Response to the Letter to the Editor on “Clinical characteristics of unvaccinated or incompletely vaccinated children with neurological manifestations due to SARS‐CoV‐2 Omicron infection”

Abstract

<p>To the Editor,</p><p>We thank Abbasi for his interests in our recent study on Omicron-associated neurological manifestations in children.^{<a href="https://onlinelibrary.wiley.com/doi/10.1002/jmv.29095#jmv29095-bib-0001">1</a>, <a href="https://onlinelibrary.wiley.com/doi/10.1002/jmv.29095#jmv29095-bib-0002">2</a>} Regarding the recruitment of study subjects, they were recruited consecutively from the three hospitals. Patients in the ambulatory settings were not excluded as children with severe neurological symptoms including seizures associated with coronavirus disease 2019 (COVID-19) were referred for further investigations and management in the public hospitals in our region during the study period. As a standard of care in our hospitals, neurotrophic viruses including herpes simplex viruses 1 and 2, varicella zoster virus, and enteroviruses were excluded by nucleic acid amplification tests of the cerebrospinal fluid if samples were available from patients presenting with suspected central nervous system infection. Moreover, as stated in the study, common respiratory viruses including influenza viruses were excluded by multiplex polymerase chain reaction of the patients’ respiratory tract specimens. In terms of the patients’ demographic details, all 15 children were ethnic Chinese with unremarkable birth history. Two of them were late preterm children with good past health before their current episode of neuro-COVID. We agree that children with positive family history of seizures may have an increased risk of seizure/epilepsy upon COVID-19 or other non-COVID-19 conditions,^{<a href="https://onlinelibrary.wiley.com/doi/10.1002/jmv.29095#jmv29095-bib-0003">3</a>, <a href="https://onlinelibrary.wiley.com/doi/10.1002/jmv.29095#jmv29095-bib-0004">4</a>} and that headache and meningism are common symptoms of neuro-COVID. Our study focuses on the major neurological manifestations such as seizures/encephalitis in children with neuro-COVID and therefore not all of the symptoms were listed out. Based on the correlation between patients’ socioeconomic status and their inflammatory/neuronal markers, there were no significant relationships between socioeconomic status and the levels of markers, suggesting that socioeconomic status is not a covariate which would affect the outcomes among patients with neurological manifestations due to severe acute respiratory syndrome coronavirus 2 Omicron infection in our cohort. Finally, as already mentioned in our discussion, there were limitations in our study and we advocate for further investigations in additional studies with larger sample size and longitudinal data on the important subject of neuro-COVID in children.</p>