Front Pediatr. 2022 Feb 10;10:815857. doi: 10.3389/fped.2022.815857. eCollection 2022.

Luca Bosa ¹, Costanza Di Chiara ², Paola Gaio ¹, Chiara Cosma ³, Andrea Padoan ^3 4, Sandra Cozzani ², Giorgio Perilongo ^1 5, Mario Plebani ^3 4, Carlo Giaquinto ², Daniele Donà ², Mara Cananzi ¹

Author information

¹Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy.

²Pediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy.

³Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy.

⁴Department of Medicine-DIMED, Medical School, University of Padova, Padova, Italy.

⁵Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy.

Abstract

Background: To date, there's no evidence of an increased risk of SARS-CoV-2 infection or more severe COVID-19 in patients with inflammatory bowel disease (IBD). However, whether COVID-19 alters the clinical course of IBD or whether IBD treatment affects the immunological response to SARS-CoV-2 is still under investigation, especially in children.

Aim: To assess the serological response to SARS-CoV-2 in children with IBD, and to evaluate the impact of COVID-19 on the clinical course of IBD.

Material and methods: This prospective study enrolled children (0-18 years) followed-up at the University Hospital of Padova for IBD, who acquired a confirmed SARS-CoV-2 infection between 02.2020 and 02.2021. The anti-SARS-CoV-2 S-RBD IgG titer was evaluated at 3 months after infection and compared to that of a control group of healthy children matched for age, sex, and COVID-19 severity.

Results: Twelve children with IBD (M = 5; median age 14 years) contracted COVID-19 during the study period. 11/12 patients were under immunomodulatory treatment (4/12 steroids; 6/12 azathioprine; 3/12 anti-TNFs; 2 vedolizumab; 1 ustekinumab). SARS-CoV-2 infection remained asymptomatic in 4/12 children and caused mild COVID-19 in the remaining 8. Mean anti-SARS-CoV-2 IgG S-RBD titer was similar between IBD patients and controls (27.3 ± 43.8 vs. 36.8 ± 35.3 kAU/L, p = ns). No children experienced IBD flares nor required gastroenterological support during the infection period.

Discussion: Children with IBD can mount a protective humoral response against SARS-CoV-2, which is comparable to that of their healthy peers regardless of ongoing immunomodulatory treatment. This study also supports the favorable course of PIBD during COVID-19 and vice-versa.

Keywords: COVID-19; SARS-CoV-2; children; immunological response; inflammatory bowel disease; neutralizing antibodies; pediatric; serology.