儿科传染病专家组(GPIP)关于 COVID-19 大流行期间儿童免疫债的立场文件,我们如何填补免疫差距?
Pediatric Infectious Disease Group (GPIP) position paper on the immune debt of the COVID-19 pandemic in childhood, how can we fill the immunity gap?
机构信息
ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; Université Paris Est, IMRB-GRC GEMINI, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France; GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Créteil, France.
ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; Centre Hospitalier Intercommunal de Créteil, France.
出版信息
Infect Dis Now. 2021 Aug;51(5):418-423. doi: 10.1016/j.idnow.2021.05.004. Epub 2021 May 12.
Since the beginning of the COVID-19 pandemic, reduced incidence of many viral and bacterial infections has been reported in children: bronchiolitis, varicella, measles, pertussis, pneumococcal and meningococcal invasive diseases. The purpose of this opinion paper is to discuss various situations that could lead to larger epidemics when the non-pharmaceutical interventions (NPI) imposed by the SARS-CoV-2 epidemic will no longer be necessary. While NPIs limited the transmission of SARS-CoV-2, they also reduced the spread of other pathogens during and after lockdown periods, despite the re-opening of schools since June 2020 in France. This positive collateral effect in the short term is welcome as it prevents additional overload of the healthcare system. The lack of immune stimulation due to the reduced circulation of microbial agents and to the related reduced vaccine uptake induced an "immunity debt" which could have negative consequences when the pandemic is under control and NPIs are lifted. The longer these periods of "viral or bacterial low-exposure" are, the greater the likelihood of future epidemics. This is due to a growing proportion of "susceptible" people and a declined herd immunity in the population. The observed delay in vaccination program without effective catch-up and the decrease in viral and bacterial exposures lead to a rebound risk of vaccine-preventable diseases. With a vaccination schedule that does not include vaccines against rotavirus, varicella, and serogroup B and ACYW Neisseria meningitidis, France could become more vulnerable to some of these rebound effects.
自 COVID-19 大流行开始以来,据报道儿童的许多病毒和细菌感染发病率降低:毛细支气管炎、水痘、麻疹、百日咳、肺炎球菌和脑膜炎球菌侵袭性疾病。本意见论文的目的是讨论在 SARS-CoV-2 流行所实施的非药物干预(NPI)不再必要时,可能导致更大规模流行的各种情况。虽然 NPI 限制了 SARS-CoV-2 的传播,但它们也减少了封锁期间和之后其他病原体的传播,尽管自 2020 年 6 月以来法国的学校已经重新开放。这种短期的积极附带效应是受欢迎的,因为它防止了医疗保健系统的额外过载。由于微生物剂循环减少和相关疫苗接种减少导致的免疫刺激减少而产生的“免疫债务”,当大流行得到控制且 NPI 被取消时,可能会产生负面影响。这些“病毒或细菌低暴露”时期持续的时间越长,未来发生流行的可能性就越大。这是由于“易感”人群的比例增加和人群中群体免疫力下降所致。观察到的疫苗接种计划没有有效追赶的延迟以及病毒和细菌暴露的减少导致了疫苗可预防疾病的反弹风险。由于疫苗接种计划不包括针对轮状病毒、水痘和血清群 B 和 ACYW 脑膜炎奈瑟菌的疫苗,法国可能更容易受到其中一些反弹效应的影响。
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