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Pediatric Infectious Disease Group (GPIP) position paper on the immune debt of the COVID-19 pandemic in childhood, how can we fill the immunity gap? - 05/08/21

Doi : 10.1016/j.idnow.2021.05.004 
Robert Cohen a, b, c, d, e, Marion Ashman a, f, Muhamed-Kheir Taha g, Emmanuelle Varon h, François Angoulvant e, i, j, Corinne Levy a, b, c, d, e, , Alexis Rybak a, d, e, Naim Ouldali a, d, e, j, k, Nicole Guiso l, Emmanuel Grimprel e, m
a ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France 
b Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France 
c Université Paris Est, IMRB-GRC GEMINI, Créteil, France 
d AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France 
e GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Créteil, France 
f Centre Hospitalier Intercommunal de Créteil, France 
g Centre National de Référence des Méningocoques, Institut Pasteur, Paris, France 
h Centre National de Référence des Pneumocoques, Centre Hospitalier Intercommunal de Créteil, France 
i Assistance Publique–Hôpitaux de Paris, Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants-Malades University Hospital, Université de Paris, France 
j INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Sorbonne Université, Université de Paris, Paris, France 
k Assistance Publique-Hôpitaux de Paris, Department of general pediatrics, pediatric infectious disease and internal medicine, Robert Debré university hospital, Université de Paris, Paris, France 
l Institut Pasteur, Paris, France 
m Service de pédiatrie, Centre Hospitalier Armand Trousseau, Paris, France 

Corresponding author at: ACTIV, 31, rue Le Corbusier, 94000 Créteil, France.ACTIV31, rue Le CorbusierCréteil94000France

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Highlights

Since the beginning of the COVID-19 pandemic, a decreased incidence of many viral and bacterial infections has been reported in children.
Non-pharmaceutical interventions limited the transmission of SARS-CoV-2 and reduced the spread of other pathogens despite school re-opening.
The lack of immune stimulation due to the reduced circulation of microbial agents and to reduced vaccine uptake induced an “immunity debt” with a growing proportion of susceptible people.
Vaccination program delay and decreased viral and bacterial exposure lead to a rebound risk of vaccine-preventable diseases.
As the French vaccination schedule does not include vaccines against rotavirus, varicella, and serogroup B and ACYW Neisseria meningitidis, stronger epidemic rebounds could be observed.

Il testo completo di questo articolo è disponibile in PDF.

Abstract

Since the beginning of the COVID-19 pandemic, reduced incidence of many viral and bacterial infections has been reported in children: bronchiolitis, varicella, measles, pertussis, pneumococcal and meningococcal invasive diseases. The purpose of this opinion paper is to discuss various situations that could lead to larger epidemics when the non-pharmaceutical interventions (NPI) imposed by the SARS-CoV-2 epidemic will no longer be necessary. While NPIs limited the transmission of SARS-CoV-2, they also reduced the spread of other pathogens during and after lockdown periods, despite the re-opening of schools since June 2020 in France. This positive collateral effect in the short term is welcome as it prevents additional overload of the healthcare system. The lack of immune stimulation due to the reduced circulation of microbial agents and to the related reduced vaccine uptake induced an “immunity debt” which could have negative consequences when the pandemic is under control and NPIs are lifted. The longer these periods of “viral or bacterial low-exposure” are, the greater the likelihood of future epidemics. This is due to a growing proportion of “susceptible” people and a declined herd immunity in the population. The observed delay in vaccination program without effective catch-up and the decrease in viral and bacterial exposures lead to a rebound risk of vaccine-preventable diseases. With a vaccination schedule that does not include vaccines against rotavirus, varicella, and serogroup B and ACYW Neisseria meningitidis, France could become more vulnerable to some of these rebound effects.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : Covid-19 pandemic, VZV, Streptococcus pneumoniae, Neisseria meningitidis, Bordetella, Vaccination


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Vol 51 - N° 5

P. 418-423 - Agosto 2021 Ritorno al numero
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