Introduction: The true incidence of SARS-CoV-2 infection in children and young people (CYP) is unclear and data are influenced by testing strategies. CYP have so far accounted for 17.5-22% of diagnosed infections. In adults, diabetes was identified as risk factor for severe symptoms and hospitalization with the COVID-19. Eighteen months into the pandemic, studies in CYP with type 1 diabetes (T1D) reported only an increased prevalence of diabetic ketoacidosis (DKA) at T1D onset.
Objectives: To investigate the prevalence and clinical characteristics of SARS-CoV-2 infection in CYP with T1D.
Methods: SARS-CoV-2 infection was defined according to self-reported previous SARS-CoV-2 nasal swab PCR results in 210 CYP followed during 18 months of the pandemic and seroprevalence of antibodies against the SARS-CoV-2 spike protein assessed in 85 CYP (Previous negative nasal swab PCR or never performed) from January to June 2021, before COVID-19 vaccination era. SARS-CoV-2 IgG were assessed using a chemiluminescent immunoassay (CLIA). Data on clinical characteristics as well as glycemic control were collected before (T0) and 3-months after (T1) infection.
Results: SARS-CoV-2 infection was detected in 39 patients (males 61.5%; median age 13.5 and T1D duration 5.49 yrs.) during second and third wave: 26 (66.6%) based on the self-reported nasal swab PCR results and 13 (33.4%) on the SARS-CoV-2 IgG assay. All patients detected by CLIA were asymptomatic. Four patients detected by nasal swab PCR were asymptomatic (15.4%). Other patients reported ≥1 symptoms lasting a median of 5 days and including: fever (46.1%), headache (28.2%), anosmia and/or ageusia (25.6%), nasal congestion (15.4%), and fatigue/myalgia (10.2%). Dry cough, pharyngeal erythema, nausea and/or vomiting, diarrhea, abdominal pain, and arthralgia were less reported (2.56%). None had dyspnea, skin lesion, and MIS-C. Hospitalizations, DKA, and severe hypoglycemic events were not recorded. Glycemic control was not impaired from T0 to T1 (see Table).
|HbA1c (mmol/mol)||62.4±16.4 (58.5)||60.2±13.6 (57.4)||0.332|
|TIR (%)||52.3±17.0 (58.5)||55.5±15.4 (56.5)||0.186|
|TAR (%)||42.1±16.2 (39.0)||40.2±15.1 (40.5)||0.518|
|TBR (%)||4.64±4.41 (3.00)||4.33±3.48 (3.00)||0.632|
Conclusions: We found evidence for increased prevalence of SARS-CoV-2 infection among CYP with T1D using antibodies against the SARS-CoV-2 spike protein assessment. Asymptomatic subjects were 43%. COVID-19 pandemic had no impact on glycemic control and acute complications. Our data suggest that serological assay is useful to diagnose previous SARS-CoV-2 infection in not vaccinated CYP and to reconstruct the disease prevalence.
15 Sep 2022 - 17 Sep 2022