key: cord-1020581-3fnbmq9x
authors: Anderson, Lorato; Caniza, Miguela
title: COVID-19 and preventative medicine for HIV infected children
date: 2020-10-26
journal: Clin Infect Dis
DOI: 10.1093/cid/ciaa1626
sha: 379d17dee7be863bcdcfaacf299d0b4a8d7d7436
doc_id: 1020581
cord_uid: 3fnbmq9x

nan

M a n u s c r i p t Dear Editor, As pediatricians concentrating on global pediatric health, we read with great interest the article by Congdon M, Hong H, Young RR, et al. published in the July 2020 issue of Clinical Infectious Diseases. We were delighted to see the decrease in pediatric hospitalizations and deaths attributed to pneumonia following the implementation of Hib and PCV-13 vaccines in children in Botswana. We appreciate the authors' work but worry about the impact of COVID-19 on basic preventive medicine, especially among HIV-infected children, a population at high risk of preventable infections. Targeted and national vaccination strategies might be necessary to prevent untimely deaths among these children during this pandemic.

In this study, almost half of the pneumonia-related deaths that occurred during the post-vaccine period were in HIV-exposed children. We would advocate for vaccine initiatives targeting the population of HIV-infected and -exposed children in the clinics where they receive treatment for HIV. Outreach via telephone may be necessary to inform patients' parents/guardians, given their reluctance to seek HIV care during the pandemic. Initiating pediatric vaccination programs at HIV health care sites could prevent a further increase in pneumonia-related deaths of HIV-exposed children in Botswana.

Suspension of vaccination programs and fear of seeking preventative care services due to COVID-19 has already led to decreased vaccination rates and outbreaks of vaccine-preventable illnesses. In Sierra Leone, a referral health center showed a 52%-83% decrease in pediatric vaccination rates during the pandemic, compared to that during the previous year 1 . Cambodia experienced an outbreak of measles; 341 cases were diagnosed during the 4-month period after their first case of COVID-19, an almost 8-fold increase over the number of cases from the same period the previous year 2 . A benefit-risk analysis examining the benefits of vaccination vs. the risk of spreading COVID-19 at vaccination sites found that the benefits outweigh the risk 3 . HIV-infected children are more susceptible to vaccine-preventable illnesses, and an outbreak could lead to deaths in this population and affect herd immunity.

Many countries have continued routine vaccination programs during the pandemic by adopting safety precautions to prevent the spread of COVID-19. In response to a measles outbreak, Cambodia mobilized teams to go door-to-door and vaccinate high-risk communities, while also providing education on COVID-19 Ref. 2 . In Syria, more than 210,000 children participated in a 5-day vaccination campaign involving nationwide health care centers, mobile teams, and temporary vaccination outposts 4 . Burkina Faso complied with COVID-19 infection prevention and control measures while it led a 4-day polio immunization campaign that vaccinated 174,304 children 5 .

The COVID-19 pandemic threatens to disrupt the progress Botswana has made toward pediatric vaccine implementation. A national vaccination campaign could help mitigate setbacks due to COVID-19 and incorporate the HIV-infected pediatric population. Strategies such as administering vaccines where patients receive HIV care, telephone outreach, and national vaccination campaigns could be implemented to prevent outbreaks of vaccine-preventable diseases and regression of previously successful vaccination efforts in Botswana.

Neither author has any potential conflicts to disclose.

Child healthcare and immunizations in Sub-Saharan Africa during the COVID-19 pandemic

Available at: www.who.int/cambodia/news/feature-stories/detail/responding-to-a-measlesoutbreak-during-the-covid-19-pandemic

Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit-risk analysis of health benefits versus excess risk of SARS-CoV-2 infection

Available at: www.emro.who.int/syr/syria-news/unicef-and-who-support-national-immunizationcampaign-in-syria-amid-covid-19-pandemic.html?format=html

Available at: www.afro.who.int/news/burkina-faso-resumes-polio-vaccination-campaigns-understrict-covid-19-prevention-measures

A c c e p t e d M a n u s c r i p t