From the end of 2021 to the present day, the attention of the entire healthcare system and the world community as a whole has been focused on one big problem - the spread of a new coronavirus infection, which WHO has characterized as an emergency of international concern. One of the most important questions that has arisen for doctors is how to treat covid-19 in adults and children. We talked about this with the head of the Department of Children's Infectious Diseases of the Krasnoyarsk State Medical University, the chief specialist in infectious diseases in children of the Ministry of Health of the Russian Federation for the Siberian Federal District and Krasnoyarsk Territory, Doctor of Medical Sciences, Professor Galina Petrovna Martynova.
-Galina Petrovna, tell us what difficulties practitioners have encountered during the pandemic.
-Coronaviruses are a large family of viruses that can infect humans and some animals; they have been known to us since the 60s of the last century. Until 2002, coronaviruses were considered to be agents that caused mild upper respiratory tract disease. However, in 2002, a highly pathogenic strain of SARS-CoV was discovered, which caused an epidemic of SARS, and 10 years later - MERS-CoV. Therefore, the appearance of another representative of the alphacoronavirus SARS-CoV-2 in December 2021 in the city of Wuhan (PRC) did not initially cause much concern. But today it is already absolutely clear that COVID-19 is a completely new infection that has swept the whole world and has posed a number of diagnostic and treatment challenges for medical workers.
Particularly great difficulties in providing medical care to patients occurred at the beginning of the pandemic, when the scale of the spread of the new coronavirus infection COVID-19 became obvious. The therapy was prescribed, essentially, off-label due to the lack of reliable evidence of the effectiveness and safety of certain medications prescribed to patients. But today, a sufficient amount of information has been accumulated about the epidemiology, clinical features, prevention and treatment of this disease, a number of clinical studies have been conducted that have confirmed the effectiveness and safety of a number of drugs that can be used in the treatment of COVID-19 in adults and children.
-There is an opinion that children practically do not get sick from COVID-19. How susceptible are they to infection?
-Children are susceptible to SARS-CoV-2: according to statistics, they make up 5 to 7% of those infected with the new coronavirus infection. However, compared to adults, children have a milder form of COVID-19. Only 10% of infected children require hospitalization, and only 1% develop severe disease.
In most cases, the new coronavirus infection COVID-19 in children occurs as a mild form of acute respiratory infection, but at the same time, despite the absence of pronounced symptoms of intoxication, physical and auscultatory changes in the lungs, 20–50% of children develop pneumonia (according to computed tomography of the chest).
It is noteworthy that, along with the new coronavirus infection, today there is a traditional seasonal increase in morbidity caused by other respiratory viruses: rhinoviruses, respiratory syncytial virus, adenovirus, influenza virus and parainfluenza. But the seasonal rise of ARVI in modern conditions is, of course, unusual: it occurs against the background of an ongoing pandemic, when, due to the great similarity of clinical manifestations, it is very difficult to determine which virus (or viruses) caused the disease, especially in an outpatient setting. That is why a rational approach to the treatment of a new coronavirus infection in children, according to experts, is carried out in accordance with the basic principles of the treatment of acute respiratory viral infections.
It should be taken into account that respiratory viruses, including coronavirus, are capable of mutating, changing their antigenic structure, and developing resistance to a number of direct antiviral drugs. Let's take the influenza virus as an example, for which powerful antiviral drugs have been created that have a convincing evidence base. At the same time, today more than 40% of influenza virus strains are insensitive to Rimantadine and other amantadine drugs. There is evidence of the emergence of influenza virus strains resistant to first-line drugs - neuraminidase inhibitors, in particular Oseltamivir. And this only applies to the flu. But we cannot exclude the possibility of combined damage to the respiratory tract, when the disease is caused by several viruses at once, which, of course, greatly complicates the choice of antiviral therapy.
In this regard, in the treatment of respiratory viral infections, it became necessary to use drugs that act not on specific viral proteins, but on the immune mechanisms of antiviral defense. In this situation, the drugs of choice for the treatment of acute respiratory viral infections of various etiologies, including the new coronavirus infection COVID-19, are recombinant interferon drugs.
-Some experts believe that the body needs enough endogenous interferon. How valid is this opinion?
-Unfortunately, this is not entirely true. Of course, viruses are powerful stimulators of the production of endogenous interferon, which does not depend on the taxonomic properties of the pathogen and will continue throughout the period of its replication. From the moment the pathogen comes into contact with the epithelium of the mucous membranes of the respiratory tract, active induction of endogenous (internal) interferon begins. However, this does not mean that its concentration is sufficient for reliable protection against infection, including the new coronavirus infection. In young children, especially newborns, infectious and inflammatory diseases reduce the body's ability to produce interferon alpha and gamma, which reduces the effectiveness of the body's defenses, including local immunity.
Moreover, the results of experimental and clinical studies of our European colleagues indicate that SARS-CoV-2, unlike other respiratory viruses, suppresses the synthesis of its own interferon in the body. When the immune system is weakened, viruses escape the immune mechanisms, the disease prolongs, and complications develop that can even cause an unfavorable outcome. In connection with the above, it is logical in this situation to use recombinant interferon drugs in pediatric practice, the antiviral, immunomodulatory and antioxidant activity of which has been demonstrated in numerous clinical studies. Recombinant interferon-α-2b preparations are effective against infections of various etiologies (viral and bacterial) and localizations (diseases of the respiratory and gastrointestinal tract, nervous and urinary systems, congenital infections). It is important that interferon preparations can be used in patients of completely different age categories: children, including newborns, adolescents, adults, including pregnant women and the elderly. Therefore, the range of indications for the use of recombinant interferon drugs is very wide, without any exaggeration.
The leader among recombinant interferon-α-2b drugs, of course, is VIFERON®, the therapeutic and preventive effectiveness of which has been proven in numerous studies in patients of different age groups with different health conditions. Our clinic also took part in studying the effectiveness and safety of recombinant interferon drugs in the treatment of children with the new coronavirus infection COVID-19.
-Why did VIFERON® become the object of research?
-First of all, because VIFERON® has convenient release forms for children's practice - suppositories (they act systemically, that is, on the entire body as a whole), as well as gel and ointment (they act locally, at the site of the lesion). When applied topically, interferon prevents the fixation and multiplication of viruses at the site of their introduction, thus creating an obstacle for them: the virus cannot penetrate the cell, it has nowhere to multiply. Therefore, local gel or ointment forms can be successfully used not only for treatment purposes, but also for effective prevention.
Administration of recombinant interferon-α-2b from the moment the very first symptoms of the disease appear suppresses viral replication. It is not surprising that not only in Russia, but also in Europe, there is currently an active study of the use of recombinant interferon drugs in the treatment and prevention of the new coronavirus infection COVID-19.
-Tell me more about the study in which you participated.
-The study was conducted in three research centers where hospitals were deployed to treat children with COVID-19: in Moscow, Krasnoyarsk and Kazan. The purpose of the study was to study the effectiveness of interferon-α-2b in high doses. After all, SARS-CoV-2 blocks the production of endogenous interferon, and therefore it is advisable to administer high doses of recombinant interferon-α-2b.
The study involved 140 children aged 1 to 17 years, who were divided into two age groups. The first - children from 1 year to 7 years old who received recombinant interferon-α-2b (VIFERON®) in the form of rectal suppositories as etiotropic antiviral therapy in the form of rectal suppositories at a dosage of 1,000,000 IU 2 times a day in combination with VIFERON® Gel 5-6 times per day locally (on the nasal mucosa).
The second group - children from 8 to 17 years old, received rectal suppositories VIFERON® 3,000,000 IU 2 times a day in combination with VIFERON® Gel topically 5-6 times a day.
The control group consisted of 70 children who received the drug with direct antiviral action “Umifenovir” as antiviral therapy in a therapeutic dosage in accordance with the age of the child.
Clinical effectiveness was assessed by reducing the severity of clinical symptoms of the disease: relief of fever, cough, nasal congestion, rhinorrhea, abdominal pain, restoration of the mucous membranes of the eyes, normalization of smell and taste. The study examined the dynamics of coronavirus isolation, the level of IgM and IgG antibodies to SARS-CoV-2 in the blood serum, which allows us to assess the rate of formation of the immune response.
-Can we already talk about the results of the work?
-Yes, the study is almost completed, and its results showed positive dynamics during therapy in patients of the main and control groups. At the same time, it should be noted that in patients of the main group receiving combination therapy with recombinant interferon-α-2b drugs (VIFERON® Rectal Suppositories and Gel), the relief of clinical symptoms of the disease occurred significantly faster compared to children in the comparison group.
Children in the main group developed antibodies to SARSCoV-2 in their blood serum significantly faster (first IgM and then IgG) compared to participants in the control group. This confirms the fact that the immune response to the new coronavirus with the use of recombinant interferon in high doses in a combined regimen was formed more quickly compared to therapy with a direct antiviral drug. Of course, this was reflected in the duration of clinical manifestations of the disease and shortened the length of stay of children in the hospital.
I would like to note that among the patients in the control group there were children (as a rule, teenagers with damage to the lower respiratory tract, pneumonia), who, on the 8th–9th day from the date of prescription of antiviral therapy with Umifenovir, still had clinical manifestations of the disease, in control smears from SARS-CoV-2 continued to be released from the nasopharynx. Prescribing patients a second course of antiviral therapy with recombinant interferon-α-2b drugs (rectal suppositories and gel) led not only to the relief of clinical symptoms of COVID-19, but also to the sanitization of the body from the virus; already on the 5th–7th day the virus was found in smears from the nasopharynx was not determined.
-That is, the use of interferon drugs reduces the period of virus shedding?
-Yes, when using the drug VIFERON®, sanitization of the body occurred faster: in nasopharyngeal swabs in more than half of the children, the virus was not detected already on the 5th–7th day (using the PCR method), unlike the children in the control group. Moreover, its use made it possible to reduce the period of virus isolation from feces, although, according to the literature, virus isolation from feces occurs over a longer period of time compared to its isolation from the mucous membranes of the nasopharynx.
We analyzed the results of a stool PCR study for SARS-CoV-2 in children with a new coronavirus infection, dividing them into three groups. The first group of patients received Umifenovir as antiviral therapy, the second group received VIFERON® in standard low dosages, and the third group received VIFERON® in high dosages (these were children who participated in our study). During therapy, patients in three groups underwent stool testing for SARS-CoV-2 using PCR at the beginning of therapy and at the end of it, on days 11–13. The results showed that with the use of the drug VIFERON®, the release of the virus in feces ceases significantly faster compared to children receiving Umifenovir. Moreover, a relationship was identified between the dose of interferon and the period of virus shedding: in the group of children receiving high dosages of the drug VIFERON®, this period was shorter than in children receiving standard dosages.
Thus, we are talking not only about the clinical effectiveness of recombinant interferon-α-2b with antioxidants in the form of rectal suppositories and gel for external use in the treatment of a new coronavirus infection, but also to a significant extent in reducing the time of viral replication and ongoing viral shedding. This is very important, since the release of the virus into the environment is the cause of the spread of infection. A patient who no longer has clinical symptoms of the disease may consider himself healthy, but in fact may continue to release the virus into the environment, remaining a potential source of infection.
-Can interferons be used to treat adult patients?
-Yes, we studied this issue as well. Many children are hospitalized with mothers who, as a rule, are also sick with coronavirus infection. Most often, they were prescribed Umifenovir as antiviral therapy, but in some cases, despite the therapy, women continued to isolate the virus in nasopharyngeal swabs. In such situations, VIFERON® was recommended, which demonstrated positive results.
Research data and clinical experience confirm that recombinant interferons, in particular VIFERON®, in systemic (suppositories) and local (gel or ointment) forms are advisable to use for the treatment of acute respiratory infections, including coronavirus infection in both children and adults .
Original publication: https://viferon.su/vestnikferona_sp_2020_2/
Author: Marina Izvarina
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Dr. Komarovsky: Children suffer from acute respiratory infections more often than adults - this is the norm, this is the law of life
In the specialized medical literature, the abbreviation BBD is often found. The standard decoding is children who are often ill. Sometimes the expression “frequently and for a long time ill children” is used.
Maturation of the immune system
In clinics, children who are often ill are kept under special dispensary care. But let's look at the situation objectively: is it worth worrying or are these statistics arbitrary? Adults lead a less healthy lifestyle than their children, but suffer from acute respiratory infections much less often. Although our mothers told each of us that in childhood we got sick 10 times a year, and then less and less. This is a law of life: children get sick with acute respiratory infections more often than adults - this is the norm.
A child is born with an immature immune system; it takes time to develop. Babies are surrounded by many people, each of whom is a carrier of a huge number of viruses and bacteria. The child will have to develop immunity to these microorganisms. But nature has done everything to ensure that frequent childhood illnesses are not dangerous. Children's bodies easily cope with acute respiratory infections. And every encounter with the virus is training, formation, and improvement of immunity. How will this all end? A frequently ill child will become an adult and healthy parent.
Tolerate or treat?
No matter how much I urge parents to treat childhood illnesses calmly, not everyone succeeds. Sometimes a mother literally cannot count how many times a year the child has had acute respiratory infections - they simply never end. But parents should know that congenital disorders of the immune system, so-called primary immunodeficiencies, are very rare. They manifest themselves not just as frequent ARVIs, but as severe ARVIs with dangerous bacterial complications that are difficult to treat. Congenital immunodeficiency is a fatal condition and has nothing to do with a two-month runny nose. On the other hand, frequent acute respiratory infections may be a consequence of secondary immunodeficiency - that is, the child was born healthy, but some external factors interfere with the normal development of his immunity.
The main conclusion: if a child who is normal from birth does not recover from illness, it means that he has a conflict with the environment. There are two options for help: try to reconcile the child with the environment with the help of medications, or try to change the environment so that the child is satisfied with it.
Environment
The formation and functioning of a child’s immune system is determined by his lifestyle. If a child often suffers from acute respiratory infections, no pills will solve this problem. Eliminate conflict with the environment, change your lifestyle.
Housing. Organize a child's room where there is no accumulation of dust, everything is subject to wet cleaning and regular ventilation. Night temperature – 18°C, humidity – 50–70%. Soft toys are accumulators of dust, allergens and microorganisms.
Nutrition. Never force a child to eat. It is ideal to feed when he begs for food. Stop snacking, don’t overuse foreign foods, and don’t diversify your diet too much. For sweets - dried fruits, not chocolates.
Drink. Optional: mineral water, compotes, fruit drinks, fruit tea. The temperature of the drinks is room temperature.
Cloth. A sufficient minimum, since sweating causes illness more often than hypothermia. The child should not be wearing more items of clothing than the parents.
Walks. Daily, active, preferably before bedtime.
Sport. Outdoor activities are ideal, rather than in confined spaces. Swimming in a pool is not appropriate for CBI.
In summer. The child should take a break from contact with people, from city air, chlorinated water and household chemicals. Holidays “at the seas” have nothing to do with improving your health, since most of the harmful factors remain, plus public catering and worse living conditions. An ideal vacation for a private person: a village, an inflatable pool with well water, a pile of sand nearby, in shorts and barefoot. A dirty naked child who jumps from water to sand, begs for food and breathes fresh air, restores immunity in 3-4 weeks.
Prevention of acute respiratory infections. Frequent illnesses are caused not by cold, but by viruses. We must avoid unnecessary contact with people, wash our hands, maintain local immunity, and vaccinate all family members against the flu.
Treatment of ARVI
Treating ARVI does not mean giving medications, but means creating conditions so that the child’s body can cope with the virus as quickly as possible and with minimal losses. It is necessary to ensure optimal temperature and humidity, dress warmly, do not overfeed, and actively water. Saline drops in the nose and antipyretic medicine if necessary are enough. Any active treatment prevents the formation of immunity. The drug should be used only when it is clearly impossible to do without it. This is especially true for antibacterial therapy.
Actions after recovery
It is important to remember: improvement in condition and normalization of temperature does not indicate that immunity has been restored. The next day after the child’s condition improves, he goes to a group where he encounters a new virus, and a new disease will begin in a weakened body. It will be more severe than the previous one and will require the use of medications.
When it gets better, you need to live a normal life for another week - walks, “working up” your appetite, healthy sleep, restoration of the mucous membranes. Antibodies to the virus are produced no earlier than the fifth day of illness. Therefore, you can resume visiting children’s groups no earlier than the sixth day after the onset of ARVI, regardless of its severity.
There are no non-kindergarten children
When the phrase “I wasn’t sick until I was three” is said, it means we have an absolutely normal child. We went to kindergarten, the environment changed - illnesses began. We must acknowledge the fact that it is impossible to start actively communicating with children and not get sick. Constant illness means either you are in a hurry to return to your children after illness, or something is fundamentally wrong in the kindergarten itself.
Even very frequent acute respiratory infections with proper treatment do not affect the child’s health.
But if every sneeze is a reason to prescribe a dozen syrups, tablets and antibiotics, a reason for a thorough examination and consultation of a dozen specialists, such acute respiratory infections are a clear and obvious evil. If a child suffers from acute respiratory infections often, even very often, but recovers not with the help of medications, but naturally, then let him be sick, let him go to kindergarten. Published: September 26, 2021
