aimed to establish an age-adjusted sNfL reference range database in a population of healthy children and adolescents, and to validate this database in paediatric patients with neurological conditions to affirm its clinical applicability. METHODS To generate a paediatric sNfL reference dataset, sNfL values were measured in a population of healthy children and adolescents (aged 0-22 years) from two large cohorts in Europe (the Coronavirus Antibodies in Kids from Bavaria study, Germany) and North America (a US Network of Paediatric Multiple Sclerosis Centers paediatric case-control cohort). Children with active or previous COVID-19 infection or SARS-CoV-2 antibody positivity at the time of sampling, or a history of primary systemic or neurological conditions were excluded. Linear models were used to restrospectively study the effect of age and weight on sNfL concentrations. We modelled the distribution of sNfL concentrations as a function of age-related physiological changes to derive reference percentile and Z score values via a generalised additive model for location, scale, and shape. The clinical utility of the new reference dataset was assessed in children and adolescents (aged 1-19 years) with neurological diseases (epilepsy, traumatic brain injury, bacterial CNS infections, paediatric-onset multiple sclerosis, and myelin oligodendrocyte glycoprotein antibody-associated disease) from the paediatric neuroimmunology clinic at the University of California San Francisco (San Francisco, CA, USA) and the Children's Hospital of the University of Regensburg (Regensburg, Germany). FINDINGS Samples from 2667 healthy children and adolescents (1336 [50·1%] girls and 1331 [49·9%] boys; median age 8·0 years [IQR 4·0-12·0]) were used to generate the reference database covering neonatal age to adolescence (target age range 0-20 years). In the healthy population, sNfL concentrations decreased with age by an estimated 6·8% per year until age 10·3 years (estimated multiplicative effect per 1 year increase 0·93 [95% CI 0·93-0·94], p<0·0001) and was mostly stable thereafter up to age 22 years (1·00 [0·52-1·94], p>0·99). Independent of age, the magnitude of the effect of weight on sNfL concentrations was marginal. Samples from 220 children with neurological conditions (134 [60·9%] girls and 86 [39·1%] boys; median age 14·7 years [IQR 10·8-16·5]) were used to validate the clinical utility of the reference Z scores. In this population, age-adjusted sNfL Z scores were higher than in the reference population of healthy children and adolescents (p<0·0001) with higher effect size metrics (Cohen's d=1·56) compared with the application of raw sNfL concentrations (d=1·28). INTERPRETATION The established normative sNfL values in children and adolescents provide a foundation for the clinical application of sNfL in the paediatric population. Compared with absolute sNfL values, the use of sNfL Z score was associated with higher effect size metrics and allowed for more accurate estimation of the extent of ongoing neuroaxonal damage in individual patients. FUNDING Swiss National Science Foundation, US National Institutes of Health, and the National Multiple Sclerosis Society.
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Affiliation(s)
- Ahmed Abdelhak
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Franziska Petermeier
- University Children's Hospital Regensburg, Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany
| | - Pascal Benkert
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sabine Schädelin
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Johanna Oechtering
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Aleksandra Maleska Maceski
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Michael Kabesch
- University Children's Hospital Regensburg, Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany
| | - Tobias Geis
- University Children's Hospital Regensburg, Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany
| | - Otto Laub
- Paediatric Office Laub, Rosenheim, Germany
| | | | - Claudio Gobbi
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Chiara Zecca
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Ari Green
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Hayrettin Tumani
- Department of Neurology, University of Ulm, Ulm, Germany; German Center for Neurodegenerative Diseases, Ulm, Germany
| | - Eline Willemse
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Cristina Granziera
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland; Translational Imaging in Neurology Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - David Leppert
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Emmanuelle Waubant
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Sven Wellmann
- University Children's Hospital Regensburg, Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany.
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.
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Lampl BMJ, Schöberl P, Atzenbeck N, Erdl M, Dillitzer N, Wallbrecher J, Weigl M, Sauer M, Kheiroddin P, Niggel J, Mauerer R, Ambrosch A, Kabesch M. Effects of infection control measures towards preventing SARS-CoV-2 outbreaks in a German choir boarding school from March 2020 to April 2022. Front Pediatr 2023; 11:1215678. [PMID: 37614901 PMCID: PMC10442800 DOI: 10.3389/fped.2023.1215678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023] Open
Abstract
Background Singing in a choir was associated with larger outbreaks in the beginning of the SARS-CoV-2 pandemic. Materials and methods We report on the effect and acceptance of various infection control measures on the occurrence of SARS-CoV-2 infections in the world famous Domspatzen boys' choir from March 2020 to April 2022. Results In addition to basic general hygiene measures, systematic rRT-PCR testing and scientifically approved concepts of distancing during singing were applied. While single infections of choir members could not be avoided, singing-related outbreaks were not observed. Until the Omicron variant emerged, potential transmission of SARS-CoV-2 in the school was limited to only one case. Incidences at the school were never higher than in the comparable general population until then. While the impact of the pandemic on daily life and singing was rated as severe, especially by staff members, most students agreed with the usefulness of protection measures and rated them as acceptable. Students viewed regular testing as the most important tool to increase safety in the school. Discussion A bundle of infection control measures including regular testing can prevent outbreaks of SARS-CoV-2 even in the setting of choir singing. Measures are acceptable for choir members if they allow to continue with singing and performing.
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Affiliation(s)
- Benedikt M. J. Lampl
- Division of Infection Control and Prevention, Regensburg Department of Public Health, Regensburg, Germany
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Patricia Schöberl
- University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | | | | | | | | | | | | | - Parastoo Kheiroddin
- University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | | | | | - Andreas Ambrosch
- Institute of Laboratory Medicine, Microbiology and Hygiene, Hospital of the Order of St. John, Regensburg, Germany
| | - Michael Kabesch
- University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
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3
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Gruendl M, Kheiroddin P, Althammer M, Schöberl P, Rohrmanstorfer R, Wallerstorfer D, Ambrosch A, Kabesch M. Analysis of COVID-19 Infection Chains in a School Setting: Data From a School-Based rRT-PCR-Gargle Pool Test System. Disaster Med Public Health Prep 2023; 17:e312. [PMID: 36789767 PMCID: PMC9947041 DOI: 10.1017/dmp.2022.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND School testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was implemented in some countries to monitor and prevent SARS-CoV-2 transmissions. Here, we analyze infection chains in primary schools and household members of infected students based on systematic real-time reverse-transcriptase polymerase-chain-reaction (rRT-PCR)-gargle pool testing. METHODS Students and school staff (N = 4300) of all 38 primary schools in the rural county of Cham, Germany, were tested twice per week with a gargle pool rRT-PCR system from April to July of 2021. Infection chains of all 8 positive cases identified by school testing were followed up. RESULTS In total, 8 positive cases were found by gargle pool PCR testing based on 96,764 school tests. While no transmissions occurred in the school setting, 20 of 27 household members of the 8 cases tested positive. The overall attack rate was 74.1% in families. CONCLUSIONS No school outbreaks occurred during the study period. All cases but 1 were initially picked up by school testing. No transmission from school to families was observed.
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Affiliation(s)
- Magdalena Gruendl
- Public Health Office, Cham, Germany
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John and the University of Regensburg, Regensburg, Germany
| | - Parastoo Kheiroddin
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John and the University of Regensburg, Regensburg, Germany
| | - Michael Althammer
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John and the University of Regensburg, Regensburg, Germany
| | - Patricia Schöberl
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John and the University of Regensburg, Regensburg, Germany
- Member of the Science and Innovation Campus Regensburg (WECARE) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | | | | | - Andreas Ambrosch
- Institute of Laboratory Medicine, Microbiology and Hygiene, Hospital of the Order of St. John, Regensburg, Germany
| | - Michael Kabesch
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John and the University of Regensburg, Regensburg, Germany
- Member of the Science and Innovation Campus Regensburg (WECARE) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
- Corresponding author: Michael Kabesch,
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Rykov MY, Dolgopolov IS. COVID-19 coronavirus infection in children: Clinical presentation, diagnosis, vaccination, and treatment. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2023. [DOI: 10.21508/1027-4065-2022-67-6-14-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In late 2019, a new subtype of coronavirus named Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19 SARS-CoV-2) rapidly spread around the world, causing a global pandemic. Initially, the proportion of confirmed cases among children was relatively small, and it was believed that children were rarely infected. Subsequent observations have shown that in children and adolescents, the infection is either asymptomatic or paucisymptomatic, and therefore the true incidence is underestimated due to the lack of testing. The article systematizes the results of studies on the prevalence, diagnosis, clinical features, vaccination, and treatment of children with a new coronavirus infection COVID-19 SARS-CoV-2. The SARS-CoV-2 positivity rate throughout the peak of the pandemic in children was low compared to adults. Children are not only less likely to become infected with the virus, but they also endure the infection more easily than adults. The mortality rate in children with COVID-19 was <0.5%. In most children, infection is either asymptomatic or paucisymptomatic. Vaccination of children and adolescents is recommended mainly to achieve herd immunity in all age groups. However, there are no convincing data on the duration of the immune response, the level of the required protective antibody titer, as well as on the long-term side effects of vaccination due to the insufficient follow-up period and the uncertainty of the immune response criteria. As information is accumulated on the viral load of children and adolescents, their role in the transmission of the virus, diagnostic approaches in this age group are optimized. The effectiveness of the treatment was tested on patients admitted to the hospital, and recommendations for treatment were developed. Currently, global research efforts are focused on the protection of particularly vulnerable children, the prospects for total childhood vaccination, its effectiveness and safety.
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Affiliation(s)
- M. Yu. Rykov
- Russian State Social University; Semashko National Research Institute of Public Health
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Callejas-Caballero I, Ruedas-López A, Berzosa-Sánchez A, Illán-Ramos M, Joyanes-Abancens B, Bodas-Pinedo A, Guillén-Martín S, Soto-Sánchez B, García-Bermejo I, Molina-Arana D, Alós JI, Baos-Muñoz E, Delgado-Iribarren A, Fuentes-Ferrer ME, Ramos-Amador JT. A Prospective Study of the Serological, Clinical, and Epidemiological Features of a SARS-CoV-2 Positive Pediatric Cohort. CHILDREN (BASEL, SWITZERLAND) 2022; 9:665. [PMID: 35626842 PMCID: PMC9139432 DOI: 10.3390/children9050665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/21/2022] [Accepted: 04/29/2022] [Indexed: 12/04/2022]
Abstract
Background: SARS-CoV-2 was a global pandemic. Children develop a mild disease and may have a different rate of seroconversion compared to adults. The objective was to determine the number of seronegative patients in a pediatric cohort. We also reviewed the clinical−epidemiological features associated with seroconversion. Methods: A multicenter prospective observational study during September−November 2020, of COVID-19, confirmed by reverse transcription-polymerase chain reaction. Data were obtained 4−8 weeks after diagnosis. Blood samples were collected to investigate the humoral response, using three different serological methods. Results: A total of 111 patients were included (98 symptomatic), 8 were admitted to hospital, none required an Intensive Care Unit visit. Median age: 88 months (IQR: 24−149). Median time between diagnosis and serological test: 37 days (IQR: 34−44). A total of 19 patients were non-seroconverters when using three serological techniques (17.1%; 95% CI: 10.6−25.4); most were aged 2−10 years (35%, p < 0.05). Univariate analysis yielded a lower rate of seroconversion when COVID-19 confirmation was not present amongst household contacts (51.7%; p < 0.05). Conclusions: There was a high proportion of non-seroconverters. This is more commonly encountered in childhood than in adults. Most seronegative patients were in the group aged 2−10 years, and when COVID-19 was not documented in household contacts. Most developed a mild disease. Frequently, children were not the index case within the family.
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Affiliation(s)
- Ignacio Callejas-Caballero
- Department of Paediatrics, Collaborator at Instituto de Investigación Sanitaria del Hospital Universitario Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (I.C.-C.); (A.B.-S.); (M.I.-R.); (B.J.-A.)
| | - Alba Ruedas-López
- Department of Microbiology, Collaborator at Instituto de Investigación Sanitaria del Hospital Universitario Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (A.R.-L.); (E.B.-M.); (A.D.-I.)
| | - Arantxa Berzosa-Sánchez
- Department of Paediatrics, Collaborator at Instituto de Investigación Sanitaria del Hospital Universitario Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (I.C.-C.); (A.B.-S.); (M.I.-R.); (B.J.-A.)
| | - Marta Illán-Ramos
- Department of Paediatrics, Collaborator at Instituto de Investigación Sanitaria del Hospital Universitario Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (I.C.-C.); (A.B.-S.); (M.I.-R.); (B.J.-A.)
| | - Belén Joyanes-Abancens
- Department of Paediatrics, Collaborator at Instituto de Investigación Sanitaria del Hospital Universitario Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (I.C.-C.); (A.B.-S.); (M.I.-R.); (B.J.-A.)
| | - Andrés Bodas-Pinedo
- Department of Paediatrics, Collaborator at Instituto de Investigación Sanitaria del Hospital Universitario Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (I.C.-C.); (A.B.-S.); (M.I.-R.); (B.J.-A.)
| | - Sara Guillén-Martín
- Department of Paediatrics, Hospital Universitario de Getafe, 28905 Madrid, Spain; (S.G.-M.); (B.S.-S.)
| | - Beatriz Soto-Sánchez
- Department of Paediatrics, Hospital Universitario de Getafe, 28905 Madrid, Spain; (S.G.-M.); (B.S.-S.)
| | - Isabel García-Bermejo
- Department of Microbiology, Hospital Universitario de Getafe, 28905 Madrid, Spain; (I.G.-B.); (D.M.-A.); (J.-I.A.)
| | - David Molina-Arana
- Department of Microbiology, Hospital Universitario de Getafe, 28905 Madrid, Spain; (I.G.-B.); (D.M.-A.); (J.-I.A.)
| | - Juan-Ignacio Alós
- Department of Microbiology, Hospital Universitario de Getafe, 28905 Madrid, Spain; (I.G.-B.); (D.M.-A.); (J.-I.A.)
| | - Elvira Baos-Muñoz
- Department of Microbiology, Collaborator at Instituto de Investigación Sanitaria del Hospital Universitario Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (A.R.-L.); (E.B.-M.); (A.D.-I.)
| | - Alberto Delgado-Iribarren
- Department of Microbiology, Collaborator at Instituto de Investigación Sanitaria del Hospital Universitario Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (A.R.-L.); (E.B.-M.); (A.D.-I.)
| | | | - José T. Ramos-Amador
- Department of Paediatrics, Universidad Complutense-Instituto de Investigación Sanitaria del Hospital Universitario Clínico San Carlos (IdISSC), 28040 Madrid, Spain;
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Autoantibodies against interleukin-1 receptor antagonist in multisystem inflammatory syndrome in children: a multicentre, retrospective, cohort study. THE LANCET RHEUMATOLOGY 2022; 4:e329-e337. [PMID: 35368387 PMCID: PMC8963770 DOI: 10.1016/s2665-9913(22)00064-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious complication of infection with SARS-CoV-2. A possible involvement of pathogenetically relevant autoantibodies has been discussed. Recently, neutralising autoantibodies against inflammatory receptor antagonists progranulin and interleukin-1 receptor antagonist (IL-1Ra) were found in adult patients with critical COVID-19. The aim of this study was to investigate the role of such autoantibodies in MIS-C. Methods In this multicentre, retrospective, cohort study, plasma and serum samples were collected from patients (0–18 years) with MIS-C (as per WHO criteria) treated at five clinical centres in Germany and Spain. As controls, we included plasma or serum samples from children with Kawasaki disease, children with inactive systemic juvenile idiopathic arthritis, and children with suspected growth retardation (non-inflammatory control) across four clinical centres in Germany and Spain (all aged ≤18 years). Serum samples from the CoKiBa trial were used as two further control groups, from healthy children (negative for SARS-CoV-2 antibodies) and children with previous mild or asymptomatic COVID-19 (aged ≤17 years). MIS-C and control samples were analysed for autoantibodies against IL-1Ra and progranulin, and for IL-1Ra concentrations, by ELISA. Biochemical analysis of plasma IL-1Ra was performed with native Western blots and isoelectric focusing. Functional activity of the autoantibodies was examined by an in vitro IL-1β-signalling reporter assay. Findings Serum and plasma samples were collected between March 6, 2011, and June 2, 2021. Autoantibodies against IL-1Ra could be detected in 13 (62%) of 21 patients with MIS-C (11 girls and ten boys), but not in children with Kawasaki disease (n=24; nine girls and 15 boys), asymptomatic or mild COVID-19 (n=146; 72 girls and 74 boys), inactive systemic juvenile idiopathic arthritis (n=10; five girls and five boys), suspected growth retardation (n=33; 13 girls and 20 boys), or in healthy controls (n=462; 230 girls and 232 boys). Anti-IL-1Ra antibodies in patients with MIS-C belonged exclusively to the IgG1 subclass, except in one patient who had additional IL-1Ra-specific IgM antibodies. Autoantibodies against progranulin were only detected in one (5%) patient with MIS-C. In patients with MIS-C who were positive for anti-IL-1Ra antibodies, free plasma IL-1Ra concentrations were reduced, and immune-complexes of IL-1Ra were detected. Notably, an additional, hyperphosphorylated, transiently occurring atypical isoform of IL-1Ra was observed in all patients with MIS-C who were positive for anti-IL-1Ra antibodies. Anti-IL-1Ra antibodies impaired IL-1Ra function in reporter cell assays, resulting in amplified IL-1β signalling. Interpretation Anti-IL-1Ra autoantibodies were observed in a high proportion of patients with MIS-C and were specific to these patients. Generation of these autoantibodies might be triggered by an atypical, hyperphosphorylated isoform of IL-1Ra. These autoantibodies impair IL-1Ra bioactivity and might thus contribute to increased IL-1β-signalling in MIS-C. Funding NanoBioMed fund of the University of Saarland, José Carreras Center for Immuno and Gene Therapy, Dr Rolf M Schwiete Stiftung, Staatskanzlei Saarland, German Heart Foundation, Charity of the Blue Sisters, Bavarian Ministry of Health, the Center for Interdisciplinary Clinical Research at University Hospital Münster, EU Horizon 2020.
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7
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Wachter F, Regensburger AP, Antonia Sophia Peter, Knieling F, Wagner AL, Simon D, Hoerning A, Woelfle J, Überla K, Neubert A, Rauh M. Continuous monitoring of SARS-CoV-2 seroprevalence in children using residual blood samples from routine clinical chemistry. Clin Chem Lab Med 2022; 60:941-951. [PMID: 35218170 DOI: 10.1515/cclm-2022-0037] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/14/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The assessment of SARS-CoV-2 infections in children is still challenging, but essential for appropriate political decisions. The aim of this study was to investigate whether residual blood samples can be used for SARS-CoV-2 seroprevalence monitoring in pediatrics. METHODS In this repeated cross-sectional cohort study, anonymous residual blood samples from pediatric patients aged 0-17 years were collected in three time-periods (Oct.-Nov. 2020, April 2021, and June-July 2021) and analyzed for SARS-CoV-2 Spike protein (anti-S) and nucleocapsid (anti-N) antibodies using commercial antibody assays. 28 reactive samples were used to compare antibody levels with a pseudotyped neutralization assay. The results were further compared to the official national COVID-19 surveillance data to calculate the number of unreported cases. RESULTS In total, n=2,626 individual blood samples were analyzed. In this unvaccinated pediatric cohort anti-S and anti-N antibody seroprevalence increased over the three time periods (anti-S: 1.38-9.16%, and 14.59%; anti-N: 1.26%, to 6.19%, and 8.56%). Compared to the national surveillance data this leads to a 3.93-5.66-fold increase in the number of unreported cases. However, a correlation between the cumulative incidence of the individual provinces and our assigned data was found (r=0.74, p=0.0151). In addition, reactive samples with anti-S and anti-N and samples with only anti-S showed neutralization capabilities (11/14 and 8/14, respectively). Anti-S levels were not significantly different between age groups and sexes (all p>0.05). CONCLUSIONS The present study suggests that residual blood samples from routine laboratory chemistry could be included in the estimation of the total SARS-CoV-2 seroprevalence in children.
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Affiliation(s)
- Felix Wachter
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian P Regensburger
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Antonia Sophia Peter
- Institute of Clinical and Molecular Virology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alexandra L Wagner
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - André Hoerning
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Klaus Überla
- Institute of Clinical and Molecular Virology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Antje Neubert
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
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8
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Rudan I, Adeloye D, Katikireddi SV, Murray J, Simpson C, Shah SA, Robertson C, Sheikh A. The COVID-19 pandemic in children and young people during 2020-2021: Learning about clinical presentation, patterns of spread, viral load, diagnosis and treatment. J Glob Health 2021; 11:01010. [PMID: 35047182 PMCID: PMC8763336 DOI: 10.7189/jogh.11.01010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Igor Rudan
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Davies Adeloye
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Josie Murray
- COVID-19 Surveillance Lead, Public Health Scotland, Fife, UK
| | - Colin Simpson
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, New Zealand
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK and Public Health Scotland, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - EAVE II collaboration
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
- MRC/CSO Social & Public Health Sciences Unit, Glasgow, UK
- COVID-19 Surveillance Lead, Public Health Scotland, Fife, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, New Zealand
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK and Public Health Scotland, Glasgow, UK
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9
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Mungmunpuntipantip R, Wiwanitkit V. Smell and Taste Loss in COVID-19 After Complete Vaccination: Correspondence. Laryngoscope 2021; 132:E18. [PMID: 34910827 DOI: 10.1002/lary.29988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/24/2021] [Indexed: 11/07/2022]
Affiliation(s)
| | - Viroj Wiwanitkit
- Department of Community Medicine, Dr DY Patil University, Pune, India
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