This literature review aims to provide an update on the problem of coronavirus infection in children. It covers specific features of the pathogens and ways of their transmission in children and focuses on the nuances of the clinical course. It also describes the approaches to diagnosis, treatment, and prevention of seasonal coronavirus infections and COVID-19. Particular attention is paid to treatment and prevention of acute respiratory viral infections (ARVIs), including seasonal coronavirus infections, during the ongoing COVID-19 pandemic using Anaferon for children, a drug with an immune-mediated antiviral effect. The article provides the data on experimental and clinical evaluation of Anaferon efficacy in children with coronavirus infections. Experimental in vitro studies of Anaferon for children demonstrated its antiviral efficacy against highly pathogenic MERS-CoV. Clinical trials, including double-blind placebo-controlled RCTs, showed that the inclusion of Anaferon for children in the comprehensive therapy of seasonal coronavirus infections reduced the disease duration, mitigated symptoms, and decreased the incidence of nosocomial infections. These effects were associated with the modulating activity of Anaferon for children affecting both cellular and humoral immunity. The analysis of studies evaluating Anaferon for children allows us to recommend this drug for widespread use in the treatment and prevention of seasonal ARVIs, including those caused by coronaviruses during the ongoing COVID-19 pandemic. Key words: Anaferon for children, treatment, coronavirus infection, prevention, COVID-19
The new coronavirus infection (COVID-1 9) is a socially significant problem around the world. According to available statistics, complications are less common among children, asymptomatic or mild forms of the disease prevail more often.This article presents the features of the viral landscape of the upper respiratory tract in children with ARVI in a pandemic, the clinical and laboratory features of the course of COVID-1 9 in children of different ages.It was found that SARS-CoV-2 is detected only in a third (32.9%) of hospitalized patients with respiratory symptoms, in 4.3% of cases — in combination with seasonal CoV-OC43 / CoV-229E, in 1 1.6% — with other respiratory viruses. The most frequent source of infection with the SARS-Cov-2 were family members. Children with a moderate form of the disease predominated among the patients. The leading symptoms of COVID-19 were fever, catarrhal symptoms, as well as gastrointestinal manifestations and anosmia. A feature of the new coronavirus infection in newborns and children of the first month of life was the absence of fever and intoxication, the lack of expression of catarrhal manifestations when the colon is involved in the pathological process (colitis, rarely — hemocolitis). In the compete blood test in children under the age of one year, monocytosis prevailed, in children over 7 years old — leukopenia and accelerated ESR. Among the changes in the biochemical analysis of blood, the most common was an increased C-reactive protein.
Objective: To describe the burden of COVID-19 in a children’s multidisciplinary hospital for two years of the pandemic, taking into account of age, severity of the disease, the spectrum of underlying conditions and the intensive care need.Methods: An assessment of 6048 cases of COVID-19 in patients under 18 years of age hospitalized from March 26, 2020 to December 31, 2021 was carried out. The diagnosis was confirmed by PCR on an outpatient basis or after hospitalization with the help of diagnostic kits registered in the Russian Federation. The features of the work of a children’s multidisciplinary hospital in new conditions, the dynamics of hospitalization, age characteristics and new coronavirus (CV) infection severity in the pandemic development process are presented. The analysis of the underlying condition’s structure depending on the severity of the disease, as well as the need and volume of therapy in the intensive care unit. The frequency and main characteristics of children’s multisystem inflammatory syndrome (MIS-C) in hospital conditions, long-term PCR positivity and its effect on the duration of inpatient treatment of children have been established.Results: The spread of SARS-COV-2 in St. Petersburg required a radical change in the work of the children’s multidisciplinary hospital. During the two years of the pandemic, four waves of hospitalization of children with new CV were revealed, differing in duration, intensity, and frequency of lung damage, but having no significant differences in the proportion of severe forms of the disease (1.7-2.8% of cases). Intensive therapy was required in 3.6% of cases, of which only 1/3 was due to the severe course of COVID-19 with a lung lesion volume of up to 100%. In 1/3 of cases, patients had risks of developing severe forms and in 1/3 – other pathology. Severe course of new CV was significantly more often accompanied by the need for respiratory support, anticoagulants and anti-inflammatory therapy. Contributing factors of severe forms and unfavorable outcomes were: pathology of the central nervous system, genetic diseases and malformations, obesity, as well as chronic bronchopulmonary pathology. Mortality in the hospital was recorded only among children with severe underlying conditions (0.1% of cases). D-MVS was registered significantly more often in boys (7 out of every 10 patients), accounting for 1.2% of cases of hospitalization of children with new CV over the entire period. Convalescent PCR-positivity in the outcome of COVID-19 was detected in 1/3 of children, significantly more often during the autumnwinter waves of the pandemic and among patients of high school age.Conclusion: New CV is gradually strengthening its position in the structure of acute respiratory pathology in children. Some of SARS-COV-2 infection cases is accompanied by extensive lung damage, as well as severe systemic inflammation independently or in the other infectious diseases structure, induction of the debut of various somatic pathology is not excluded. The presented data confirm the need for increased attention at high risk of adverse respiratory diseases outcomes children. All severe cases of COVID-19 in children require a personalized approach, taking into account the existing background diseases and possible options for the progression of the process. MIS-C should be considered as a systemic inflammatory response syndrome within the framework of an infectious disease of various etiologies, differentiated with Kawasaki disease and the debut of systemic diseases. The long-term PCR-positivity in the outcome of COVID-19 requires further study to address the need and nature of therapy in order to prevent further spread of infection in the population.
In 1900 children of different ages and 690 adults with laboratory confirmed influenza in different epidemic seasons studied levels of interferons and interleukins 4 and 10 in the serum calculating the ratio of interleukin 4, 10 to interferon gamma. There are three type of immune response to influenza depending on the clinical course. It was shown that in flu with moderate intoxication in 66.3 % of cases in children and 72.0 % of adults marked polarization on Th1 type with increase level in serum and spontaneous interferon gamma in all age groups, in which the ratio of IL-4/IFN-g from 0.8 to 2, while in severe intoxication only 33.5 and 43.9 %, respectively. In children with bronchitis immune response Th2 type and mixed Th1/Th2 type were observed in 54.6 and 33.3 % of cases respectively, and only 12.1 % of Th1 type. With influenza, pneumonia is a complication, in 76 % of cases were determined humoral immune response by Th2 type when the ratio of IL-4/IFN-g and IL-10/ IFN-g is greater than 3, due to the increase of the content of interleukin 4 and 10, while significantly reducing levels of interferon gamma. In 23.7 % of cases observed Th1/Th2 mixed type of immune response with a ratio of 2 to 3. The obtained data allow us to determine the type of immune response to influenza infection and to predict the severity of the disease and the development of complications in children and adults, and also to determine the necessity of including in the therapy drugs of immunocorrection.
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