From H1N1 to COVID-19: What we have seen in children with hemoglobinopathies

Oliveira, Claudia de Melo; Soares, Victor Jablonski; Rechenmacher, Ciliana; Daudt, Liane Esteves; Michalowski, Mariana Bohns

doi:10.1016/j.clinsp.2021.100004

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Sumário

Review articles • Clinics 77 • 2022 • https://doi.org/10.1016/j.clinsp.2021.100004 copy

From H1N1 to COVID-19: What we have seen in children with hemoglobinopathies

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This work aimed to better understand the impact of pandemics of respiratory viruses on children with hemoglobinopathies through a comprehensive review of the literature. MEDLINE, SCIELO, LILACS, and PUBMED were used as data sources to find articles without time period restrictions. Previous observations suggest that patients with hemoglobinopathies are a group especially susceptible to the complications of viral respiratory infections, with greater morbidity and mortality related to them. Within this context, this review found that, during the 2009 H1N1 pandemic, the risk of hospitalization in children and adults increased, especially in patients with a history of complications such as acute chest syndrome. In addition, the Coronavirus Disease 2019 (COVID-19) pandemic appears to have less repercussion among children with hemoglobinopathies compared to adults, similar to what is seen in the general population. In the H1N1 pandemic, patients with hemoglobinopathies behaved as a group more susceptible to complications, with increased morbidity and mortality. However, for COVID-19, the existing data to date on these patients do not show the same clinical impact. Thus, although these children deserve attention in case of infection due to their potential risks, they seem to have a favorable evolution.

Highlights

Children with hemoglobinopathies have less severe conditions with Coronavirus 2019 Disease (COVID-19) compared to adults, which is similar to that observed in the general population
In the H1N1 pandemic, patients with hemoglobinopathies behaved as the group most susceptible to complications, with increased morbidity and mortality

Author, year	Design	Study population	Main findings
Strouse et al.,¹⁸18 Strouse JJ, Reller ME, Bundy DG, Amoako M, Cancio M, Han RN, et al. Severe pandemic H1N1 and seasonal influenza in children and young adults with sickle cell disease. Blood 2010;116(18):3431-4. 2010	Retrospective cohort	123 SCD patients < 22 yo with diagnoses of influenza A (66); B (28); and H1N1 (29)	Patients with seasonal influenza were younger and less likely to have asthma. Patients with H1N1 more often developed ACS, severe pain, and illness requiring intensive care. The most frequent treatments used with these patients were antiviral agents, red blood cell transfusions, and exchange transfusions (10% for those with H1N1 vs. 3% for seasonal influenza, p=0.045). No patient died.
George et al.,¹⁹19 George A, Benton J, Pratt J, Kim MO, Kalinyak KA, Kalfa TA, et al. The impact of the 2009 H1N1 influenza pandemic on pediatric patients with sickle cell disease. Pediatr Blood Cancer 2011;57(4):648-53. 2011	Retrospective chart review	48 children with all forms of SCD and diagnosis of H1N1 or influenza A	The most common diagnosis in hospitalized patients was ACS. No mechanical ventilation was required, or death reported. History of ACS or reactive airway disease was correlated with a higher rate of admission and of ACS incidence during the acute illness.
Colombatti et al.,²⁰20 Colombatti R, Perrotta S, Masera N, Palazzi G, Notarangelo LD, Pusiol A, et al. Lessons learned from the H1N1 pandemic: the need to improve systematic vaccination in sickle cell disease children. A multi center survey in Italy. Vaccine 2011;29(6): 1126-8. 2011	Retrospective survey	17 patients < 17 yo with SCD and H1N1	15 HbS/HbS and 2 HbS/betha patients. Mean age: 7 years (range 1-17). 8 (47%) patients had ACS; 8 (47%), flu-like syndrome with vaso-occlusive crises; and 1 (6%), acute splenic sequestration. 7 (41%) patients received a simple transfusion and 5 (29%) underwent erythrocytapheresis.

Author, year	Design	Study population	Main findings
Telfer et al.,²⁵25 Telfer P, De la Fuente J, Sohal M, Brown R, Eleftheriou P, Roy N, et al. Real-time national survey of COVID-19 in hemoglobinopathy and rare inherited anemia patients. Haematologica 2020;105(11):2651-4. 2020	Real-time survey	195 patients (17 children) with confirmed and suspected diagnoses of COVID-19 and hemoglobinopathy or rare inherited anemia	166 patients had SCD; 26, thalassemia; and 3, rare inherited anemia. None required non-invasive and/or mechanical ventilation. No death was reported in this group.
Singh et al.,²⁶26 Singh A, Brandow AM, Panepinto JA. COVID-19 in individuals with sickle cell disease/trait compared with other Black individuals. Blood Adv 2021;5(7):1915-21. 2021	Retrospective cohort	624 black patients with diagnoses of COVID-19, 312 with SCD/SCT and 312 without SCD/SCT trait	Patients with SCD had a higher risk of hospitalization (RR = 2.0) and development of pneumonia (RR = 2.4) and pain (RR = 3.4) compared with those without SCD/SCT. The fatality rate was not significantly different. No comparison between adults and children was made.
Minniti et al.,²⁸28 Minniti CP, Zaidi AU, Nouraie M, Manwani D, Crouch GD, Crouch AS, et al. Clinical predictors of poor outcomes in patients with sickle cell disease and COVID-19 infection. Blood Adv 2021;5(1):207-15. 2021	Cohort	66 patients with SCD and diagnosis of COVID-19	Patients aged > 50 years, with preexisting cardiopulmonary, renal disease, and/or stroke who were not receiving hydroxyurea had as risk factors for death high serum creatinine, lactate dehydrogenase, and D-dimer levels, irrespective of genotype or sex. 75% required hospitalization, and 10.6% died. No children died.

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[1] *Corresponding author. E-mail address: claumeloo@gmail.com (C.d.M. Oliveira).