ABSTRACT
Introduction: The impact of the COVID19 pandemic on pediatric neurodevelopmental disorders like mitochondrial disease (MtD) has not been well characterized. Viral infection is a major cause of morbidity in children with MtD. Historically, pediatric patients with MtD experience neurologic decline and metabolic decompensation if exposed to viral infection and families practice strict risk mitigation behavior to avoid infection. As many caregivers of children with MtD are essential workers, the household serves as a transmission risk factor. To better understand SARS-CoV-2 infection in children with MtD, we conducted a serologic study of MtD households. Methods: Families with a child with MtD were shipped a Neoteryx Blood Collection kit. Patient samples came from fifteen states across the United States as well as two European countries. All household individuals provided a dried blood sample which was shipped back for analysis of SARS-CoV-2 antibodies against both the nucleocapsid and the spike protein. Online questionnaires were also distributed to each family to assess exposure risks, MtD severity, and viral symptomatology. These data will allow us to define the status of proximate contacts of children with MtD, as well as symptomatology and asymptomatic infection. Results: Twenty families enrolled with N = 83 samples collected. All 20 families had at least one member with a positive nucleocapsid antibody test. Of the 21 patients with mitochondrial disease, 18 were positive for antibodies against the nucleocapsid antibody. However, of the 14 MtD patients who reported community testing prior to sampling, only one patient with MtD had known a positive test in the community. Of those with positive nucleocapsid antibodies, 29% had a known exposure to someone with COVID-19 infection. Symptomatology analysis concluded that between March of 2020 and the sampling date, 6 patients experienced fever or chills, 2 experienced a new or worsening cough, 1 experienced shortness of breath, 2 experienced pneumonia and 1 presented with muscle or body aches. Conclusion: There is serologic evidence that the majority of families affected by mitochondrial disease have been exposed to COVID19 despite strict risk mitigation behaviors. Of the patients exposed to COVID19, almost all had another family member also exposed, indicating the household as a possible transmission factor. None of these patients experienced hospitalization, neurologic decline, or metabolic decompensation. This implies that patients with mitochondrial disease may be capable of having asymptomatic COVID19 infections and may be able to tolerate this disease without acute decompensation. This may have implications about mitochondrial function in the immune response to COVID19. Future directions for this study include a network scale up model which will aid in making broader generalizations about this disease community through exposure levels.
ABSTRACT
Aims Suicide accounts for 2.2% of all years of life lost worldwide. We aimed to establish whether infectious epidemics are associated with any changes in the incidence of suicide or the period prevalence of self-harm, or thoughts of suicide or self-harm, with a secondary objective of establishing the frequency of these outcomes. Methods In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO and AMED were searched from inception to 9 September 2020. Studies of infectious epidemics reporting outcomes of (a) death by suicide, (b) self-harm or (c) thoughts of suicide or self-harm were identified. A random-effects model meta-analysis for the period prevalence of thoughts of suicide or self-harm was conducted. Results In total, 1354 studies were screened with 57 meeting eligibility criteria, of which 7 described death by suicide, 9 by self-harm, and 45 thoughts of suicide or self-harm. The observation period ranged from 1910 to 2020 and included epidemics of Spanish Flu, severe acute respiratory syndrome, human monkeypox, Ebola virus disease and coronavirus disease 2019 (COVID-19). Regarding death by suicide, data with a clear longitudinal comparison group were available for only two epidemics: SARS in Hong Kong, finding an increase in suicides among the elderly, and COVID-19 in Japan, finding no change in suicides among children and adolescents. In terms of self-harm, five studies examined emergency department attendances in epidemic and non-epidemic periods, of which four found no difference and one showed a reduction during the epidemic. In studies of thoughts of suicide or self-harm, one large survey showed a substantial increase in period prevalence compared to non-epidemic periods, but smaller studies showed no difference. As a secondary objective, a meta-analysis of thoughts of suicide and self-harm found that the pooled prevalence was 8.0% overall (95% confidence interval (CI) 5.2-12.0%;14 820 of 99 238 cases in 24 studies) over a time period of between seven days and six months. The quality assessment found 42 studies were of low quality, nine of moderate quality and six of high quality. Conclusions There is little robust evidence on the association of infectious epidemics with suicide, self-harm and thoughts of suicide or self-harm. There was an increase in suicides among the elderly in Hong Kong during SARS and no change in suicides among young people in Japan during COVID-19, but it is unclear how far these findings may be generalised. The development of up-to-date self-harm and suicide statistics to monitor the effect of the current pandemic is an urgent priority. © The Author(s), 2021. Published by Cambridge University Press.