Patel Harsita, McArdle Andrew, Seaby Eleanor, Levin Michael, Whittaker Elizabeth
Department of Infectious Disease, Section of Paediatric Infectious Disease Imperial College London London UK.
Genomic Informatics Group University of Southampton Southampton UK.
Clin Transl Immunology. 2022 Jul 25;11(7):e1405. doi: 10.1002/cti2.1405. eCollection 2022.
Symptoms and outcomes for paediatric COVID-19 differ vastly from those for adults, with much lower morbidity and mortality. Immunopathogenesis drives severe outcomes in adults, and it is likely that age-related differences in both the innate and specific immune responses underlie much of the variation. Understanding the protective features of the paediatric immune system may be crucial to better elucidate disease severity in adult COVID-19 and may pave the way for novel therapeutic approaches. However, as well as uncommon cases of severe paediatric acute COVID-19, there have been children who have presented with delayed multisystem inflammation, including cardiac, gastrointestinal, skin, mucosa and central nervous system involvement. The occurrence of coronary artery aneurysms has drawn comparisons with Kawasaki Disease, but similarities with the inflammatory phase of adult acute COVID-19 have also been drawn. In this review, we summarise findings from studies investigating pre-existing immunity, cytokine profiles, innate, B-cell, antibody, T-cell and vaccine responses in children with acute COVID-19 and multisystem inflammation, compared with COVID-19 adults and controls. We further consider the relevance to therapeutics in the context of limited evidence in children and highlight key questions to be answered about the immune response of children to SARS-CoV-2.
儿童新冠病毒病（COVID-19）的症状和转归与成人有很大不同，其发病率和死亡率要低得多。免疫发病机制导致成人出现严重后果，先天免疫反应和特异性免疫反应中与年龄相关的差异很可能是造成大部分差异的原因。了解儿童免疫系统的保护特性对于更好地阐明成人COVID-19的疾病严重程度可能至关重要，并可能为新的治疗方法铺平道路。然而，除了儿童严重急性COVID-19的罕见病例外，还有儿童出现了延迟性多系统炎症，包括心脏、胃肠道、皮肤、黏膜和中枢神经系统受累。冠状动脉瘤的出现引发了与川崎病的比较，但也有人将其与成人急性COVID-19的炎症期进行了类比。在本综述中，我们总结了与COVID-19成人及对照组相比，对患有急性COVID-19和多系统炎症的儿童的既往免疫力、细胞因子谱、先天免疫、B细胞、抗体、T细胞和疫苗反应的研究结果。我们还在儿童证据有限的背景下进一步考虑了其与治疗的相关性，并强调了关于儿童对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）免疫反应需回答的关键问题。
