THE STATE OF HUMORAL IMMUNITY AGAINST DIPHTHERIA AND TETANUS IN SCHOOL-AGED CHILDREN WITH INFECTIOUS DISEASES DURING THE COVID-19 PANDEMIC
DOI:
https://doi.org/10.11603/24116-4944.2024.2.15091Keywords:
children, COVID-19, severity, infection, immunity, diphtheria, tetanusAbstract
The aim of the study – to assess levels of immunoglobulins G against diphtheria and tetanus in school-age children with infectious diseases during the COVID-19 pandemic as a possible marker of disease severity.
Materials and Methods. 124 children aged 6 to 18 years were examined: 60 patients with laboratory-confirmed SARS-CoV-2 infection, 32 patients with the signs of infectious diseases and negative laboratory tests for COVID-19, and 32 children without signs of the disease (control group). Determination of the level of antibodies G against tetanus and diphtheria was carried out in all children by the method of enzyme immunoassay. Some laboratory indicators (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin, neutrophil count, ferritin, D-dimer), saturation (SpO2), presence of respiratory failure, severity and duration of hyperthermic syndrome were evaluated.
Results and Discussion. Positive result for the presence of specific immunoglobulins G to tetanus toxin was detected in 96.67 % of patients of the control group of observation, in 37.10 % of children in the group with manifestations of COVID-19, and in 84.38 % cases in the group with manifestations of non-covid infectious pathology (P<0.001*, χ2=33.94). The number of patients with a positive result for the presence of tetanus antibodies decreased along with the increase in the severity of the course of coronavirus disease (P<0.001, χ2=36.11). The average level of immunoglobulins (Ig) G against diphtheria toxin in patients in the control group was 0.51 [0.22; 0.81] IU/ml, in children with SARS-CoV-2 infection – 0.19 [0.08; 0.84] IU/ml, with manifestations of non-covid infectious pathology – 0.51 [0.16; 0.63] IU/ml (P=0.037, H=6.61). The average index of anti-diphtheria immunoglobulins decreased with the increase in the severity of the course of coronavirus infection (P<0.001, H=24.84). The number of children who required revaccination against diphtheria was 7.5 times higher in patients with SARS-CoV-2 infection, 2.8 times higher in the group of children with manifestations of other infectious pathology compared to the control group of children (χ2=20.83, р<0.001). The percentage of children who needed revaccination against the causative agent of diphtheria increased with the increase in the severity of SARS-CoV-2 infection (χ2=32.67, р<0.001). Coronavirus infection, in the absence of specific tetanus immunoglobulins and insufficient levels of anti-diphtheria antibodies, was accompanied by a higher frequency of febrile body temperature and a longer duration of hyperthermia, higher rates of pro-inflammatory factors, D-dimer, a higher incidence of pneumonia and a decrease in SpO2. There was no statistically significant difference between the presence of tetanus antibodies, the number of anti-diphtheria immunoglobulins and the duration of hyperthermia, the number of children with febrile body temperature, pro-inflammatory markers, D-dimer, the incidence of pneumonia, and a decrease in SpO2 among patients with non-COVID infectious pathology. In the group of children with non-COVID infectious pathology, an insufficient level of immunoglobulins G to diphtheria toxin was accompanied by an increase in ferritin.
Conclusions. Coronavirus infection in observation patients, especially its severe course, was accompanied by the lowest level of humoral immunity against diphtheria and tetanus. An increase in pro-inflammatory markers, D-dimer, the incidence of pneumonia and respiratory failure in the absence of tetanus antibodies and a low level of anti-diphtheria immunoglobulins also indicated the severity of the course of COVID-19. An increase in ferritin in a group of children with non-COVID infectious pathology accompanied by insufficient indicators of immunoglobulins G to diphtheria toxin also indicated a more severe course of the infectious process.
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