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Change in the Frequency of Autoimmune Diseases in Children During the COVID-19 Pandemic and Lock-Down Period Compared to the Pre-Pandemic Period

Year 2023, Volume: 45 Issue: 1, 42 - 49, 23.01.2023
https://doi.org/10.20515/otd.1116439

Abstract

We aimed to determine the frequencies of new-onset disease/attacks of autoimmune diseases (AD) during the COVID-19 pandemic and lock-down period compared to the pre-pandemic period. The patients (n=171) (aged between 0-18 yrs.) who were applied with AD to our hospital during the one year period before and first year of the COVID-19 pandemic and lock-down were included in this study. The frequencies of hospital applications with new-onset disease/attacks of AD were investigated retrospectively and compared between the two periods. The number of new-onset disease/attacks in the pre-pandemic and pandemic periods were determined as follows, 111 and 65 respectively (p<0.001). The proportions of applications to hospital in patients with post-streptococal disease and Henoch-Schönlein purpura have decreased during the pandemic, while a significant increase in frequency of new-onset type 1 diabetes mellitus has been observed. The frequency of applications for minimal change disease, systemic lupus erythematosus and Guillain Barre syndrome and multiple sclerosis did not alter substantially between the two periods. None of the patients were diagnosed with COVID-19. During the COVID-19 pandemic and lockdown period, the frequencies of AD diseases such as Henoch-Schönlein purpura and post-streptococal disease have decreased considerably indicating indirectly that infectious agents related with the etiology/course of AD and thus highlights the importance of isolation and hygiene measures. Increased frequency of type diabetes mellitus during this period suggests that factors other than infections may be effective in the etiopathogenesis of disease, or that protective agents or their effects might have decreased or changed.

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References

  • Referans1 Hacımustafaoğlu M. COVID-19 and re-opening of schools: Opinions with scientific evidence. Turk Pediatri Ars. 2020; 55: 337-44.
  • Referans2 Oikonomou N, Aznaouridis K, Barbetseas J et al. Hospital attendance and admission trends for cardiac diseases during the COVID-19 outbreak and lock-down in Greece. Public Health. 2020; 187: 115-9.
  • Referans3 Mulholland RH, Wood R, Stagg HR et al. Impact of COVID-19 on accident and emergency attendances and emergency and planned hospital admissions in Scotland: an interrupted time-series analysis. J R Soc Med. 2020; 113: 444-53.
  • Referans4 Mahmassani D, Tamim H, Makki M, Hitti E. The impact of COVID-19 lockdown measures on ED visits in Lebanon. Am J Emerg Med. 2020; 46: 634-9.
  • Referans5 Iozzi L, Brambilla I, Foiadelli T, Marseglia GL, Ciprandi G. Paediatric emergency department visits fell by more than 70% during the COVID-19 lockdown in Northern Italy. Acta Paediatr. 2020; 109: 2137-8.
  • Referans6 Angoulvant F, Ouldali N, Yang DD et al. Coronavirus disease 2019 pandemic: impact caused by school closure and national lockdown on pediatric visits and admissions for viral and nonviral Infections-a time series analysis. Clin Infect Dis. 2021; 72: 319-22.
  • Referans7 Hejrati A, Rafiei A, Soltanshahi M et al. Innate immune response in systemic autoimmune diseases: a potential target of therapy. Inflammopharmacology. 2020; 28:1421–1438
  • Referans8 Fujinami RS, von Herrath MG, Christen U, Whitton JL. Molecular mimicry, bystander activation, or viral persistence: infections and autoimmune disease. Clin Microbiol Rev. 2006; 19: 80-94.
  • Referans9 Bach JF. The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med. 2002; 347: 911–20.
  • Referans10 Bach JF. Infections and autoimmune diseases. J Autoimmun. 2005;25 Suppl:74-80
  • Referans11 Taddio A, Rossetto E, Rosé CD, Brescia AM et al. Prognostic impact of atypical presentation in pediatric systemic lupus erythematosus: Results from a multicenter study. J Pediatr. 2010; 156: 972–7.
  • Referans12 Rigante D, Mazzoni MB, Esposito S. The cryptic interplay between systemic lupus erythematosus and infections. Autoimmun Rev. 2014; 13: 96–102.
  • Referans13 Simone IL, Carrara D, Tortorella C et al. Course and prognosis in early-onset MS: comparison with adult-onset forms. Neurology. 2002; 59: 1922–8.
  • Referans14 Chitnis T, Glanz B, Jaffin S, Healy B. Demographics of pediatric-onset multiple sclerosis in an MS center population from the Northeastern United States. Mult Scler. 2009; 15: 627–31.
  • Referans15 Ascherio A, Munger KL. Environmental risk factors for multiple sclerosis. Part I: the role of infection. Ann Neurol. 2007; 61: 288–99.
  • Referans16 Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet. 2016; 388: 717-27.
  • Referans17 Filippi CM, von Herrath MG. Viral trigger for type 1 diabetes: pros and cons. Diabetes. 2008; 57: 2863-71.
  • Referans18 Eddy AA, Symons JM. Nephrotic syndrome in childhood. Lancet. 2003; 362: 629–39.
  • Referans19 Uwaezuoke SN. Steroid-sensitive nephrotic syndrome in children: triggers of relapse and evolving hypotheses on pathogenesis. Ital J Pediatr. 2015; 41: 19.
  • Referans20 Rigante D, Castellazzi L, Bosco A, Esposito S. Is there a crossroad between infections, genetics, and Henoch-Schönlein purpura? Autoimmun Rev. 2013; 12: 1016-21.
  • Referans21 Gewitz MH, Baltimore RS, Tani LY et al; American Heart Association Committee on rheumatic fever, endocarditis, and Kawasaki disease of the council on cardiovascular disease in the oyung. Revision of the Jones criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation. 2015; 131: 1806-18.
  • Referans22 KDIGO clinical practice guideline for glomerulonephritis. Kidney Int Suppl. 2012; 2: 139–274.
  • Referans23 Ozen S, Pistorio A, Iusan SM et al. EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II:final classification criteria. Ann Rheum Dis. 2010; 69: 798–806.
  • Referans24 Petri M, Orbai AM, Alarcón GS et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012; 64: 2677–86.
  • Referans25 Thompson AJ, Banwell BL, Barkhof F et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018; 17: 162-173.
  • Referans26 Mayer-Davis EJ, Kahkoska AR, Jefferies C et al. ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2018; 19 Suppl 27: 7-19.
  • Referans27 Saulsbury FT. Clinical update: Henoch-Schönlein purpura. Lancet. 2007; 369: 976-8.
  • Referans28 Harambat J, Allard L, Godron-Dubrasquet A. Relapse rate of nephrotic syndrome in the time of COVID-19. Pediatr Nephrol. 2021; 36: 211-2.
  • Referans29 Alexandre-Silva GM, Brito-Souza PA, Oliveira ACS, Cerni FA, Zottich U, Pucca MB. The hygiene hypothesis at a glance: Early exposures, immune mechanism and novel therapies. Acta Trop. 2018; 188: 16-26.
  • Referans30 Unsworth R, Wallace S, Oliver NS et al. New-Onset Type 1 Diabetes in Children During COVID-19: Multicenter regional findings in the U.K. Diabetes Care. 2020; 43: e170-1.
  • Referans31 Tittel SR, Rosenbauer J, Kamrath C et al. Did the COVID-19 lockdown affect the incidence of pediatric type 1 diabetes in Germany? Diabetes Care. 2020; 43: e172-3.
  • Referans32 Kamrath C, Mönkemöller K, Biester T et al. Ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes during the COVID-19 pandemic in Germany. JAMA. 2020; 324: 801-4.

COVID-19 Pandemisi ve Karantina Döneminde Çocuklarda Otoimmün Hastalıkların Sıklığının Pandemi Öncesi Döneme Göre Değişimi

Year 2023, Volume: 45 Issue: 1, 42 - 49, 23.01.2023
https://doi.org/10.20515/otd.1116439

Abstract

COVID-19 pandemi ve kapanma döneminde pandemik öncesi döneme kıyasla yeni başlangıçlı hastalık/otoimmün hastalıkların ataklarının sıklığını belirlemeyi amaçladık. Bu çalışmaya COVID-19 pandemisi ve kapanma döneminin bir yıl öncesi ve ilk yılı boyunca hastanemizde otoimmun hastalık tanısı ile izlenen hastalar (n = 171) (0-18 yaş arası) dahil edildi. Yeni tanı alan hasta sayısı ve otoimmun hastalığın atak sayılarının sıklıkları geriye dönük olarak araştırıldı ve iki dönem arasında sıklıklar karşılaştırıldı. Pandemi öncesi ve pandemik dönemde yeni başlangıçlı hastalık/atakların sayısı sırasıyla 111 ve 65 olarak belirlendi (p <0.001). Post-streptokal hastalık ve Henoch-Schönlein purpurası hastalarında hastaneye başvuru oranları pandemi sırasında azalırken, yeni tanı tip 1 diyabetes mellitus sıklığında önemli bir artış gözlendi. Minimal lezyon hastalığı, sistemik lupus eritematozus, Guillain Barre sendromu (GBS) ve multipl skleroz için başvuru sıklığı iki dönem arasında anlamlı bir farklılık göstermedi. Hastaların hiçbirine COVID-19 teşhisi konmadı. COVID-19 pandemisi ve kapanma dönemi boyunca, Henoch-Schönlein purpurası ve post-streptokal hastalık gibi otoimmun hastalıkların sıklıkları, otoimmun hastalık etiyolojisi ve seyrinde infeksiyöz ajanların rol oynadığını destekleyecek şekilde önemli ölçüde azalmıştır. Bu durum izolasyon ve hijyen ölçümlerinin önemini vurgulamaktadır. Bu dönemde tip 1 diyabet mellitus sıklığının artmış sıklığı, enfeksiyonlar dışındaki faktörlerin hastalığın etiopatogenezinde etkili olabileceğini veya koruyucu ajanların veya etkilerinin azalmış olabileceğini veya değişebileceğini düşündürmektedir.

Project Number

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References

  • Referans1 Hacımustafaoğlu M. COVID-19 and re-opening of schools: Opinions with scientific evidence. Turk Pediatri Ars. 2020; 55: 337-44.
  • Referans2 Oikonomou N, Aznaouridis K, Barbetseas J et al. Hospital attendance and admission trends for cardiac diseases during the COVID-19 outbreak and lock-down in Greece. Public Health. 2020; 187: 115-9.
  • Referans3 Mulholland RH, Wood R, Stagg HR et al. Impact of COVID-19 on accident and emergency attendances and emergency and planned hospital admissions in Scotland: an interrupted time-series analysis. J R Soc Med. 2020; 113: 444-53.
  • Referans4 Mahmassani D, Tamim H, Makki M, Hitti E. The impact of COVID-19 lockdown measures on ED visits in Lebanon. Am J Emerg Med. 2020; 46: 634-9.
  • Referans5 Iozzi L, Brambilla I, Foiadelli T, Marseglia GL, Ciprandi G. Paediatric emergency department visits fell by more than 70% during the COVID-19 lockdown in Northern Italy. Acta Paediatr. 2020; 109: 2137-8.
  • Referans6 Angoulvant F, Ouldali N, Yang DD et al. Coronavirus disease 2019 pandemic: impact caused by school closure and national lockdown on pediatric visits and admissions for viral and nonviral Infections-a time series analysis. Clin Infect Dis. 2021; 72: 319-22.
  • Referans7 Hejrati A, Rafiei A, Soltanshahi M et al. Innate immune response in systemic autoimmune diseases: a potential target of therapy. Inflammopharmacology. 2020; 28:1421–1438
  • Referans8 Fujinami RS, von Herrath MG, Christen U, Whitton JL. Molecular mimicry, bystander activation, or viral persistence: infections and autoimmune disease. Clin Microbiol Rev. 2006; 19: 80-94.
  • Referans9 Bach JF. The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med. 2002; 347: 911–20.
  • Referans10 Bach JF. Infections and autoimmune diseases. J Autoimmun. 2005;25 Suppl:74-80
  • Referans11 Taddio A, Rossetto E, Rosé CD, Brescia AM et al. Prognostic impact of atypical presentation in pediatric systemic lupus erythematosus: Results from a multicenter study. J Pediatr. 2010; 156: 972–7.
  • Referans12 Rigante D, Mazzoni MB, Esposito S. The cryptic interplay between systemic lupus erythematosus and infections. Autoimmun Rev. 2014; 13: 96–102.
  • Referans13 Simone IL, Carrara D, Tortorella C et al. Course and prognosis in early-onset MS: comparison with adult-onset forms. Neurology. 2002; 59: 1922–8.
  • Referans14 Chitnis T, Glanz B, Jaffin S, Healy B. Demographics of pediatric-onset multiple sclerosis in an MS center population from the Northeastern United States. Mult Scler. 2009; 15: 627–31.
  • Referans15 Ascherio A, Munger KL. Environmental risk factors for multiple sclerosis. Part I: the role of infection. Ann Neurol. 2007; 61: 288–99.
  • Referans16 Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet. 2016; 388: 717-27.
  • Referans17 Filippi CM, von Herrath MG. Viral trigger for type 1 diabetes: pros and cons. Diabetes. 2008; 57: 2863-71.
  • Referans18 Eddy AA, Symons JM. Nephrotic syndrome in childhood. Lancet. 2003; 362: 629–39.
  • Referans19 Uwaezuoke SN. Steroid-sensitive nephrotic syndrome in children: triggers of relapse and evolving hypotheses on pathogenesis. Ital J Pediatr. 2015; 41: 19.
  • Referans20 Rigante D, Castellazzi L, Bosco A, Esposito S. Is there a crossroad between infections, genetics, and Henoch-Schönlein purpura? Autoimmun Rev. 2013; 12: 1016-21.
  • Referans21 Gewitz MH, Baltimore RS, Tani LY et al; American Heart Association Committee on rheumatic fever, endocarditis, and Kawasaki disease of the council on cardiovascular disease in the oyung. Revision of the Jones criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation. 2015; 131: 1806-18.
  • Referans22 KDIGO clinical practice guideline for glomerulonephritis. Kidney Int Suppl. 2012; 2: 139–274.
  • Referans23 Ozen S, Pistorio A, Iusan SM et al. EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II:final classification criteria. Ann Rheum Dis. 2010; 69: 798–806.
  • Referans24 Petri M, Orbai AM, Alarcón GS et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012; 64: 2677–86.
  • Referans25 Thompson AJ, Banwell BL, Barkhof F et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018; 17: 162-173.
  • Referans26 Mayer-Davis EJ, Kahkoska AR, Jefferies C et al. ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2018; 19 Suppl 27: 7-19.
  • Referans27 Saulsbury FT. Clinical update: Henoch-Schönlein purpura. Lancet. 2007; 369: 976-8.
  • Referans28 Harambat J, Allard L, Godron-Dubrasquet A. Relapse rate of nephrotic syndrome in the time of COVID-19. Pediatr Nephrol. 2021; 36: 211-2.
  • Referans29 Alexandre-Silva GM, Brito-Souza PA, Oliveira ACS, Cerni FA, Zottich U, Pucca MB. The hygiene hypothesis at a glance: Early exposures, immune mechanism and novel therapies. Acta Trop. 2018; 188: 16-26.
  • Referans30 Unsworth R, Wallace S, Oliver NS et al. New-Onset Type 1 Diabetes in Children During COVID-19: Multicenter regional findings in the U.K. Diabetes Care. 2020; 43: e170-1.
  • Referans31 Tittel SR, Rosenbauer J, Kamrath C et al. Did the COVID-19 lockdown affect the incidence of pediatric type 1 diabetes in Germany? Diabetes Care. 2020; 43: e172-3.
  • Referans32 Kamrath C, Mönkemöller K, Biester T et al. Ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes during the COVID-19 pandemic in Germany. JAMA. 2020; 324: 801-4.
There are 32 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section ORİJİNAL MAKALE
Authors

Birgül Kırel 0000-0002-8313-5677

Aslı Kavaz Tufan

Ayşe Sülü 0000-0001-6384-3935

Gonca Kılıç Yıldırım

Nuran Cetın 0000-0001-5763-9815

Koray Harmanci 0000-0002-8494-648X

Birsen Ucar 0000-0002-7746-6058

Sabiha Sahin 0000-0003-0759-4158

Enver Simsek 0000-0003-0120-9976

Kursat Bora Carman 0000-0002-4629-1873

Ömer Kılıç 0000-0003-0168-4080

Eren Göçhasanoğlu 0000-0002-1482-9528

Sumeyye Emel Yel 0000-0002-2271-2776

Hülya Özen 0000-0003-4144-3732

Ersin Yüksel 0000-0001-9894-8278

Can Aydın 0000-0003-2933-180X

Coşkun Yarar 0000-0001-7462-4578

Project Number -
Publication Date January 23, 2023
Published in Issue Year 2023 Volume: 45 Issue: 1

Cite

Vancouver Kırel B, Kavaz Tufan A, Sülü A, Kılıç Yıldırım G, Cetın N, Harmanci K, Ucar B, Sahin S, Simsek E, Carman KB, Kılıç Ö, Göçhasanoğlu E, Yel SE, Özen H, Yüksel E, Aydın C, Yarar C. Change in the Frequency of Autoimmune Diseases in Children During the COVID-19 Pandemic and Lock-Down Period Compared to the Pre-Pandemic Period. Osmangazi Tıp Dergisi. 2023;45(1):42-9.


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