IT | EN
Francesca Rossi
Full Professor of the Department of General and Specialized Surgery for Women and Children - University of Campania Luigi Vanvitelli
Is it true that children get less sick from Covid than adults? Is the Delta variant more worrying? Should children in paediatric age be vaccinated? We asked Francesca Rossi, professor of general and specialist paediatrics at the Vanvitelli University, in an in-depth study dedicated to children.
We often hear that children get less sick from Covid. Is this true?
Children get Covid but generally in a less severe form than adults. There have been several hypotheses to explain this phenomenon. One of the first concerns the ACE2 receptor, the receptor that guides the entry of the virus into human cells, which is poorly expressed in the respiratory system of children. Another hypothesis argues that children have a more "stimulated" immune system and therefore more "ready" to respond against Covid due to numerous contacts with other viruses and thanks to exposure to the mandatory vaccines in childhood. Finally, a further hypothesis argues that a key role in protecting children from Covid is played by the "innate immunity", that is, the defence system that is particularly powerful in children. Although the “Innate immunity” cannot selectively attack pathogens because it does not use immunological memory, it has the advantage of being quick and fast.
Symptoms in paucisymptomatic and symptomatic children.
Children and teenagers generally show silent or mild symptoms, with rare complications. In young symptomatic patients, fever is the most common clinical manifestation in addition to symptoms mostly affecting the respiratory system (sore throat, dry cough, cold, chest pain, dyspnoea). Compared to adult patients, paediatric cases show a higher rate of gastrointestinal symptoms such as nausea, vomiting and diarrhoea, sometimes even in the absence of respiratory symptoms.
According to a survey carried out by the Italian Society of Paediatrics and the Italian Society of Paediatric Infectious Diseases on a sample of over 750 patients aged between 1 month and 19 years, it was found that in 82% of cases, fever is the most frequent symptom, followed by cough (38%), rhinitis (20.8%) and diarrhoea (16%).
Furthermore, the study confirms that the appearance of symptoms is also related to age. Adolescents generally have symptoms more similar to those of adults, with headaches, alterations in taste and smell, vomiting, chest pain, while younger children can become infected but in a mostly asymptomatic or paucisymptomatic manner.
Pneumonia is one of the possible implications of Covid in adults. And in children?
Interstitial pneumonia can also occur in children but with different forms and especially with different severeness than in adults. A recent study has shown, in fact, that COVID-19 infection rarely affects the lung function of children and adolescents. However, the most relevant problem in this age group seems to be pericarditis.
Delta variant, children are very affected?
The Delta variant did not change the history of Covid infection in children, but being much more contagious than the previous version and since children, unlike adults and adolescents (> 12 years), are not vaccinated, it circulates a lot in this age range. The real risk is that circulating so much, the possibility of the onset of a more aggressive variant increases in the future, not only from the point of view of contagiousness, even among children.
What are the long-term effects of Covid on children?
Only time will allow us to answer this question in a clear and exhaustive way. The data reported, to date, in literature on the incidence of "Long Covid" among children are few and conflicting. An Italian study published in Acta Paediatrica attests a high incidence of "Long Covid" even among children: more than one third of the sample analysed shows one or two persistent symptoms four months or more after infection, and another quarter have three or more symptoms.
Insomnia, asthenia, myalgia and flu-like syndrome are the most common "Long Covid" symptoms, analogously to what is observed in adult populations. A more recent English study, on the other hand, shows a much lower incidence of "Long Covid" among children, no more than 10%. To clarify the incidence and above all the nature of the long-term effects of Covid in children, clinics dedicated to the follow-up of children and adolescents who have had a SARS-Cov2 infection have been activated in most paediatric facilities operating throughout the country.
Currently, the long-term effects of Covid in this age group seem to have little to do with lung, cardiological or neurological damage reported in adults.
That is?
In fact, the long-term effects of Covid in children and adolescents to date are, in fact, mainly of a psychological nature. Depression, anxiety, restlessness, closure, anger, loneliness have increased exponentially among the young generation since the start of the pandemic. Access to emergency rooms, as well as hospitalizations for neuropsychiatric disorders, increased by about 80%, as reported in a study by the Italian Society of Paediatrics. The boredom, the sedentary lifestyle, felt by children during the lockdown, have increased the rate of overweight and obesity. The job loss of millions of parents has emphasized social and cultural inequalities.
How can all this be contained?
Increasing vaccination coverage is therefore essential to avoid new lockdowns and to curb neuropsychiatric disorders, eating disorders, social and cultural inequalities in our children.
What happens if a child becomes seriously ill with Covid?
In Italy, the number of deaths in developmental age due to Covid is limited, out of 723 thousand people under the age of 18 affected by the virus there were 32 victims. There have been several cases of severe forms that required intensive care, in particular due to the onset of Mis-C, a multisystem inflammatory syndrome that can occur 2 to 6 weeks after SARS-CoV-2 infection in children and in adolescents and that in the initial phase of the pandemic was confused with Kawasaki disease. Symptoms and signs of this fearful disease are represented by persistent fever (> 38 ° C), systemic inflammatory state with increased inflammation, neutrophilic leucocytosis, lymphopenia and organ dysfunction, together with laboratory or epidemiological evidence of infection by SARS-CoV-2 and exclusion of other microbiological causes.
Is the transmissibility of Covid among children the same as among adults?
It has been one of the most important and most discussed questions since the beginning of the pandemic and for which we still do not have a definitive answer. A few months ago, a study published in a prestigious international journal, Jama Paediatrics, showed that children under the age of five can have levels of viral RNA equal to and even higher than those of adults in the nose and throat. On the contrary, a more recent Canadian study demonstrates a reduced infectivity of viral samples isolated from children compared to those isolated from adults.
Children, especially the younger ones, are probably not "super diffusers" of SARS-CoV-2 as they are for other viruses, including influenza. The arise of variants that spread more rapidly, together with the increase in vaccination rates among adults and adolescents, however, could soon make children extremely relevant for the spread of the infection.
Will infections increase with the reopening of schools?
Up to now, there has not been an increase in Covid cases after returning to class, but obviously, the situation must be monitored for a few more weeks. In the previous year, we observed limited infections within schools where all recommended health safety measures are respected. In fact, most of the infections among children occurred within the family.
How has the Italian Society of Paediatrics expressed itself regarding the vaccine in pediatric age?
The Italian Society of Paediatrics (SIP) has clearly expressed itself in favour of vaccination among adolescents and hopes that the vaccine will soon be available also for children under 12 years of age. SIP has recently created a poster, now exhibited in all paediatric studies throughout the country, which answers the 8 most frequently asked questions about the vaccine in this age range to help paediatricians guide adolescents and their families
The COVID 19 vaccine can also be administered without specific time intervals compared to the vaccines provided for by the National Vaccine Prevention Plan, only the 15 days following vaccination are necessary for the evaluation of any adverse events. For children with previous SARS-CoV-2 infection there is an interval of at least 90 days between the diagnosis of infection and the first administration of the Covid-19 vaccine. Furthermore, the SIP does not recommend the prescription of drugs aimed at the prevention of any post-vaccine adverse events, but stresses the need to inform parents on how to manage the most frequent post-vaccine symptoms and the timing for contacting their own paediatrician. Finally, all paediatricians agree on the need to strongly reaffirm to adolescents and their families the value of continuous and constant compliance with the rules for the containment and spread of SARS-CoV-2, even after vaccination.