HUMORAL IMMUNITY AGAINST DIPHTHERIA IN SCHOOL-AGE CHILDREN DURING THE COVID-19 PANDEMIC
DOI:
https://doi.org/10.11603/1681-2727.2023.4.14246Keywords:
children, infection, disease severity, immunoglobulins G, diphtheria, COVID-19Abstract
SUMMARY. The aim of the study was to find out the features of the course of infectious diseases in children depending on the state of humoral immunity against diphtheria, assessing the level of specific immunoglobulins G against diphtheria toxin in blood serum.
Patients and methods. Totally of 124 children aged 6 to 18 years were examined: 62 patients with laboratory-confirmed SARS-CoV-2 infection, 32 patients with other infectious diseases (with the exception of diphtheria) and negative laboratory tests for COVID-19, 30 children without signs of disease (control group). All children were tested for C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin, cortisol, D-dimer, 25(OH)vitamin D, duration of hyperthermic syndrome and duration of treatment, as well as determination of immunoglobulin G (Ig G) against diphtheria toxin by enzyme-linked immunosorbent assay (Diphtheria Elisa Ig G, IBL, Germany). The results were evaluated as follows: less than 0.01 IU/ml – recommended basic immunization, 0.01–0.1 IU/ml – recommended booster vaccination (revaccination), more than 0.1 IU/ml – good immunity.
Results and discussion. The indicator of antitoxic immunoglobulin G was 1.9 times higher in children of the control group compared to patients with manifestations of infectious diseases. A decrease in immunoglobulin G levels is associated with an increase in pro-inflammatory markers, cortisol, duration of hyperthermic syndrome, and duration of treatment. 4.17 % of children in the control group needed booster vaccination, 37.14 % in the group with SARS-CoV-2 infection, and 19.05 % of children in the group of children with other infectious diseases needed a booster dose of anti-diphtheria toxoid. In children with infectious pathology, a reduced number of antibodies to diphtheria toxin was associated with an increase in the number of leukocytes, ESR, D-dimer, CRP, cortisol, the duration of hyperthermia and the duration of treatment. There is a negative medium-strength correlation between the level of immunoglobulin G against diphtheria toxin and ESR (r=-0.40, p<0.001), CRP (r=-0.34, p=0.007), D-dimer (r=-0.33, p=0.018), cortisol (g=-0.38, p<0.001), duration of hyperthermia (r=-0.52, p<0.001), duration of treatment (r=-0.32, p=0.017), and positive medium-strength correlation (r=0.43, p<0.001) between the level of specific immunoglobulin G and 25(OH)vitamin D.
Conclusions. Children with SARS-Co-2 infection had significantly lower levels of Ig G against diphtheria toxin compared to other groups of children. A decrease in the level of humoral immunity against diphtheria was accompanied by an increase in pro-inflammatory markers and cortisol and a decrease in the level of 25(OH)D, which may indicate a more severe course of the infectious process.
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