new study, for the expert here are the real risks today and what to expect in the fall

For the first time, the intestinal microbiota profile of children with COVID-19 was characterized, which, thanks to special anti-inflammatory properties, appears to protect them against severe forms of the disease. The identity comes from researchers from the Bambino Gesù Pediatric Hospital, who conducted a study – the first at an international level – dedicated to the relationship between the microbiota and SARS-CoV-2 infection in children. The research has just been published in the scientific journal Frontiers in Cellular and Infectious Microbiologysuggest possible therapeutic interventions on the microbiota to help control the disease.

Benedetta de Mattei the interview Prof. Paolo Palma – UOC Director of Clinical Immunology and Vaccinology at the Bambino Gesù Pediatric Hospital in Rome – to understand what the data emerged from this study, the real risks for children in the current situation and what to expect from next autumn.

What can you tell us about this study?
The study of the composition and function of the intestinal microbiota in pediatric patients with COVID-19 was carried out by the Human Microbiome Research Unit, led by Prof. Lorenza Putignani, as part of the project “CACTUS – Immunological studies in children affected by COVID and acute diseases “coordinated by me. We evaluated several things, including the appearance of the microbiota, which obviously should not be interpreted as an entity in itself, but is part of the set of bacteria that surround us and interact with our immune system. Children, as already seen through the previous data, have an ability to better manage the inflammation given by Covid-19, and this data supports this evidence showing how pediatric patients actually have a microbiota that is inherently less inflammatory. Taken together, the collected data highlight a potential link between gut microbiota function and the clinical course of pediatric COVID-19. The research group’s analyzes support the hypothesis that children’s microbiota with its anti-inflammatory properties – compared to adults – helps to reduce the severity of the infection. The study therefore opens up the hypothesis of therapeutic interventions on the microbiota to help control the development of important diseases, including COVID-19.

How is the situation today for children affected by Covid-19, have admissions decreased?
From a practical point of view, Covid-19 infection in children often remains silent, but continues to represent a consistent problem as it affects children with chronic diseases. The patients we see most are chronic patients who have only partially responded to vaccination and are therefore re-infected; It is clear that the infection in these children is much more problematic, not only for the disease they develop, since it complicates the path of access to treatment and some follow-up that they have to follow, with a consequent delay in the treatment of ​​these patients.

What are the most significant data that emerged from the studies you have conducted in the pediatric field on Covid-19?
Among the most interesting evidence, later also supported by other research groups, it was first shown that this inflammatory condition in children affects all age groups.
also this month, data came from Franco-Swiss colleagues showing how the so-called systemic inflammatory forms also affect in neonatal age. Children have a much greater ability to control inflammation induced by Covid, so they become less inflamed than adults, and this clearly determines a reduced mortality and morbidity.. However, some children do not have this ability to control and in these few cases a very serious systemic inflammation is observed, which can appear in acute heart failure but also in quite important neurological forms with images of thrombosis.

Why are some children asymptomatic and others develop more severe symptoms?
There is a very important genetic background, there are some genes specifically involved in the inflammation pathway that are differentially expressed. The ability to modulate this genetic activation is at the bottom, along with the ability of our immune system’s regulatory cells to modify and modulate inflammation. In the pediatric field, what we see with Covid-19 infection is not so different from what we have studied in immunology for many years, that is, there are previously healthy children who, in contact with an infectious agent, develop a particularly serious situation.: Effects that become fatal, encephalitis, etc. In these children who had to study, we often saw a genetic change in the mechanisms that our immune system has to regulate the infection in the encounter with the pathogen; therefore this is something we already knew and which covid has confirmed: there are predisposing genes and this is even more evident in the pediatric patient.

Can a child who has already had Covid and re-infection develop a severe form by not having had it before?
THATin the pediatric field, based on the data we have available, reinfection does not lead to an increased risk of developing a severe form.

Many children also suffer from Long Covid, who does it affect and what are the symptoms?
It is a very current and very difficult subject that we are studying. This Long Covid includes many children with symptoms that are also of a psychological nature, also linked to the restrictive measures that have been given to our children over time. Then there are patients with images compatible with what is generally considered a “Long covid”, here again given by another control of inflammation. In fact, it seems that an underlying chronic inflammatory process has been established, which is the basis of this pathology characterized by chronic fatigue, low-grade fever, muscle pain, etc. Patients with this problem can also be children who have had the disease in an asymptomatic form. Patients with Long Covid are considered to be all those who have typical symptoms after Covid-19 infection. The problem is that all children with various psychiatric symptoms such as air hunger, chest pain, sleep disturbances etc. also fall under this definition. This condition makes screening of these patients difficult. However, a study was recently published in the Lancet magazine about a month ago which highlights how the Omicron variant provides a reduced Long Covid rate compared to the Delta variant.

Will children continue to be vaccinated in September?
In September, we will certainly continue to vaccinate the most fragile children,
for the rest, we have learned to be very careful in forecasting, because we risk saying inaccuracies, since what we say today tomorrow may be completely unreal. We will have an important autumn, because we expect an improvement in the number on the basis of other respiratory infections, which we know well. Our goal is to achieve the widest possible coverage in the fragile population most affected by these pathologies both directly, with the development of more serious conditions, and indirectly, because the spread of these respiratory diseases has often given and from an important disability. in dealing with patients who are unable to take the exams in a timely manner.

Benedetta de Mattei


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