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January 2022; 9 (1) ArticleOpen Access

Impact of COVID-19 in Immunosuppressed Children With Neuroimmunologic Disorders

Gemma Olivé-Cirera, Elianet Fonseca, Verónica Cantarín-Extremera, María Vázquez-López, María Jiménez-Legido, Verónica González-Álvarez, Juliana Ribeiro-Constante, Ana Camacho-Salas, Itxaso Martí, Ramon Cancho-Candela, María Jesús Martínez-González, Albert Saiz, View ORCID ProfileThaís Armangué
First published November 10, 2021, DOI: https://doi.org/10.1212/NXI.0000000000001101
Gemma Olivé-Cirera
From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain.
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  • For correspondence: olive.cirera.gemma@gmail.com
Elianet Fonseca
From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain.
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  • For correspondence: elianet.fonsec@gmail.com
Verónica Cantarín-Extremera
From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain.
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  • For correspondence: veronica.cantarin@salud.madrid.org
María Vázquez-López
From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain.
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  • For correspondence: maria.vazquez@salud.madrid.org
María Jiménez-Legido
From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain.
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  • For correspondence: mjimenezl@salud.madrid.org
Verónica González-Álvarez
From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain.
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  • For correspondence: vgonzalez@sjdhospitalbarcelona.org
Juliana Ribeiro-Constante
From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain.
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  • For correspondence: jribeiroconstante@gmail.com
Ana Camacho-Salas
From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain.
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  • For correspondence: acamachosalas@yahoo.es
Itxaso Martí
From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain.
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  • For correspondence: itxasomarti@gmail.com
Ramon Cancho-Candela
From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain.
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  • For correspondence: rcanchoc@saludcastillayleon.es
María Jesús Martínez-González
From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain.
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  • For correspondence: mariajesus.martinezgonzalez@osakidetza.eus
Albert Saiz
From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain.
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  • For correspondence: asaiz@clinic.cat
Thaís Armangué
From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain.
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Citation
Impact of COVID-19 in Immunosuppressed Children With Neuroimmunologic Disorders
Gemma Olivé-Cirera, Elianet Fonseca, Verónica Cantarín-Extremera, María Vázquez-López, María Jiménez-Legido, Verónica González-Álvarez, Juliana Ribeiro-Constante, Ana Camacho-Salas, Itxaso Martí, Ramon Cancho-Candela, María Jesús Martínez-González, Albert Saiz, Thaís Armangué
Neurol Neuroimmunol Neuroinflamm Jan 2022, 9 (1) e1101; DOI: 10.1212/NXI.0000000000001101

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Abstract

Background and Objectives To investigate whether children receiving immunosuppressive therapies for neuroimmunologic disorders had (1) increased susceptibility to SARS-CoV2 infection or to develop more severe forms of COVID-19; (2) increased relapses or autoimmune complications if infected; and (3) changes in health care delivery during the pandemic.

Methods Patients with and without immunosuppressive treatment were recruited to participate in a retrospective survey evaluating the period from March 14, 2020, to March 30, 2021. Demographics, clinical features, type of immunosuppressive treatment, suspected or confirmed COVID-19 in the patients or cohabitants, and changes in care delivery were recorded.

Results One hundred fifty-three children were included: 84 (55%) female, median age 13 years (interquartile range [8–16] years), 79 (52%) on immunosuppressive treatment. COVID-19 was suspected or confirmed in 17 (11%) (all mild), with a frequency similar in patients with and without immunosuppressive treatment (11/79 [14%] vs 6/74 [8%], p = 0.3085). The frequency of neurologic relapses was similar in patients with (18%) and without (21%) COVID-19. Factors associated with COVID-19 included having cohabitants with COVID-19 (p < 0.001) and lower blood levels of vitamin D (p = 0.039). Return to face-to-face schooling or mask type did not influence the risk of infection, although 43(28%) children had contact with a classmate with COVID-19. Clinic visits changed from face to face to remote for 120 (79%) patients; 110 (92%) were satisfied with the change.

Discussion In this cohort of children with neuroimmunologic disorders, the frequency of COVID-19 was low and not affected by immunosuppressive therapies. The main risk factors for developing COVID-19 were having cohabitants with COVID-19 and low vitamin D levels.

Glossary

IVIg=
IV immunoglobulin;
MS=
multiple sclerosis;
PIMS=
pediatric inflammatory multisystem syndrome

Footnotes

  • Go to Neurology.org/NN for full disclosures. Funding information is provided at the end of the article.

  • Spanish Study Group NeuroimmunoPed-Covid coinvestigators are listed in the appendix at the end of the article.

  • The Article Processing Charge was funded by Instituto Salud Carlos III-FEDER.

  • Received June 1, 2021.
  • Accepted in final form September 14, 2021.
  • Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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