COVID-19 AND VACCINATION IN CHILDREN AND ADOLESCENTS WITH NEUROIMMUNOLOGICAL DISORDERS

INTRODUCTION:  The understanding of how COVID-19 impacts children with neuroimmunological diseases and those receiving immunosuppressant treatment remains limited. Moreover, despite the progress in vaccinating the pediatric population, the safety and efficacy of immunization agents in this specific group of children need to be more extensively investigated.

OBJECTIVES: To analyze the clinical manifestations and impact of COVID-19 disease and vaccination in the pediatric population with neuroimmunological disorders followed in a Brazilian specialized center.

METHODS: This is a cross-sectional and retrospective evaluation of pediatric patients with neuroimmunological disorders followed from January 2019 until March 2022. Demographics, clinical and therapeutic features, COVID-19 pandemic aspects, suspected/confirmed cases of COVID-19, laboratory, radiologic findings, vaccination details, and disease exacerbations were recorded.

RESULTS: ninety-three patients were identified, 63 (67.7%) were female, 31 (44.9%) from white ethnicity. Mean age at disease onset was 6.65 (±4.1) years. At last follow-up, the final diagnosis was: multiple sclerosis (19.4%), myasthenia gravis(11.8%), opsoclonus myoclonus ataxia(23.7%), neuromyelitis spectrum disorders(6.5%), MOG-IgG associated disorder(5.4%), ADEM (5.4%), CIS(7.6%), autoimmune encephalitis (5.4%), CIDP(2.2%), other (13%). Thirty-eight (42.2%) patients presented with a relapsing-remitting disease course, and 28,1% had a relapse during the pandemic. Seventeen patients were diagnosed with COVID19. Fever, cough, asthenia, and dyspnea were the most common clinical features. 16.7% patients required hospitalization. No patient required ICU or died. Four (23.5%) patients reported worsening of neurological symptoms during COVID19. Two patients disclosed new brain MRI lesions. 57.6% (34/59) parents reported hesitation to vaccinate their children. Two (4%) out of 50 vaccinated children reported worsening of neurological symptoms after vaccination.

Conclusions: neurologic complications of COVID19 infection and vaccination in patients diagnosed with neuroimmunologic disorders were rare. Most parents hesitated to vaccinate their children. Telephonic interview is a feasible instrument in our population.