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Why Does the Severity of COVID-19 Differ With Age?: Understanding the Mechanisms Underlying the Age Gradient in Outcome Following SARS-CoV-2 Infection.
Zimmermann, Petra; Curtis, Nigel.
  • Zimmermann P; From the Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.
  • Curtis N; Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland.
Pediatr Infect Dis J ; 41(2): e36-e45, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1722659
ABSTRACT
Although there are many hypotheses for the age-related difference in the severity of COVID-19, differences in innate, adaptive and heterologous immunity, together with differences in endothelial and clotting function, are the most likely mechanisms underlying the marked age gradient. Children have a faster and stronger innate immune response to SARS-CoV-2, especially in the nasal mucosa, which rapidly controls the virus. In contrast, adults can have an overactive, dysregulated and less effective innate response that leads to uncontrolled pro-inflammatory cytokine production and tissue injury. More recent exposure to other viruses and routine vaccines in children might be associated with protective cross-reactive antibodies and T cells against SARS-CoV-2. There is less evidence to support other mechanisms that have been proposed to explain the age-related difference in outcome following SARS-CoV-2 infection, including pre-existing immunity from exposure to common circulating coronaviruses, differences in the distribution and expression of the entry receptors ACE2 and TMPRSS2, and difference in viral load.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Age Factors / Adaptive Immunity / Immunity, Heterologous / SARS-CoV-2 / COVID-19 / Immunity, Innate Type of study: Prognostic study / Randomized controlled trials Topics: Vaccines Limits: Adult / Child / Humans Language: English Journal: Pediatr Infect Dis J Journal subject: Communicable Diseases / Pediatrics Year: 2022 Document Type: Article Affiliation country: INF.0000000000003413

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Age Factors / Adaptive Immunity / Immunity, Heterologous / SARS-CoV-2 / COVID-19 / Immunity, Innate Type of study: Prognostic study / Randomized controlled trials Topics: Vaccines Limits: Adult / Child / Humans Language: English Journal: Pediatr Infect Dis J Journal subject: Communicable Diseases / Pediatrics Year: 2022 Document Type: Article Affiliation country: INF.0000000000003413