key: cord-0908983-dev5ojtj authors: Cohen, Robert; Pettoello-Mantovani, Massimo; Somekh, Eli; Levy, Corinne title: European pediatric societies call for an implementation of regular vaccination programs to contrast the immune debt associated to COVID-19 pandemic in children date: 2021-11-27 journal: J Pediatr DOI: 10.1016/j.jpeds.2021.11.061 sha: 4d23312e71f63f80d8fa51c5b2cf5e73bb2fd4f7 doc_id: 908983 cord_uid: dev5ojtj nan In the initial months of the coronavirus disease 2019 (COVID-19) pandemic , due to the lack of effective treatments and unavailability of a vaccine, governments worldwide developed a variety of safety measures to control the spread of virus among their populations. Heterogeneous strategies variously implemented during the first year of the pandemic, were often maintained after COVID-19 vaccines were made available 2 . Public health and social measures of containment, non-pharmaceutical interventions (NPI), that were developed and enforced at local level worldwide, proved to be effective in limiting the spread of the disease and reducing the number of deaths 3 . Safety measures adopted to minimize possible viral contamination included frequent hand washing, wearing facemasks and social distancing policies taken on by communities in order to limit the spread of a disease. To further reduce person to person transmission of the virus most countries have introduced a combination of school and workplace closures; public events cancellations, restrictions on public gatherings, closures of public transport and stay-at-home orders 4 . The implementation of strict public health NPIs targeting COVID-19 has been credited for a reduction of many viral and bacterial infectious diseases in children 5, 6 . For instance, global rates of Respiratory Syncytial Virus (RSV), the most common cause of admission to hospital for infants in high-income countries, accounting for 60-80% of bronchiolitis hospitalizations, have been significantly low since early 2020 6, 7 . (EPA/UNEPSA), briefly discusses the insurgence of infectious diseases due to the immune debt associated to the public health NPIs established to control the COVID-19 pandemic. Our aim is to raise awareness of pediatricians and public health authorities on the importance vaccination programs in children to contrast the immune debt associated to the pandemic 6, 9 . Since the beginning of the COVID-19 pandemic, children and adolescents have shown low rates of infection, as well as relatively low rates of severe or critical forms of SARS-CoV-2 10,11 . NPIs have limited the spread of COVID-19 in Europe 6, 12 . NPIs imposed to reduce the SARS- However, the long-term impact of an extensive adoption of useful NPI safety measures is currently unknown 6 . In particular, it is unclear whether and to what extent , infectious diseases that significantly declined during the pandemic, will re-emerge after COVID-19 mitigation J o u r n a l P r e -p r o o f measures are lifted. Data on increasing numbers of RSV cases after the summer 2021 seems to suggest an imminent risk for children's health 6 . Due to the NPIs enforced during the pandemic, children have experienced extended periods of low exposure to pathogens 7, 14 . Immune memory is a defining feature of the acquired immune system 15 . Concerns have been raised about the lack of exposure to common infections and the possibility that prolonged periods of reduced contacts with pathogens may reduce protective immunity 6, 7, 16 and influence the development of adaptive immunity against infectious agents 6, 16, 17 . Activation of the innate immune system can also result in enhanced responsiveness to triggers 15 . In the absence of exposure to seasonal infectious diseases, immunity may decrease while the susceptibility to infections increase 6 . Therefore, the immunity debt caused by the NPIs adopted during the pandemic (Figure) could expose children to a greater potential for an increase in outbreaks and possible epidemics due to new or re-emerging infectious agents 6, 7 . . In Australia, RSV infections began to increase during the spring months and peaked in late September 2021 with the number of cases significantly greater than in previous years 24, 25 . In Japan, a significant outbreak of RSV infections was reported starting in spring 2021 30 Immunity debt in children following the adoption of COVID-19 non-pharmaceutical interventions (NPI) Effects of Coronavirus Disease 2019 (COVID-19) on Family Functioning Monitoring non-pharmaceutical public health interventions during the COVID-19 pandemic. Sci Data Effects of non-pharmaceutical interventions against COVID-19 on the incidence of other diseases. Lancet Reg Health Eur Non-pharmaceutical interventions during the COVID-19 pandemic: A review The impact of COVID-19 nonpharmaceutical interventions on the future dynamics of endemic infections Pediatric Infectious Disease Group (GPIP) position paper on the immune debt of the COVID-19 pandemic in childhood, how can we fill the immunity gap? Respiratory syncytial virus: paying the immunity debt with interest. Lancet Child Adolesc Health Association between COVID-19 pandemic and pertussis in France using multiple nationwide data sources New Approach to the Surveillance of Pediatric Infectious Diseases From Ambulatory Pediatricians in the Digital Era The impact of COVID-19 public health measures on detections of influenza and respiratory syncytial virus in children during the 2020 Australian winter The Interseasonal Resurgence of Respiratory Syncytial Virus in Australian Children Following the Reduction of Coronavirus Disease 2019-Related Public Health Measures Characteristics of the delayed respiratory syncytial virus epidemic Delayed Bronchiolitis Epidemic in French Primary Care Setting Driven by Respiratory Syncytial Virus: Preliminary Data from the Oursyn Study Unexpected lessons from the COVID-19 lockdowns in France: Low impact of school opening on common communicable pediatric airborne diseases Viral etiologies of infant bronchiolitis, croup and upper respiratory illness during 4 consecutive years Increased Interseasonal Respiratory Syncytial Virus (RSV) Activity in Parts of the Southern United States Pan American Health Organization. Regional update, influenza. Epidemiological week 25 Unusual surge of respiratory syncytial virus in children As children's COVID cases surge, there's another virus on the rise UK Health Security Agency and Office for Health Improvement and Disparities. Health chiefs issue warning as childhood respiratory infections rise ahead of winter Information Platform on Vaccinations Impact of COVID-19 social distancing on viral infection in France: A delayed outbreak of RSV Delayed respiratory syncytial virus epidemic in children after relaxation of COVID-19 physical distancing measures The Israeli Center for Disease Control Virus respiratorio neonati European Centre for Disease Prevention and Control. COVID-19 surveillance guidance -Transition from COVID-19 emergency surveillance to routine surveillance of respiratory pathogens Changes in Routine Pediatric Practice in Light of Coronavirus 2019 (COVID-19) Fostering Resilience in Children: The Essential Role of Healthcare Professionals and Families Pop TL et al Viewpoint of the European Pediatric Societies over Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccination in Children Younger Than Age