Abstract
BackgroundTo date, there's no evidence of an increased risk of SARS-CoV-2 infection or more severe COVID-19 in patients with inflammatory bowel disease (IBD). However, whether COVID-19 alters the clinical course of IBD or whether IBD treatment affects the immunological response to SARS-CoV-2 is still under investigation, especially in children.AimTo assess the serological response to SARS-CoV-2 in children with IBD, and to evaluate the impact of COVID-19 on the clinical course of IBD.Material and MethodsThis prospective study enrolled children (0–18 years) followed-up at the University Hospital of Padova for IBD, who acquired a confirmed SARS-CoV-2 infection between 02.2020 and 02.2021. The anti-SARS-CoV-2 S-RBD IgG titer was evaluated at 3 months after infection and compared to that of a control group of healthy children matched for age, sex, and COVID-19 severity.ResultsTwelve children with IBD (M = 5; median age 14 years) contracted COVID-19 during the study period. 11/12 patients were under immunomodulatory treatment (4/12 steroids; 6/12 azathioprine; 3/12 anti-TNFs; 2 vedolizumab; 1 ustekinumab). SARS-CoV-2 infection remained asymptomatic in 4/12 children and caused mild COVID-19 in the remaining 8. Mean anti-SARS-CoV-2 IgG S-RBD titer was similar between IBD patients and controls (27.3 ± 43.8 vs. 36.8 ± 35.3 kAU/L, p = ns). No children experienced IBD flares nor required gastroenterological support during the infection period.DiscussionChildren with IBD can mount a protective humoral response against SARS-CoV-2, which is comparable to that of their healthy peers regardless of ongoing immunomodulatory treatment. This study also supports the favorable course of PIBD during COVID-19 and vice-versa.
Highlights
Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread globally, evolving into a pandemic and a serious public health threat across the world [1]
Our prospective study shows that children with pediatric IBD (PIBD) under treatment with immunomodulatory agents can mount a humoral immunological response against SARS-CoV-2 comparable to that of a control group of healthy subjects matched for age, sex and COVID-19 severity
Our data provide further evidence for the overall benign course of COVID-19 in PIBD patients regardless of immunosuppressive therapy, and show that SARS-CoV-2 infection does not negatively influence the course of inflammatory bowel disease (IBD) in children previously co-affected with COVID-19
Summary
Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread globally, evolving into a pandemic and a serious public health threat across the world [1]. The induction of protective immunity to SARS-CoV-2 is critical to contain viral replication in individual subjects, suppress viral transmission across the population, and prevent the emergence of novel viral variants [11, 12]. It remains to be determined whether COVID-19 affects the clinical course of IBD. There’s no evidence of an increased risk of SARS-CoV-2 infection or more severe COVID-19 in patients with inflammatory bowel disease (IBD). Whether COVID-19 alters the clinical course of IBD or whether IBD treatment affects the immunological response to SARS-CoV-2 is still under investigation, especially in children
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