Corona Virus Disease 2019 and Paediatric Inflammatory Bowel Diseases

Abstract

Introduction: With the current coronavirus disease 2019 (COVID-19) pandemic, concerns have been raised about the risk to children with inflammatory bowel diseases (IBD). We aimed to collate global experience and provide provisional guidance for managing paediatric IBD (PIBD) in the era of COVID-19. Methods: An electronic reporting system of children with IBD infected with SARS-CoV-2 has been circulated among 102 PIBD centres affiliated with the Porto and Interest-group of ESPGHAN. A survey has been completed by major PIBD centres in China and South-Korea to explore management during the pandemic. A third survey collected current practice of PIBD treatment. Finally, guidance points for practice have been formulated and voted upon by 37 PIBD authors and Porto group members. Results: Eight PIBD children had COVID-19 globally, all with mild infection without needing hospitalization despite treatment with immunomodulators and/ or biologics. No cases have been reported in China and South Korea but biologic treatment has been delayed in 79 children, of whom 17 (22%) had exacerbation of their IBD. Among the Porto group members, face-to-face appointments were often replaced by remote consultations but almost all did not change current IBD treatment. Ten guidance points for clinicians caring for PIBD patients in epidemic areas have been endorsed with consensus rate of 92% to 100%. Conclusions: Preliminary data for PIBD patients during COVID-19 outbreak are reassuring. Standard IBD treatments including biologics should continue at present through the pandemic, especially in children who generally have more severe IBD course on one hand, and milder SARS-CoV-2 infection on the other.

Children are not COVID-19 super spreaders: time to go back to school

“…All three children who required intubation in a large Chinese cohort study had comorbidities (including leukaemia, hydronephrosis and intussusception), 13 but it is not clear if COVID-19 was the reason for their needing intensive care. Limited data on children post liver transplant, 14 with inflammatory bowel disease on immunosuppression 15 and cancer, 16 are reassuring. Limited data from the USA CDC are available on children with comorbidities; however, 23% of confirmed cases were found to have a comorbid condition (most commonly respiratory), and 77% of patients with known hospitalisation status (n=37) had a comorbidity (including all six cases admitted to PICU).…”

Management of inflammatory bowel disease patients in the COVID-19 pandemic era: a Brazilian tertiary referral center guidance

“…A recent paper from the Pediatric IBD PORTO Group of ESPGHAN outlined key information about children with IBD and SARS-CoV-2 infection and provided clear guidance on how to proceed (12). Chinese and Korean pediatric GI specialists reported 272 cases in children with IBD and SARS-CoV-2 infection during the pandemic while Europeans reported 8 PIBD patients (14-19 years) with COVID-19 from the PORTO-IBD group and SECURE-IBD database.…”

“…The period of viral secretion from pediatric feces is longer than in adults (10). These observations suggest that the inflamed gut of adults and children with IBD could be more susceptible to infection with SARS-CoV-2 because it is a doorway for the virus (11,12).…”

The expression level of angiotensin-converting enzyme 2 determines the severity of COVID-19: lung and heart tissue as targets

“…The COVID-19 incubation period is estimated from 1 to 14 days (Lauer et al, 2020;Linton et al, 2020). The lungs are the main organs that are affected by COVID-19 (Aigner et al, 2020;, but in serious cases other parts of the body such as central nervous system (CNS) (Baig et al, 2020), kidney (Cheng, Luo, et al, 2020;He, Mok, et al, 2020), liver (Feng et al, 2020;, heart (Akhmerov & Marban, 2020;Shi et al, 2020), stomach (Poggiali et al, 2020), intestine (Cao, 2020;Monteleone & Ardizzone, 2020;Turner et al, 2020) can also be affected.…”