Impact of COVID-19 on Pediatric Immunocompromised Patients

Connelly, James A.; Chong, Hey; Esbenshade, Adam J.; Frame, David; Failing, Christopher; Secord, Elizabeth; Walkovich, Kelly

Although living with the threat of severe infection is a constant worry for many pediatric immunocompromised patients, the pandemic begotten by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) created new fears and challenges for families and health care providers. As people around the world through government directive or independent choice moved into protective isolation, immunosuppressed children who routinely require medical management were challenged with necessary public ventures to health care facilities. Medical centers adapted by developing new approaches to care for immunocompromised children such as expanding telemedicine services and conversion to at home immune therapies to reduce infectious exposure. Testing for SARS-CoV-2 of asymptomatic patients prior to medical therapies became routine in most modern health care units and development of highly sensitive assays was critical to avoid patient and staff exposure as well as initiation of new immunosuppressive treatment in positive patients. As the prevalence of coronavirus disease (COVID-19) amplified and infected immunocompromised patients became more common, questions quickly arose including how aggressively to treat the infection with most agents still in clinical trials. Additionally how should chronic immunosuppressant drugs that may interfere with the ability to clear the virus be adjusted? Finally, what if the infection leads to excessive immune responses or flares of the underlying disorder? In this review, we explore the impact of the COVID-19 pandemic on immunocompromised children during the first year, summarizing what is known and yet to be discovered, approaches to testing and treatment of SARS-CoV-2, considerations in management of underlying immune suppressive medications, outcomes published to date, and strategies for vaccinating this unique population.