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?
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?
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DOI：
10.1016/j.idnow.2021.05.004
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发表时间：
2021-08
影响因子：
3.5
通讯作者：
Grimprel E
中科院分区：
文献类型：
--
作者：
Cohen R;Ashman M;Taha MK;Varon E;Angoulvant F;Levy C;Rybak A;Ouldali N;Guiso N;Grimprel E
自新冠肺炎大流行开始以来，报告的许多病毒和细菌感染在儿童中的发病率有所下降：毛细支气管炎、水痘、麻疹、百日咳、肺炎球菌和脑膜炎双球菌侵袭性疾病。本意见书的目的是讨论在不再需要SARS-CoV-2疫情施加的非药物干预措施(NPI)时，可能导致更大流行病的各种情况。虽然NPIS限制了SARS-CoV-2的传播，但它们也减少了其他病原体在封锁期间和之后的传播，尽管法国的学校自2020年6月以来重新开学。这种积极的附带效应在短期内是受欢迎的，因为它防止了医疗体系额外的过载。由于微生物制剂的循环减少和相关的疫苗接种量减少而缺乏免疫刺激，导致了“免疫债务”，当大流行得到控制和非传染性疾病被解除时，这可能会产生负面后果。这些“病毒或细菌低暴露”的时间越长，未来流行的可能性就越大。这是由于“易感”人群比例越来越高，人群免疫力下降所致。观察到疫苗接种计划的延迟而没有有效的追赶，以及病毒和细菌暴露的减少导致疫苗可预防疾病的风险反弹。由于疫苗接种计划不包括针对轮状病毒、水痘、B群和ACYW奈瑟氏菌脑膜炎的疫苗，法国可能会变得更容易受到其中一些反弹影响的影响。
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.
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