Covid-19, because it can rarely become serious in children

It is a very rare reality. But there are cases where COVID-19 it can become particularly concerning too in children, which more often have almost no symptoms related to Sars-CoV-2 virus infection or in any case have ailments similar to those of a cold or a mild flu. The experts present at the Congress of the Italian Society of Pediatric Allergy and Immunology (SIAIP) explain what happens in this situation.

The role of genetics in the response

To explain what can happen in a very small number of children who contract the virus is Luigi Notarangelo, Director of the American Laboratory of Clinical Immunology and Microbiology of the NIH (National Institute of Health), who has investigated precisely this aspect.

“Our starting hypothesis was that some of the subjects who developed a particularly severe form of Covid-19 had basic a genetic defect the ability of the immune system to cope with the virus and that, on the contrary, subjects who, while presenting comorbidities ”- explains the expert.

“These subjects, despite being elderly, when exposed to the virus do not develop disease, they have a genetic constitution capable of determining resistance to viral infection. In collaboration with various Italian centers we have studied the genome of these subjects, focusing in particular on genes involved in defense mechanisms against viruses.

We already knew that alterations in some of these genes are responsible for fatal forms of influenza. In fact, we observed the presence of mutations in these 13 genes in 3.5% of patients with a critical form of Covid-19. These are genes that are important for producing first type interferons which in the initial phase of a viral infection, before the specific immunity responses with the production of antibodies and T lymphocytes are triggered, are produced by the immune system and by the cells of the respiratory tract infected by the virus with the aim of reducing viral replication as much as possible “.

If for genetic reasons an individual is unable to produce first type interferon, the virus remains free to replicate and thus manages to spread much more in the organism. But the researchers also made another observation. “10% of subjects with critical Covid-19 – concludes the expert – without genetic defects had some autoantibodies against first type interferons that blocked its activity leaving the virus free to replicate “.

These are observations destined to have an impact on therapy with the use, for example, at a very early stage of the disease, of interferons in patients unable to produce them or with interventions that allow the elimination of antibodies against interferons in patients who present them.

Vaccines, but not only

Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH) in Bethesda. Virtually present at the congress, he remembers that vaccines are not the only way out of the pandemic.

“Having recently entered the second year of this historic Covid-19 pandemic, we are all understandably exhausted, eager to end the suffering, tragic deaths and constraints the pandemic has placed on our lives. Extraordinarily, we have created in record time – explains Fauci – several vaccines against Covid-19 that have shown great effectiveness by offering us the hope of having the tools in hand to defeat Sars VOC 2.

While vaccines are essential to achieve this, we obviously cannot see them as our only way out of the pandemic. It is necessary act on two fronts: vaccinate as many people as possible in the shortest time possible while continuing to follow public health prevention measures. We can put an end to this pandemic but when we do it depends on each one of us being committed to being part of the solution ”.

“The scientific objective of our society is that of a transversal vision of allergology and immunology – reports the SIAIP president Gian Luigi Marseglia, Director of the Pediatric Clinic of the University of Pavia, Fondazione IRCCS Policlinico San Matteo – It is not focused only on purely allergological or purely immunological diseases, but to the evaluation of all the pathologies in which allergology and immunology they represent the common denominator of the child’s illnesses. This is why we also deal with rheumatology, the immunological aspects of gastrointestinal diseases, the allergological and immunological aspects of diseases of the central nervous system and so on ”.

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