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Subject Area

Obstetrics and Gynecology

Article Type

Review

Abstract

Objective The aim was to review and summarize potential explanation for the difference between children and adults in susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which could help in suggestion of targets for future therapies. Materials and methods Systematic online search was applied using PubMed, Medscape, Science Direct, and WHO EMF databases with no date restrictions. English-language reports of the possible causes in the difference of immune response to SARS-CoV-2 infection in children from adults were included. Articles not reporting on the immune response to SARS-CoV-2 infection in children and adults were not included. Data were extracted on immunological mechanisms and other causes of health outcomes in Coronavirus Disease 2019 (COVID-19). Comparisons were made through a structured review, with the results tabulated. There were five studies about the role of angiotensin-converting enzyme 2 receptors, five studies about the role of the adaptive immune response, two studies about the role of telomere length, one study about the role of viral interference, two studies about the role of natural antibodies, and seven studies about other reasons for the difference between children and adults in susceptibility to SARS-CoV-2. Findings The most possible reasons for the difference between children and adults in susceptibility to COVID-19 include the expression and maturity of angiotensin-converting enzyme 2 receptors, the adaptive immune response to SARS-CoV-2 infection is qualitatively different in children from adults, shortened telomere length in adult leukocytes compared to children, viral interference with other viral infection in the respiratory tract, and more natural antibodies and lactoferrin with immunomodulatory characteristics in children. Conclusion Combination of some possibilities rather than one cause may explain the difference in pediatric and adult COVID-19 incidence, clinical presentation, and severity. More clinical trials on lactoferrin efficacy against SARS-CoV-2 infections should be done.

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