Updates on Epidemiology, Variants, Vaccines, Immunity and More…
by Dr. Debbie-Ann Shirley, Division Head of Pediatric Infectious Disease
COVID-19 in children. It has been a year since the very first COVID-19 cases were reported in the US, and there have now been over 2.7 million cases in children as of January 21, representing 12.7% of all US cases. During the week of January 7-14, we saw 211,000 children diagnosed with COVID-19, representing the largest single-week increase in this age group so far since the beginning of the pandemic according to the American Academy of Pediatrics. The burden in children continues to disproportionately affect those living in communities adversely affected by social determinants of health. While severe disease remains rare among children in the US and worldwide, indirect effects to children continue to be recognized. For example, it was recently reported that the prevalence of myopia increased 1.4- 3 times in children 6-8 years of age living in China in 2020. The significance of COVID-19 in children received national attention during the Advisory Committee on Immunization Practices (ACIP) January 27th meeting last week, and further studies are needed to better understand the role of children in SARS-CoV-2 transmission, risk factors for severe illness and complications of COVID-19 such as MIS-C.
What are SARS-CoV2 variants of concern? In other news, SARS-CoV-2 variants continue to spread. Variants associated with mutations that have the potential to alter the ease of transmissibility, severity of disease or ability to escape immune protection are the ones of most concern. The B.1.1.7 variant that first emerged in the United Kingdom and has now been detected in more than 50 countries and over 30 US states, for example, is thought to be associated with increased transmissibility and some suggestions that this strain could be deadlier than other strains. Last week, health officials in South Carolina reported the first two US cases of the B.1.351 variant first detected in South Africa. There is some evidence that one of the spike protein mutations of the B.1.351 variant may affect neutralization by polyclonal and monoclonal antibodies. As of January 31, two cases of the B.1.1.7 variant have been reported in the state of Virginia, with no cases yet of the B.1.351 variant. We know from a Virginia Department of Health newsroom release last week, the first of these two cases was in an adult without known travel history. As we await further studies to understand the efficacy of COVID-19 vaccines against B.1.351 and other emerging variants, travel restrictions in the US and several other countries around the world have been instituted in response to help mitigate spread.
How is UVA helping with the vaccine response to combat COVID-19? COVID-19 vaccines are providing a glimmer of hope to the end of this pandemic and UVA has been taking part in the vaccine roll out. As of last week, over 23,000 doses of COVID-19 vaccine were administered by UVA. The Blue Ridge Health District is currently prioritizing vaccinating Phase 1A front-line healthcare workers, some Phase 1B essential workers, and individuals ages 75 and older. To support community vaccination efforts, UVA in partnership with the Blue Ridge Health District opened a second community vaccination site this weekend at Seminole Square, standing in addition to the first vaccination site set up on Hydraulic Road earlier this month.
When can my patient get vaccinated? The currently licensed Pfizer/BioNTech and Moderna COVID-19 mRNA vaccines are available for use in those ≥ 16-18 years of age under an FDA Emergency Use Authorization. Vaccine makers are expanding age eligibility in vaccine trials and several have begun trial planning to include younger children in order to address the need to understand safety and efficacy in pediatric populations. For patient-related inquiries about how and when UVA will be providing COVID-19 vaccine you can use the Smartphrase .COVIDVACCINE to help with communicating this information and a children’s specific vaccine FAQs should be available soon. In the meantime, investigational therapy with monoclonal antibodies is available under an FDA Emergency Use Authorization and can be considered for carefully selected pediatric outpatients (≥ 12 years of age and ≥ 40 kg) with COVID-19 who have mild to moderate symptoms and are at high risk of disease progression or hospitalization.
Neonatal immunity news. Speaking of passive antibodies, a single-center study investigating maternal and cord blood sera from 1471 eligible maternal-infant dyads published last week found that while only 83 (6%) of the mothers had detectable SARS-CoV-2 serology at delivery, the majority (87%) of infants born to seropositive mothers had detectable IgG antibodies in their cord blood at birth (none had detectable IgM). This transplacental transfer of antibody took place regardless of symptomatology or severity, and higher transfer ratios correlated to increasing time between maternal infection and delivery. This study provides further evidence that maternally derived SARS-CoV-2 specific antibodies may help to protect newborns, supporting the need to better understand the optimal time to initiate maternal vaccination in order to attain the highest level of protection possible to both newborns and mothers through maternal vaccination.
Keep on keeping on! In the face of emerging variants of concern and the considerable time it will take to vaccinate the entire population, including children, we cannot let up on the tools that we have at hand help to protect our patients, families, friends and ourselves. So please continue to remember the importance of masks and other personnel protective equipment, hand hygiene and social distancing.
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Filed Under: Features