Frequency of Lymphopenia in Infants with COVID-19: Vaccination Dilemma

Abstract

Objective Although coronavirus disease 2019 (COVID-19) is mainly a respiratory system disease, many hematological abnormalities have been reported. Due to the application of primary immunization in infancy, our study aimed to examine the relationship between lymphopenia frequency and duration of lymphopenia in infants with COVID-19.

Methods The files of infants hospitalized with the diagnosis of COVID-19 in the Pediatric Pandemic Service of Istanbul Medical Faculty between January 2020 and October 2022 were evaluated retrospectively. Demographic characteristics, leukocyte, lymphocyte count, comorbidity, hospitalization, and lymphopenia recovery time were recorded.

Results In this study, 93 infants with COVID-19 were included. Lymphopenia was detected in 62 of these patients (n = 62/93, 66.7%). The 47.3% of the patients were female (n = 44) and the mean age was 6 ± 3.42 months. Comorbidities were detected in the 33% of the patients. Lymphopenia resolved in an average of 11 days. While the mean hospitalization period of patients with lymphopenia was 3.6 ± 2.9 (minimum: 1 and maximum: 15) days, the mean hospitalization period of patients without lymphopenia was 2.5 days. Leukopenia (p: 0.014) and lymphopenia (p: 0.005) were more common in infants with chronic disease. Similarly, the duration of hospitalization and recovery from lymphopenia were statistically significantly longer (p: 0.016). A statistically significant correlation was found between the duration of lymphopenia recovery and the duration of hospitalization (p: 0.001).

Conclusion Although we found lymphopenia as a common finding in infancy in our study, it was not observed frequently enough to require the postponement of the vaccination program due to its short duration. Vaccination should not be delayed due to lymphopenia in infants with COVID-19 to avoid a missed opportunity for vaccination.

Keywords

COVID-19 - lymphopenia - infant

Authors' Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by N.M.A. The first draft of the manuscript was written by N and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Consent to Participate

Informed consent was obtained from all individual participants included in the study. Written informed consent was obtained from the parents.

Publication History

Received: 18 May 2023

Accepted: 11 September 2023

Article published online:
29 October 2023

• References

• 1 Kosmeri C, Koumpis E, Tsabouri S, Siomou E, Makis A. Hematological manifestations of SARS-CoV-2 in children. Pediatr Blood Cancer 2020; 67 (12) e28745
• 2 Cui X, Zhao Z, Zhang T. et al. A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID-19). J Med Virol 2021; 93 (02) 1057-1069
• 3 Dobrijević D, Andrijević L, Antić J, Rakić G, Pastor K. Hemogram-based decision tree models for discriminating COVID-19 from RSV in infants. J Clin Lab Anal 2023; 37 (06) e24862
• 4 Dobrijević D, Katanić J, Todorović M, Vučković B. Baseline laboratory parameters for preliminary diagnosis of COVID-19 among children: a cross-sectional study. Sao Paulo Med J 2022; 140 (05) 691-696
• 5 Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hall E., Wodi A.P., Hamborsky J.. et al., eds. 14th ed.. Washington, D.C.: Public Health Foundation; 2021
• 6 Kroger ABL, Long S, Sanchez P. General Best Practice Guidelines for Immunization 2023. Accessed August 1, 2023 at: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf
• 7 Lanzkowsky P. Lanzkowsky's Manual of Pediatric Hematology and Oncology. 6 ed.. Boston, MA: Elsevier; 2016: 788
• 8 Fathi N, Rezaei N. Lymphopenia in COVID-19: therapeutic opportunities. Cell Biol Int 2020; 44 (09) 1792-1797
• 9 Barathan M, Mohamed R, Yong YK. et al. Viral persistence and chronicity in hepatitis C virus infection: role of T-cell apoptosis, senescence and exhaustion. Cells 2018; 7 (10) 165
• 10 Zheng M, Gao Y, Wang G. et al. Functional exhaustion of antiviral lymphocytes in COVID-19 patients. Cell Mol Immunol 2020; 17 (05) 533-535
• 11 Huang C, Wang Y, Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506
• 12 Toba N, Gupta S, Ali AY. et al. COVID-19 under 19: a meta-analysis. Pediatr Pulmonol 2021; 56 (06) 1332-1341
• 13 Yasuhara J, Kuno T, Takagi H, Sumitomo N. Clinical characteristics of COVID-19 in children: a systematic review. Pediatr Pulmonol 2020; 55 (10) 2565-2575
• 14 Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis 2020; 20 (06) 689-696
• 15 Spoulou V, Noni M, Koukou D, Kossyvakis A, Michos A. Clinical characteristics of COVID-19 in neonates and young infants. Eur J Pediatr 2021; 180 (09) 3041-3045
• 16 Szilagyi PG, Rodewald LE. Missed opportunities for immunizations: a review of the evidence. J Public Health Manag Pract 1996; 2 (01) 18-25
• 17 Halsey NA, Boulos R, Mode F. et al. Response to measles vaccine in Haitian infants 6 to 12 months old. Influence of maternal antibodies, malnutrition, and concurrent illnesses. N Engl J Med 1985; 313 (09) 544-549
• 18 Ndikuyeze A, Munoz A, Stewart J. et al. Immunogenicity and safety of measles vaccine in ill African children. Int J Epidemiol 1988; 17 (02) 448-455
• 19 Lindegren ML, Atkinson WL, Farizo KM, Stehr-Green PA. Measles vaccination in pediatric emergency departments during a measles outbreak. JAMA 1993; 270 (18) 2185-2189
• 20 Lewis T, Osborn LM, Lewis K, Brockert J, Jacobsen J, Cherry JD. Influence of parental knowledge and opinions on 12-month diphtheria, tetanus, and pertussis vaccination rates. Am J Dis Child 1988; 142 (03) 283-286
• 21 Farizo KM, Stehr-Green PA, Markowitz LE, Patriarca PA. Vaccination levels and missed opportunities for measles vaccination: a record audit in a public pediatric clinic. Pediatrics 1992; 89 (4 Pt 1): 589-592