Year 2022: exploring COVID-19 pandemic in children

Of note, COVID-19 pandemic had also an indirect effect on other diseases, interfering with their epidemiology and diagnostic approach. For example, a strong impact on the diagnosis and management of diabetes in children was noted, revealing a more severe onset presentation compared to pre-pandemic period [35‐37]. A significant reduction of stimulating tests investigating growth hormone secretion in short children have been described in a paediatric endocrinology outpatient department. Although these children might have undergone the exam and eventually treated at a later stage, it is known that the efficacy of treatment is higher when the diagnosis is prompt. In case of a delay in the diagnosis and therapy, the risk of an adult short stature is high [38]. Opposite, evidence suggests that there was an increment of precocious puberty during the pandemic period compared to previous period [38‐42]. Additionally, central precocious puberty had been found linked to sleep disturbances even if the relationship has been not fully explained [39]. As evidenced by Mutlu et al., girls referred for early puberty during COVID-19 pandemic were younger than in the previous period. Of note real precocious puberty was more prevalent than pubertal variants, so that the need for pubertal suppression therapy had increased as expected [43].

Again, Mameli et al. demonstrated that COVID-19 pandemic altered the epidemiology of acute respiratory tract infections in children aged 0–5 years, with toddlers younger than 12 months of age at a higher risk [44]. Hygiene measures, social distancing, and masks by the older children may have influenced the results as well [45, 46]. Finally, Covid-19 pandemic had also an impact on reproductive health, perinatal period, and childbirth. In Iran, the incidence of congenital birth anomalies had been found significantly increased during pandemic period, mainly referring to congenital anomalies of the central nervous and genitourinary systems [47‐49]. Many factors might have contribute to congenital abnormalities, including chronic maternal stress, decreased routine access to prenatal care for foetal screening and diagnosis and poverty [47].

Children with some specific chronic diseases are considered at risk of a severe disease course. The Italian Society of Pediatrics together with affiliated Scientific Societies recently proposed a Consensus document to detail which patients affected by comorbidities may be benefit for monoclonal antibodies administration [50‐52]. As for the others, it is not possible to identify which ones may develop severe clinical manifestations, long COVID or psychosocial problems [21, 53]. Allergic rhino conjunctivitis and asthma, if under control, do not represent risk factors for the susceptibility to SARS CoV2. (54i) Patients with allergies do not present a more severe course than those without in line with the hypothesis of a positive role exerted by the Th2 immune response in COVID-19 pathogenesis [54‐56].

Researchers agree on the key role of vaccination to prevent Sars Cov2 infection and, most of all, severe disease. According to The manifesto of Pediatricians of Emilia-Romagna region vaccines against COVID are the most effective and safe tool to contrast COVID 19 and for this reason should be considered as a right of children to protect themselves [57]. Vaccine product-related reactions are seldom reported such as Henoch-Schoenlein purpura reported in an adolescent by Casini et al. [58]. Nonetheless, the benefits of vaccination greatly outweigh the risks [57, 59]. Moreover, the likelihood of severe reactions such as anaphylaxis to COVID-19 mRNA vaccines in children seems very low [60, 61]. In case of previous systemic reaction to COVID-19 vaccines or excipients, Scientific Societies suggest to limit contraindications to vaccination and help to safely immunize [62].

The vaccination availability together with the application of safety protocols gives the opportunity not only to prevent infection spread but also to schedule clinical controls as well as diagnostic procedures which may have been postponed in non-urgent cases, such as pulmonary function tests [63, 64].

Nevertheless, vaccination coverage in the pediatric age is actually lower compared to adults, leading minors to a higher susceptibility to SARS-CoV-2 [65]. Of notes, many parents have a positive attitude towards their children’s vaccination [66]. Factors that may influence children’s willingness to be vaccinated against COVID-19 include gender, age, residence, number of children in the household, parent education [67, 68]. Adolescents as well have been described in favour of immunisation by Cupertino et al. Parents' opinion strongly affects the immunization status of adolescents as in Cupertino et al. survey the most important predictors of being immunized against SARS-CoV2 were having both parents immunized. Of note, minors reported their willing on getting COVID 19 vaccine information by family doctors and at school, underling the potential role of paediatricians and school educators [69]. Increased information and sensibilization on the safety and efficacy of vaccination is required to increase vaccine coverage and should be supported by effective persuasion campaign for those reluctant to accept the vaccine [70].

Strength of our manuscript is to summarize the latest evidence on COVID 19 as published in the Italian Journal of Pediatrics, an open access peer-reviewed journal that includes all aspects of pediatric medicine. Limiting the search strategy to articles published in the Italian Journal of Pediatrics in 2022 represents the weakness of the present manuscript.