Prof. dr hab. Sylwia Kołtan: non-immunocompetent children need Covid-19 prophylaxis with the use of antibodies

What are the current recommendations of the Polish Society of Pediatric Oncology and Hematology on the prevention of SARS-CoV-2 infection, especially in immunosuppressed children?

Children should primarily be vaccinated with at least two doses in the primary immunization program, and three doses in selected moderate and severe immune dysfunction groups. A booster dose is also indicated in the pediatric population. We know that the vaccine response in non-immunocompetent children is worse and therefore additional options that can protect these children are very much needed. For older children, over the age of 12 and weighing at least 40 kg, a new opportunity has arisen. We have proposed two long-acting monoclonal antibodies that we can use in these children, for example, before the transplantation of hematopoietic cells. This cocktail of antibodies protects babies against infection, and certainly against severe complications associated with SARS-CoV-2 infection for at least six months.

What is the benchmark for building immunity in these patients?

Ideally, children already vaccinated should come to us, but we have very poor immunization coverage in pediatric groups in Poland. Sometimes it is difficult for us to vaccinate these children before they get sick, especially when we are talking about, for example, acute lymphoblastic leukemia. Children are then often in very poor condition, and this is not the best time to vaccinate. This is, however, a very good time to apply the antibodies. Importantly, it is not our job to evaluate the vaccine response. For this reason, when we have a child that comes to us for a transplant, we should protect it with these antibodies, even if it was previously vaccinated.

How is immunoprophylaxis provided in children younger than 12 years of age?

Research is currently underway. There is no registration for the younger age group and lower body weight. I hope that such registration is only a matter of time, and not too long. It is a myth that Covid-19 is a mild disease in children. Indeed, it is rarely severe, but we see a lot of complications, such as multi-system inflammatory syndrome or severe hepatitis of unclear etiology, but possibly related to SARS-CoV-2. We also never had so many children with a thrombotic complication before.

How large group of children you work with would be indicated for prophylaxis?

We estimate that this would be around twenty children per year, but time will tell if the group will not be expanded to include other diagnoses. Now it will be mainly patients who start treatment due to the occurrence of acute leukemia, because it is a difficult and long-term therapy. They are also children referred for hematopoietic cell transplantation.

Thanks for the interview.