Allergy and Immunology Unit, Schneider Children's Medical Center of Israel, Felsenstein Medical Research Center, Kipper Institute of Immunology, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Front Immunol. 2021 Jan 14;11:614086. doi: 10.3389/fimmu.2020.614086. eCollection 2020.
In the last few months the world has witnessed a global pandemic due to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection causing coronavirus disease 2019 (COVID-19). Obviously, this pandemic affected individuals differently, with a significant impact on populations considered to be at high-risk. One such population, was assumed to be patients with primary genetic defect involving components or pathways of the immune system. While human immunity against COVID-19 is not fully understood, it is, so far, well documented, that both adaptive and innate cells have a critical role in protection against SARS-CoV-2. Here, we aimed to summarize the clinical and laboratory data on primary immunodeficiency (PID) patients in Israel, who were tested positive for SARS-CoV-2, in order to estimate the impact of COVID-19 on such patients. Data was collected from mid-February to end-September. During this time Israel experienced two "waves" of COVID-19 diseases; the first, from mid-February to mid-May and the second from mid-June and still ongoing at the end of data collection. A total of 20 PID patients, aged 4 months to 60 years, were tested positive for SARS-CoV-2, all but one, were detected during the second wave. Fourteen of the patients were on routine monthly IVIG replacement therapy at the time of virus detection. None of the patients displayed severe illness and none required hospitalization; moreover, 7/20 patients were completely asymptomatic. Possible explanations for the minimal clinical impact of COVID-19 pandemic observed in our PID patients include high level of awareness, extra-precautions, and even self-isolation. It is also possible that only specific immune pathways (e.g. type I interferon signaling), may increase the risk for a more severe course of disease and these are not affected in many of the PID patients. In some cases, lack of an immune response actually may be a protective measure against the development of COVID-19 sequelae.
在过去的几个月里，由于严重急性呼吸系统综合症冠状病毒 2（SARS-CoV-2）感染导致 2019 年冠状病毒病（COVID-19），全世界见证了一场全球性大流行。显然，这种大流行对个人的影响不同，对被认为处于高风险的人群产生了重大影响。这样的人群之一是患有原发性遗传缺陷的患者，这些缺陷涉及免疫系统的成分或途径。虽然人类对 COVID-19 的免疫力尚未完全了解，但迄今为止，已有大量文献记录表明，适应性和固有细胞在抵抗 SARS-CoV-2 方面都起着关键作用。在这里，我们旨在总结以色列原发性免疫缺陷（PID）患者检测出 SARS-CoV-2 阳性的临床和实验室数据，以评估 COVID-19 对这些患者的影响。数据收集自 2 月中旬至 9 月底。在此期间，以色列经历了两波 COVID-19 疾病；第一波从 2 月中旬到 5 月中旬，第二波从 6 月中旬开始，在数据收集结束时仍在继续。共有 20 名年龄在 4 个月至 60 岁之间的 PID 患者检测出 SARS-CoV-2 阳性，除 1 名外，均在第二波中被检测到。在病毒检测时，有 14 名患者正在接受常规每月静脉注射免疫球蛋白（IVIG）替代疗法。没有患者出现严重疾病，也没有患者需要住院治疗；此外，20 名患者中有 7 名完全无症状。我们的 PID 患者中观察到 COVID-19 大流行的临床影响最小的可能解释包括高度的认识、额外的预防措施，甚至是自我隔离。也有可能只有特定的免疫途径（例如 I 型干扰素信号）可能会增加疾病更严重的风险，而这些途径在许多 PID 患者中不受影响。在某些情况下，缺乏免疫反应实际上可能是预防 COVID-19 后遗症的一种保护措施。
