April 14, 2021 | Volume 12 | Issue 15
mRNA vaccination following SARS-COV-2 infection
From an elegant study of sera obtained from recovered and naïve SARS-CoV-2 infected donors collected prior to, and following immunization with existing mRNA vaccines, it appears that a single immunization booster produces sufficient neutralizing antibodies to the receptor binding domain of the Corona virus of all SARS-CoV-2 variants (to date) by up to 1,000-fold (a second post-infectious immunization DOES NOT appear to further enhance antibody production).

Underwriter
Association of age with SARS-CoV-2 antibody response
The number of COVID-19 cases in children appears low (approximately 7% in the USA as of august 2020) with only 4.1% of school age pediatric patients (5-17 years of age) having confirmed COVID-19. Most children are either asymptomatic or exhibit mild symptoms. The question is why this occurs.

A cross-sectional study investigated the association of age with quantity and quality of SARS-CoV-2 antibody responses (31,426 SARS-CoV-2 antibody tests) from pediatric and adult patients (ages 1-102 years) specifically comparing responses between children ages 1-10 years, adolescents 11-18 years and young adults 19-24 years.

Children have higher IgE levels (total and binding avidity/quantitative and qualitative) than adolescents/young adults (the younger the child the greater the difference) and adolescents have higher levels than young adults. This information may account for the different clinical manifestations see in different age groups.


See related video HERE and below:
Antibodies and COVID-19: Explained
Acute knee injury in children and adolescents
“Knee injuries in children and adolescents are exceedingly common.” Up to 60 million children ages 6 to 18 years participate in organized sport each year, (in the US) with 60% of sports-related surgeries occurring in high school athletes involving the knee.

An excellent review of knee injuries in children and adolescents addresses etiology, history, physical examination, imaging and management of knee injuries emphasizing those topics that involve injuries in skeletally immature patients (plus covering patellar dislocations, ligamentous injuries, meniscal tears and a variety of bone fractures). (Well worth reading and keeping as a reference Ed.)


See related video HERE.
Meat consumption and age at menarche
An interesting study examined the association between meat consumption and age at menarche among 986 school girls aged 6-18 years in Shanghai, China (covariants included household income, physical activity and others), assessed by a standardized questionnaire.

Higher consumption of poultry (but not pork, beef, lamb or processed meat) appears to be associated with a significant increased risk of early (<12 years of age) menarche.


See related video HERE and below:
Hormone Health Network

Hormones play a big role in an adolescent's development and overall health. Hormone disorders can lead to early puberty, delayed puberty and other health issues.
Early-term caesarean section (c-section) and the risk of offspring behavioral problems at 6-8 years of age
A study which examined adverse behavioral issues of children at 6-8 years of age following elective c-section birth either at early term (38+3 weeks gestation) vs. full-term (39+3 weeks gestation), (adjusted for maternal education, parity and child sex), indicates that childhood behavior at 6-8 years is unaffected by the difference in timing, with outcomes being similar in both groups.
Rupture of the Corpus Cavernosum in a pediatric patient
“Pediatric penile pain is an uncommon complaint and is associated with a wide differential diagnosis including traumatic, infectious, inflammatory, and idiopathic conditions.” Penile pain associated with a penile fracture (a torn tunica albuginea/rupture of the corpus cavernosum) is rare and occurs almost always in mature males associated with forceful penile manipulation during sexual activity. In young males, damage to the penis is usually caused by blunt trauma (though trauma with penile manipulation/sexual activity has been described).

A case presentation of a 7-year-old boy who presented to an Emergency Department with a complaint of penile pain after falling and colliding with a staircase railing, demonstrates the ecchymosis and swelling of the shaft (with ultrasound confirming discontinuity along the corpus cavernosum) consistent with rupture. Treatment is emergency surgical repair to prevent residual penile angulation, persistent hematoma, abscess, erectile dysfunction and fibrosis.
Association of SARS-CoV-2 seropositive antibody test with risk of future infection
Most patients who clear their SARS-CoV-2 infection develop serum antibodies against the virus that last for several months. The presence of serum antibodies may be associated with a decreased risk of subsequent SARS-CoV2 infection but this is unknown at present. (Positive patients may shed virus for 12 weeks or more after symptom resolution).

A retrospective observational longitudinal study from 3.2 million US patients with a SARS-CoV-2 test (negative or positive serum antibodies) examined the relationship of the post-index case to symptomatology and subsequent NAAT result (a nucleic acid amplification test (NAAT) is a technique used to detect and identify very small amounts of genetic material (RNA or DNA) rather than antibodies of a particular virus (or bacterium) by an amplification process (e.g., polymerase chain reaction – PCR).

Seropositive patients appear to have a 10-fold lower chance of having a future SARS-CoV-2 infection (the duration of protection is unknown (perhaps 6 months – 2 years) and protection may wane over time. Ed.

A positive NAAT test for SARS-CoV-2 found early (first 30days) is likely due to prolonged shedding of viral RNA. After 90 days, most viral shedding ceases and a positive NAAT test result probably reflects new infection.

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Meet Dr Toba Niazi
Nicklaus Children's Hospital via YouTube
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Meet John M. Peters, MD, Pediatric Gastroenterologist
Nicklaus Children's Hospital via YouTube
COVID-19 - Current Situation in Florida
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Florida's COVID-19 Data and Surveillance Dashboard
Florida Department of Health, Division of Disease Control and Health Protection
Dear Reader:

Though there may be many among you who have undergone immunization against COVID-19, this pandemic may by no means be over. We should be cautious as new mutant strains have arisen which make certainty about the absolute protection afforded by vaccination unclear, their response to treatment uncertain and there is the possibility that the variant viruses may spread even from those who are immunized.

Please continue to take care, wear a mask whenever in public, wash hands well and often, use sanitizer if available, cough or sneeze into elbow and socially distance yourself (preferably at least 6 feet from any person), outdoors, or in a well ventilated area whenever and where ever possible.
 
Best of luck.

Jack Wolfsdorf, MD, Editor
Staff NCH
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