Rose Klaus, Grant-Kels Jane M, Ettienne Earl B, Tanjinatus Oishi, Striano Pasquale, Neubauer David
klausrose Consulting, Riehen, Switzerland.
UConn Health, Farmington, CT, USA.
Rambam Maimonides Med J. 2021 Apr 29;12(2):e0010. doi: 10.5041/RMMJ.10433.
Children are infected with coronavirus disease 2019 (COVID-19) as often as adults, but with fewer symptoms. During the first wave of the COVID-19 pandemic, multisystem inflammatory syndrome (MIS) in children (MIS-C), with symptoms similar to Kawasaki syndrome, was described in young minors testing positive for COVID-19. The United States (US) Centers for Disease Control and Prevention (CDC) defined MIS-C as occurring in <21-year-olds, triggering hundreds of PubMed-listed papers. However, postpubertal adolescents are no longer children biologically; the term MIS-C is misleading. Furthermore, MIS also occurs in adults, termed MIS-A by the CDC. Acute and delayed inflammations can be triggered by COVID-19. The 18th birthday is an administrative not a biological age limit, whereas the body matures slowly during puberty. This blur in defining children leads to confusion regarding MIS-C/MIS-A. United States and European Union (EU) drug approval is handled separately for children, defined as <18-year-olds, ascribing non-existent physical characteristics up to the 18th birthday. This blur between the administrative and the physiological meanings for the term child is causing flawed demands for pediatric studies in all drugs and vaccines, including those against COVID-19. Effective treatment of all conditions, including COVID-19, should be based on actual physiological need. Now, the flawed definition for children in the development of drugs and vaccines and their approval is negatively impacting prevention and treatment of COVID-19 in minors. This review reveals the necessity for redefining pediatric age groups to rapidly establish recommendations for optimal prevention and treatment in minors.
儿童感染2019冠状病毒病（COVID-19）的几率与成人相同，但症状较少。在COVID-19大流行的第一波期间，在COVID-19检测呈阳性的年幼儿童中发现了儿童多系统炎症综合征（MIS-C），其症状与川崎综合征相似。美国疾病控制与预防中心（CDC）将MIS-C定义为发生在21岁以下的人群中，这引发了数百篇被PubMed收录的论文。然而，青春期后的青少年在生物学上已不再是儿童；MIS-C这个术语具有误导性。此外，MIS也发生在成人中，被CDC称为MIS-A。COVID-19可引发急性和迟发性炎症。18岁生日是一个行政年龄限制，而非生物学年龄限制，而身体在青春期会缓慢成熟。这种对儿童定义的模糊导致了对MIS-C/MIS-A的混淆。美国和欧盟对儿童（定义为18岁以下）的药物批准是分开处理的，赋予了直至18岁不存在的身体特征。儿童这个术语在行政和生理意义之间的这种模糊，正在导致对所有药物和疫苗（包括针对COVID-19的药物和疫苗）进行儿科研究的不合理需求。对包括COVID-19在内的所有疾病的有效治疗都应基于实际的生理需求。目前，药物和疫苗研发及批准过程中对儿童的错误定义正在对未成年人COVID-19的预防和治疗产生负面影响。本综述揭示了重新定义儿科年龄组以迅速制定未成年人最佳预防和治疗建议的必要性。
