Measles is a vaccine-preventable disease that continues to be a major cause of morbidity and mortality in children and young adults across the world. Immunization efforts have reduced the incidence of measles over the last 3 decades, but outbreaks are seen in high-transmission areas with susceptible populations, as is seen in hospitals and student campuses. The protection offered by prior vaccination may wean off over time making vaccinated individuals susceptible to infection. Hence, catch-up immunization drives should be undertaken for vulnerable populations such as healthcare personnel, along with routine immunization programs, with the goal to eliminate measles in the future. This case series presents measles in two of our medical residents who got infected despite being vaccinated in childhood.
Objective:
To study impact of COVID-19 pandemic on frequency, clinical/electrophysiological profile and treatment outcomes in pediatric Guillain-Barré syndrome (GBS).
Background:
GBS is the most frequent cause of pediatric acute flaccid paralysis. The effect of the COVID-19 pandemic on pediatric GBS is unclear in the literature.
Methods:
We conducted an ambispective, multicentric, cohort study involving 12 of 27 centres in GBS Consortium, during two periods: pre-COVID-19 (March-August 2019) and during COVID-19 (March-August 2020). Children ≤12 years who satisfied National Institute of Neurological Diseases and Stroke criteria for GBS/variants were enrolled. Details pertaining to clinical/laboratory parameters, treatment and outcomes (modified Rankin Scale (mRS) at discharge, GBS Disability score at discharge and 3 months) were analysed.
Results:
We enrolled 33 children in 2019 and 10 in 2020. Children in 2020 were older (median 10.4 [interquartile range 6.75–11.25] years versus 5 (2.5–8.4) years;
P
= 0.022) and had more sensory symptoms (50% versus 18.2%;
P
= 0.043). The 2020 group had relatively favourable mRS at discharge (median 1 (1–3.5) versus 3 (2–4);
P
= 0.042) and GBS disability score at 3 months (median 0 (0–0.75) versus 2 (0–3);
P
= 0.009) compared to 2019. Multivariate analysis revealed bowel involvement (
P
= 0.000) and ventilatory support (
P
= 0.001) as independent predictors of disability. No child in 2020 had preceding/concurrent SARS-CoV2 infection.
Conclusions:
The COVID-19 pandemic led to a marked decline in pediatric GBS presenting to hospitals. Antecedent illnesses, clinical and electrophysiological profile of GBS remained largely unchanged from the pre-pandemic era.
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