ABSTRACT
BACKGROUND: Inborn errors of immunity (IEIs) are considered significant challenges for children with IEIs, their families, and their medical providers. Infections are the most common complication of IEIs and children can acquire coronavirus disease 2019 (COVID-19) even when protective measures are taken. OBJECTIVES: To estimate the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children with IEIs and analyse the demographic parameters, clinical characteristics and treatment outcomes in children with IEIs with COVID-19 illness. METHODS: For this systematic review, we searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline for studies on the development of COVID-19 in children with IEIs, published from December 1, 2019 to February 28, 2023, with English language restriction. RESULTS: Of the 1095 papers that were identified, 116 articles were included in the systematic review (73 case report, 38 cohort 4 case-series and 1 case-control studies). Studies involving 710 children with IEIs with confirmed COVID-19 were analyzed. Among all 710 IEIs pediatric cases who acquired SARS-CoV-2, some children were documented to be admitted to the intensive care unit (ICU) (n = 119, 16.8%), intubated and placed on mechanical ventilation (n = 87, 12.2%), suffered acute respiratory distress syndrome (n = 98, 13.8%) or died (n = 60, 8.4%). Overall, COVID-19 in children with different IEIs patents resulted in no or low severity of disease in more than 76% of all included cases (COVID-19 severity: asymptomatic = 105, mild = 351, or moderate = 88). The majority of children with IEIs received treatment for COVID-19 (n = 579, 81.5%). Multisystem inflammatory syndrome in children (MIS-C) due to COVID-19 in children with IEIs occurred in 103 (14.5%). Fatality in children with IEIs with COVID-19 was reported in any of the included IEIs categories for cellular and humoral immunodeficiencies (n = 19, 18.6%), immune dysregulatory diseases (n = 17, 17.9%), innate immunodeficiencies (n = 5, 10%), bone marrow failure (n = 1, 14.3%), complement deficiencies (n = 1, 9.1%), combined immunodeficiencies with associated or syndromic features (n = 7, 5.5%), phagocytic diseases (n = 3, 5.5%), autoinflammatory diseases (n = 2, 3%) and predominantly antibody deficiencies (n = 5, 2.5%). Mortality was COVID-19-related in a considerable number of children with IEIs (29/60, 48.3%). The highest ICU admission and fatality rates were observed in cases belonging to cellular and humoral immunodeficiencies (26.5% and 18.6%) and immune dysregulatory diseases (35.8% and 17.9%) groups, especially in children infected with SARS-CoV-2 who suffered severe combined immunodeficiency (28.6% and 23.8%), combined immunodeficiency (25% and 15%), familial hemophagocytic lymphohistiocytosis (40% and 20%), X-linked lymphoproliferative diseases-1 (75% and 75%) and X-linked lymphoproliferative diseases-2 (50% and 50%) compared to the other IEIs cases. CONCLUSION: Children with IEIs infected with SARS-CoV-2 may experience higher rates of ICU admission and mortality in comparison with the immunocompetent pediatric populations. Underlying immune defects does seem to be independent risk factors for severe SARS-CoV-2 infection in children with IEIs, a number of children with SCID and CID were reported to have prolonged infections-though the number of patients is small-but especially immune dysregulation diseases (XLP1 and XLP2) and innate immunodeficiencies impairing type I interferon signalling (IFNAR1, IFNAR2 and TBK1).
ABSTRACT
BACKGROUND: During a public health crisis such as the current COVID-19 pandemic, governments and health authorities need quick and accurate methods of communicating with the public. While social media can serve as a useful tool for effective communication during disease outbreaks, few studies have elucidated how these platforms are used by the Ministry of Health (MOH) during disease outbreaks in Saudi Arabia. OBJECTIVE: Guided by the Crisis and Emergency Risk Communication model, this study aimed to explore the MOH's use of Twitter and the public's engagement during different stages of the COVID-19 pandemic in Saudi Arabia. METHODS: Tweets and corresponding likes and retweets were extracted from the official Twitter account of the MOH in Saudi Arabia for the period of January 1 through August 31, 2020. Tweets related to COVID-19 were identified; subsequently, content analysis was performed, in which tweets were coded for the following message types: risk messages, warnings, preparations, uncertainty reduction, efficacy, reassurance, and digital health responses. Public engagement was measured by examining the numbers of likes and retweets. The association between outbreak stages and types of messages was assessed, as well as the effect of these messages on public engagement. RESULTS: The MOH posted a total of 1393 original tweets during the study period. Of the total tweets, 1293 (92.82%) were related to COVID-19, and 1217 were ultimately included in the analysis. The MOH posted the majority of its tweets (65.89%) during the initial stage of the outbreak. Accordingly, the public showed the highest level of engagement (as indicated by numbers of likes and retweets) during the initial stage. The types of messages sent by the MOH significantly differed across outbreak stages, with messages related to uncertainty reduction, reassurance, and efficacy being prevalent among all stages. Tweet content, media type, and crisis stage influenced the level of public engagement. Engagement was negatively associated with the inclusion of hyperlinks and multimedia files, while higher level of public engagement was associated with the use of hashtags. Tweets related to warnings, uncertainty reduction, and reassurance received high levels of public engagement. CONCLUSIONS: This study provides insights into the Saudi MOH's communication strategy during the COVID-19 pandemic. Our results have implications for researchers, governments, health organizations, and practitioners with regard to their communication practices during outbreaks. To increase public engagement, governments and health authorities should consider the public's need for information. This, in turn, could raise public awareness regarding disease outbreaks.