From Streptococcus A to the flu, this winter children are getting infections they should have had during lockdown.

The season of sore throats and sickness is approaching, and as any parent will tell you, schools and kindergartens are once again full of winter viruses and infections. Talk of a post-pandemic explosion in childhood illnesses and the Group A Streptococcus outbreak, which has claimed the lives of 15 children in the UK since September, is understandably a cause for concern. Group A streptococci can cause scarlet fever, which is usually mild, easily treated with antibiotics, and highly contagious.

But what impact does Covid-19 really have on our children’s immune systems? Is social distancing the cause of all these bugs and infections, and is it true that babies in cages are getting sicker than babies born before the pandemic?

There’s a lot to unpack here, so let’s start with the kids in isolation. We know that infants and young children are particularly susceptible to infections in the first three months of life because their immune systems are still developing. We also know that babies born during the 2020-2021 lockdown have had far from typical experiences as social distancing and other measures have largely protected them from viral and bacterial infections. The big question is whether a protected childhood made them more susceptible to infection.

“Children born during lockdown have had a very privileged first year of life in terms of exposure to infection,” the doctor said. Liz Whittaker, Pediatric Infectious Diseases and Immunology Consultant and Secretary of the UK Children’s Allergy, Immunity and Infection Group. “When your children go to kindergarten or other care, you really get the feeling that they are constantly sick for the first six months. It’s really a universal pre-pandemic experience for first-born parents that we never worried about because it’s normal.

She adds that children born in 2020 and 2021 either did not go to kindergarten, or if they did, there were far fewer respiratory viruses in the environment, so they did not become infected with them.

With that in mind, while the children in isolation and their parents no doubt faced other major challenges, they did quite well, at least from an immunological standpoint. “If you look at the cohort of children born in 2020 and 2021, you will see that they tended to have fewer hospitalizations[thanweusuallysee”bothinthefirstandsecondyearsoflife[thanweusuallysee”Whittakersays[thanweusuallysee—saysWhittakers[alswirnormalerweisesehenwürden“sagtWhittaker[alswirnormalerweisesehenwürtkerden“danwenormaalzoudenzien”zegtWhittaker[thanwewouldnormallysee”Whittakersays[чеммыобычновидим»каквпервыйтакивовторойгоджизни[чеммыобычновидим»—говоритУиттекер[чеммыобычносм—говоритУиттакерс[alswirnormalerweisesehenwürden“sagtWhittaker[alswirnormalerweisesehenwürden“sagtWhittaker[danwenormaalzoudenzien”zegtWhittaker[thanwewouldnormallysee”Whittakersays

What we’re actually seeing now, she adds, is not that these children are more susceptible, but simply that they get respiratory infections like the flu and respiratory syncytial virus (RSV) later when they are less susceptible and less likely to get sick. be hospitalized. The reason the numbers seem higher is simply because they get sick at the same time as younger children.

“While there was a lot of interest in increasing uptake of the virus last fall/winter, this was due to two cohorts being infected at the same time – a normal level of children under 1 year of age and a small cohort of 1 to 2 years of age. old ones that we don’t usually see,” the doctor explains. Whittaker.

Essentially, children in quarantine are picking up all the viruses they were protected from as children. “If you don’t get the typical four or five viruses in your first year of life, instead of four or five in your second year of life, you could get eight or nine — and that’s why you probably feel like you’re about to get sick. at some point.” much more.”

It is also worth noting, adds Dr. Whittaker added that while research in this area is still rare, there is currently no evidence that Covid-19 infection causes immunodeficiency in children. “There has been no serious longitudinal study of children in this country. This data is coming in and it’s important to keep an open mind, but clinically we don’t see an increase in immunocompromised children and I don’t think there’s a huge difference in the types of our patients. “Compared to previous years,” she says.

One change we’ve seen since the beginning of the pandemic is slightly altered infection patterns, largely coinciding with the lifting of restrictions and people returning to their pre-pandemic behavior. “For almost two years, people behaved differently: there was less international travel, people wore masks, they washed their hands more thoroughly and saw people less often when they had a cold. During this time, we have seen fewer cases of influenza, RSV, and all winter respiratory viruses.

“It’s interesting that they didn’t come back when schools reopened, but they came back when people’s behavior in the wider population changed – people started socializing more, going to bars and restaurants, traveling more,” says Whittaker.

As a result, she adds, last year in the UK we experienced a viral winter season that started around May/June and lasted a whole year, which is very atypical. Regarding these winter viruses, she believes we are now back to normal with even fewer cases found than in 2019, which was a particularly bad year. However, these unusual infection patterns also explain where group A streptococcus enters.

“All the behavioral changes that people made in 2020-2021 resulted in group A streptococcal infections not appearing in large numbers for two years, which was nice because these are really terrible bacteria that cause very serious illness,” the doctor explains. Whittaker leaves. “It just reappeared this spring and is lasting longer than usual because it’s circulating among all the people who haven’t had it in a long time.”

Here, isolation and continued social distancing may have affected children’s immunity. We don’t have long-term immunity to group A streptococcus, so kids who haven’t had it in two years are more likely to get it this year, Whittaker says.

However, she adds, the number of Streptococcus A cases we’re seeing this year is actually not much higher than before the pandemic, although peaking in winter is rare and peaking usually in the spring. “We’ve always seen waves of group A streptococci, and every two or three years you get a big wave,” says the doctor. Whittaker. “I think we’re seeing a surge at a time when it’s a little off-season and in a group of kids that haven’t had it in a few years, so there’s a lot of them.”

In 2017 and 2018, the number of streptococcal infections was high, and four children under the age of 10 died from invasive streptococcus A. There were more deaths this year, but the number of cases is still lower than in the 2018 wave.

“What is being reported in microbiology labs in the UK is a lot of common or horticultural variants of group A streptococcus causing you just a little bit of tonsillitis, also known as laryngitis. Unfortunately, when you have many cases on the normal side of the teething spectrum, the more severe side of the spectrum also shows up.”

It’s not helped by the unusual nature of the outbreak, the doctor says. Whittaker, which means children will be hit with the double whammy of winter viruses and group A bacterial streptococcal infection, leading to more serious illnesses. “When the virus becomes infected, the lining of the nose, throat, and lungs is damaged, making it easier for bacteria to enter the body and cause an infection. What we see is children who get a secondary bacterial infection after a viral infection and this leads to a lot of pneumonia,” she explains.

But she says outbreaks this season shouldn’t cause panic. “The situation with group A streptococcus is unusual, but other than that it seems that we are back to what we would normally expect to see in hospitals at this time of year.”