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儿童自身免疫性神经精神疾病相关的综合征/链球菌感染后自身免疫性神经精神疾病在 COVID-19 感染后与疫苗接种后的症状发作。

Symptom flares after COVID-19 infection versus vaccination among youth with PANS/PANDAS.

机构信息

From the Department of Human Development and Family Sciences, and.

Department of Anthropology and Human Rights Institute, University of Connecticut, Storrs, Connecticut.

出版信息

Allergy Asthma Proc. 2023 Sep 1;44(5):361-367. doi: 10.2500/aap.2023.44.230049.

Abstract

Flares of autoimmune conditions can happen after coronavirus disease 2019 (COVID-19) infection and after COVID-19 vaccines. Patients and clinicians confront difficult decisions about vaccine safety when considering efforts to balance the risks of disease exacerbation after vaccines versus the protection that vaccines offer to potential serious life-threatening complications of COVID-19 infection. To examine symptom flares after COVID-19 infection and vaccines in the case of a form of autoimmune encephalitis that primarily affects children and young adults (pediatric acute-onset neuropsychiatric syndrome [PANS] / pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections [PANDAS]). A cross-sectional study that used a survey distributed through PANS/PANDAS groups, organizations, and clinics. Surveys were completed by 496 parents and/or caregivers of children with PANS/PANDAS. Among the children reported to have had a COVID-19 infection (n = 178), 43% reported severe flares of PANS/PANDAS symptoms, 23% reported mild flares, and 30% reported no symptom flares. Among those who had received COVID-19 vaccines (n = 181), 65% observed no changes in PANS/PANDAS symptoms after the vaccine, 19% reported mild flares, and 15% reported severe flares. Paired sample t-tests showed that, after COVID-19 infections, children with PANS/PANDAS were significantly more likely to experience a severe symptom flare than a mild flare or no change in symptoms. In contrast, after receiving COVID-19 vaccines, children were significantly more likely to experience no change in PANS/PANDAS symptoms than to endure a mild or severe symptom flare. In addition, children who recovered from PANS/PANDAS were significantly more likely to have no symptom change versus children who were managing the condition, both after COVID-19 infection (92% versus 25%) and vaccine receipt (100% versus 66%). These results support COVID-19 vaccination for most individuals with PANS/PANDAS given that the frequencies of symptom flares and setbacks after COVID-19 infection were significantly higher than after the COVID-19 vaccine. Nonetheless, further studies are needed to fully assess the risk-benefit balance and to provide a more individualized approach to disease prevention in people with immune vulnerabilities.

摘要

自身免疫性疾病在感染 COVID-19 后和 COVID-19 疫苗接种后可能会出现爆发。当考虑到平衡疫苗接种后疾病恶化的风险与疫苗对 COVID-19 感染潜在严重危及生命的并发症的保护作用时,患者和临床医生在疫苗安全性方面面临着艰难的决策。

为了研究 COVID-19 感染和疫苗接种后一种主要影响儿童和青少年的自身免疫性脑炎(儿科急性发作神经精神综合征 [PANS] / 与链球菌感染相关的儿科自身免疫性神经精神障碍 [PANDAS])的症状爆发情况。

一项使用通过 PANS/PANDAS 团体、组织和诊所分发的调查进行的横断面研究。

共有 496 名 PANS/PANDAS 患儿的父母或照顾者完成了调查。在报告有 COVID-19 感染的儿童中(n = 178),43%报告 PANS/PANDAS 症状严重爆发,23%报告轻度爆发,30%报告无症状爆发。在接种 COVID-19 疫苗的儿童中(n = 181),65%观察到疫苗接种后 PANS/PANDAS 症状无变化,19%报告轻度爆发,15%报告严重爆发。配对样本 t 检验显示,COVID-19 感染后,PANS/PANDAS 患儿发生严重症状爆发的可能性明显高于轻度爆发或症状无变化。相比之下,接种 COVID-19 疫苗后,患儿 PANS/PANDAS 症状无变化的可能性明显高于轻度或重度症状爆发。此外,与正在治疗该疾病的患儿相比,从 PANS/PANDAS 中康复的患儿在 COVID-19 感染(92%比 25%)和疫苗接种(100%比 66%)后发生症状无变化的可能性明显更高。

这些结果支持为大多数 PANS/PANDAS 患儿接种 COVID-19 疫苗,因为 COVID-19 感染后症状爆发和病情恶化的频率明显高于 COVID-19 疫苗接种后。然而,仍需要进一步研究来充分评估风险效益平衡,并为免疫脆弱人群的疾病预防提供更个体化的方法。

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