Questions and answers
Covid 19 and Down Syndrome
The information presented is provided by the Dr. David Combariza, Epidemiologist Physician
Chairman of the Board of Directors of the Down Syndrome Corporation
Date: February 09, 2021
Studies carried out to date by entities such as the Trisomy 21 Research Society have made it possible to identify that, in a general way, the increased risk of presenting complications or an adverse outcome of COVID-19 in people with Down Syndrome (DS) is related to with age and with the presence of other health conditions such as chronic heart, lung or kidney diseases, obesity, sleep apnea or immunosuppression.
The results of the studies conclude that adults with Down syndrome over 40 years of age have a greater risk of developing a more severe disease that leads to death, which is why they should be considered as people with high vulnerability to COVID 19. Regarding In adults between 18 and 40 years of age, their risk of requiring hospitalization and developing serious illness will be related to the presence of underlying comorbidity conditions, such as those already mentioned.
Regarding children and young people with Down syndrome, the information available to date has shown that the vast majority of them do not become seriously ill and that in general, the infection behaves very similarly to children without DS, therefore who are not considered high risk and should be able to attend their educational or therapeutic activities, following the recommendations of distancing, hand washing and use of face masks; however, the risk may vary if the child or young person has an underlying disease that represents comorbidity.
Taking into account that research carried out by the American Academy of Pediatrics has identified that people with Down syndrome tend to have a greater tendency to develop complications or require hospitalization when they develop viral respiratory infections or present a chronic respiratory disease, it is considered that present respiratory disorders chronic is a factor that increases the risk. Likewise, immune alterations or treatments that lead to the reduction of defenses (immunosuppression), are part of the comorbidities that increase the risk of a possible adverse outcome in case of contracting an infection by SARS CoV-2 (COVID 19) in children and young
According to the aforementioned, adults over 40 years of age, as well as young people and adults with some of the highest-risk comorbidities, may be safer if they remain isolated and only go out for strictly necessary activities such as medical check-ups. Likewise, children, youth or adults who present behavioral characteristics that make it difficult to adequately comply with the measures established in the biosafety protocols (eg, intolerance to masks), can be safer at home, while infection control is achieved. with measures such as general vaccination.
Of course, especially in those over 40 years old. The clinical trials carried out on the different vaccines have met the safety and efficacy requirements of the regulatory agencies, and there is no evidence to suggest that the vaccine represents any additional risk, therefore, according to the vaccination plan established by the Government National, it is expected to be able to vaccinate all people over 18 years of age. Likewise, it is very important that the family group is vaccinated, once the vaccine is available, in order to reduce the risk of infection.
Because the development of the vaccines has been carried out in a record period of time, the studies have not included children, for which the developing pharmaceutical companies have not authorized their use in children. Pfizer recommends its vaccine for those over 16 years of age and Moderna for those over 18 years of age. This leads to temporarily not having enough information on the safety and effectiveness of the vaccine, for its application in minors. Once more information is available, it will be defined how the vaccination process will be carried out in children under 18 years of age.
In general, the vaccine is not recommended for people with a history of severe allergic reactions. For people with diseases that reduce immunity, it has been considered that the risk is less than the benefit of applying the vaccine, so it should be applied; however, as this information has been obtained from the general population without Down syndrome, there are still concerns regarding the eventual risk of autoimmunity that the vaccine may trigger.
To return to face-to-face activities, the already known measures for the prevention of contagion must be taken into account, among which are temperature control, physical distancing, the use of face masks, hand washing, the respiratory label, periodic cleaning and disinfection of surfaces, among others. The identification and self-report of symptoms is important to know if any of the children or relatives may be having the infection to avoid and thus consult the health service in a timely manner and avoid the spread of the virus.
In general, from two years of age, the mask should be worn permanently in settings where there is a risk of exposure to the virus. For children under two years of age, its use is not recommended because their airways are smaller and it is difficult for them to breathe through a mask, in addition, as it is an uncomfortable object, they will try to remove it and touch their face many times, which it could increase the risk of contagion. It is difficult for babies to remove the mask themselves if they have difficulty breathing, which increases the risk of suffocation.
More information regarding COVID 19 and Down syndrome can be found at the following web addresses:
Global Foundation for Down Syndrome https://www.globaldownsyndrome.org/covid-19/
Down Syndrome Medical Interest Group - United Kingdom https://www.dsmig.org.uk/covid-19-and-down-syndrome/
Down Syndrome Medical Interest Group - United States https://www.dsmig-usa.org/covid19
Down Spain https://www.sindromedown.net/noticia/nuevos-datos-sobre-covid-19-y-sindrome-de-down/
The Down Syndrome Corporation, according to the information available and the recommendations of the institutions that conduct research on health aspects of people with Down syndrome, considers that all adults over 18 years of age with Down syndrome should be vaccinated once once the vaccine is available (a request for prioritization by vulnerability is in progress).
It is hoped that when the results of the vaccine studies are published in a population under 18 years of age, this population group will be vaccinated. While access to the vaccine is achieved, adults with Down syndrome over 40 years of age, and those under 40 with risk factors or comorbidities, should be kept isolated because they are more susceptible to complications from COVID-infection. 19. For their part, children, youth and adults under 40 years of age, who do not have risk comorbidities, could return to face-to-face activities, keeping in compliance with the established biosecurity measures.
References: Beckhaus, A. Castro-Rodríguez J. Down Syndrome and the Risk of Severe RSV Infection: A Meta-analysis Pediatrics September 2018, 142 (3) e20180225; DOI: https://doi.org/10.1542/peds.2018-0225
Malle, L., Gao, C., Hur, C. et al. Individuals with Down syndrome hospitalized with COVID-19 have more severe disease. Genet Med (2020). https://doi.org/10.1038/s41436-020-01004-w
Clift Ash K, Coupland Carol AC, Keogh Ruth H, Diaz-Ordaz Karla, Williamson Elizabeth, Harrison Ewen M et al. Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults: national derivation and validation cohort study BMJ 2020; 371: m3731
Anke Hulls, et al An international survey on the impact of COVID-19 in individuals with Down syndrome Medrxiv. Nov 5 2020 doi: https://doi.org/10.1101/2020.11.03.20225359