FOR DOCTORS of the Italian Association of Pediatric Hematology and Oncology (Aieop) it is not a possibility but a necessity: the anti-Sars-CoV-2 vaccination for children (aged 5 years and over) affected by cancer or who have undergone a transplant it is essential to protect them from the risk of developing a severe form of Covid-19 and to allow regular care, hospitalizations, checks. This is, in summary, what is reported in the new Consensus Document prepared by the Infections and Supportive Therapies Working Group of the scientific society.
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The risks of Covid for children with onco-haematological diseases
Tumors, primary or secondary immunodeficiencies (including those caused by treatments), autoimmune cytopenias or bone marrow failure are conditions that define a pediatric patient as fragile, who if infected with Sars-Cov-2 would be more likely than others to undergo complications. Furthermore, the active infection could force to change the schedule of treatments and controls, causing delays.
This is stated by the data of the Global Covid-19 Registry, which in the period between 15 April 2020 and 1 February 2021 registered 1,520 pediatric oncohematological patients. Only 30.5% of the young patients infected with the coronavirus were asymptomatic, while 67.4% required hospitalization and 55.8% had to change their treatment due to the infection. In addition, in 19.9% of cases the disease manifested itself in severe or very serious forms and the mortality from Covid-19 in these patients was 3.8%.
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The situation in Italy
Fortunately, the incidence of Covid-19 has remained limited so far in Italian pediatric onco-hematology centers. In the registered cases, the disease generally had a favorable course and only 3% of cases required hospitalization, without any deaths from Covid. But with the advance of the omicron variant, the situation could change and, experts say, we must do everything possible to protect young patients.
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When to vaccinate children
The AIEOP doctors specify that the choice must be made on the patient, that is, personalized on the basis of his condition, the treatment he is following and the intensity of care. The decision, therefore, is the result of a dialogue with the treating pediatric oncologist. Covid vaccination should be performed, for example, when the patient is clinically stable, has no fever or is not on steroid therapies. Therefore, vaccination can be done during active chemotherapy treatment respecting time intervals, which may vary according to the drug and the distance from the last treatment; in patients undergoing cell therapy (transplant or Car-T) the minimum waiting interval is three months; in patients receiving anti-CD20 monoclonal antibody therapy (rituximab) or other monoclonal therapy resulting in severe and persistent B-lymphocytopenia, the minimum interval is six months from the last treatment.
“Vaccination, on the other hand, is not recommended only in case of documented allergy to a component of the vaccine, such as PEG, or in patients who have had a severe allergic reaction to the first dose of Covid-19 vaccine“, specifies Simone Cesaro, Director of Pediatric Oncohematology of the Verona Hospital and Coordinator of the Infections and Supportive Therapies Working Group of Aieop: “The history of allergic reactions to previous vaccinations is not, however, a contraindication to the Covid-19 mRna vaccine. If the patient has a history of severe allergic reactions to more than one drug, an evaluation of the risk / benefit ratio with the allergy specialist is recommended ”.
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The other recommendations
Finally, onco-haematologist pediatricians remind that to protect young patients to the maximum extent possible, vaccination is recommended for family members, as well as the use of masks, hand hygiene and physical and social distancing outside. of the narrow core. Influenza vaccination for patients and family members is also recommended.