Adults older than 40 with Down syndrome are about three times more likely to die of COVID-19 than the remainder of the inhabitants, pointing to the necessity to prioritize coronavirus vaccination to this group, a study revealed yesterday within the Lancet’s EClinicalMedicine has discovered.
A group led by Emory University researchers carried out the worldwide on-line survey of the clinicians or caregivers of 1,046 sufferers with Down syndrome identified as having COVID-19 from April to November 2020.
The outcomes had been in contrast with these of a UK survey of 59,025 hospitalized COVID-19 sufferers, 109 of them with Down syndrome, from February to July 2020. One-hundred of the 109 Down syndrome sufferers had full age, intercourse, and ethnicity knowledge and had been included within the survey.
The researchers discovered a steep improve in loss of life fee amongst hospitalized Down syndrome sufferers beginning at age 40 (relative danger [RR], 3.5 vs 2.9 within the UK survey), whereas the loss of life fee elevated amongst sufferers with out the genetic situation at age 60. After adjustment for recognized COVID-19 danger components for loss of life, the RR for loss of life amongst Down syndrome sufferers was 2.5.
Thirteen p.c of the 1,046 COVID-19 sufferers with Down syndrome died at, on common, 51 years. Death charges for hospitalized Down syndrome sufferers youthful than 40 had been low however nonetheless elevated in contrast with these of the overall inhabitants (7% vs 3%).
More COVID issues
Clinicians, who had been requested about medical issues, reported that 60% of Down syndrome sufferers developed COVID-19 issues, notably issues with the lungs, which had been linked to increased loss of life charges.
The most typical issues included viral pneumonia (36%), acute respiratory misery syndrome (ARDS, 34%), secondary bacterial pneumonia (17%), and septic shock (11%). Down syndrome sufferers with coronavirus-related pneumonia had been more likely to die of viral pneumonia than controls (57% vs 23%).
Mean age of Down syndrome sufferers within the worldwide survey was 29 years (customary deviation, 18). Most had been from Europe, the United States, Latin America, and India.
Down syndrome sufferers’ most typical COVID-19 indicators and signs included fever, cough, and shortness of breath, comparable to these of different coronavirus sufferers. While joint and muscle ache and nausea or vomiting had been much less widespread in Down syndrome sufferers, altered consciousness and confusion had been more widespread, particularly in these 40 years and older.
About half of the Down syndrome sufferers (56%) had been hospitalized, with 50% of them admitted to an intensive care unit and 29% requiring mechanical air flow. In addition to the danger components for hospital admission and loss of life additionally discovered within the basic inhabitants, congenital coronary heart defects made Down syndrome COVID-19 sufferers more susceptible to requiring hospitalization.
Prioritization for vaccination
The impaired immunity and pro-inflammatory profile linked to Down syndrome might predispose these sufferers to more extreme viral diseases, the study authors famous. Other danger components, akin to weight problems, circumstances associated to untimely getting older (eg, Alzheimer’s illness), diabetes, craniofacial abnormalities, and different comorbid circumstances might contribute to an elevated danger of respiratory tract infections.
In addition, Americans and Europeans over 40 with Down syndrome usually reside in group houses, different assisted-living services, or nursing houses, placing them at elevated danger for infections from different residents and employees, the researchers mentioned, noting that this was not a big issue for increased coronavirus loss of life charges of their study.
Lead creator Anke Huels, PhD, of Emory University, mentioned in a Case Western Reserve University press release that the study exhibits that sufferers with Down syndrome usually have more extreme signs at hospitalization and are susceptible to lung issues linked to elevated danger of loss of life from COVID-19. “These results have implications for preventive and clinical management of COVID-19 patients with Down syndrome and emphasize the need to prioritize individuals with Down syndrome for vaccination,” she mentioned.
Coauthor Alberto Costa, MD, PhD, of Case Western, famous within the launch that the US Centers for Disease Control and Prevention has, primarily based partly on the study findings, categorized Down syndrome as a (*3*) that must be prioritized for COVID-19 vaccination. “Similar decisions have been made in the United Kingdom and Spain, and we hope that other countries will soon follow,” he mentioned.
A UK study revealed Oct 21, 2020, within the Annals of Internal Medicine discovered that adults with Down syndrome had been at almost 5 times the danger of COVID-19 an infection and 10 times the danger for associated loss of life. Huels and colleagues mentioned that that study might need undercounted circumstances in Down syndrome sufferers as a result of some might need had solely gentle circumstances and lacked entry to their main care physicians throughout the first pandemic peak.