- In an open letter taken up by Le Monde , the pediatricians say they are "worried about the organization of the start of the school year as it looms, both in terms of prevention and that of the care of children".
- These experts, for the most part from the French Pediatric Society, estimate "the persistence of the circulation of the virus in France [...] requires the adoption of appropriate but reasonable and effective measures".
- Their first concerns relate to PCR tests and vaccinations.
PCR tests, return of seasonal viruses this winter, or even measures to be taken in the event of screening of a positive child in a school ... With a fortnight before the start of the school year, pediatricians are not reassured by the evolution of the coronavirus epidemic. In an open letter from seven learned societies taken up by Le Monde , they say they are "worried about the organization of the start of the school year as it looms, both in terms of prevention and that of the care of children" .
Admittedly, children "are less often contaminated by SARS-CoV-2, less often sick and less contaminating than adults", point out the professionals of these learned societies, most of them from the French Pediatric Society. But they believe that “the persistence of the circulation of the virus in France accompanied, in recent weeks, by a significant increase in the number of cases in certain regions, makes the situation delicate and requires the adoption of appropriate but reasonable and effective measures. "
Favor the saliva test rather than PCR tests
Their first concern relates to PCR testing. “The practice of almost systematic nasopharyngeal swabs from children with fever, respiratory or digestive signs is not as trivial as it may seem,” they explain. These tests, in addition to their unpleasant and necessarily repetitive aspect in children (viral episodes during the cold season being much more frequent in children than in adults), have a modest return, a certain cost and exposes us to refusals. children and / or parents ”.
Thus, “if the PCR positivity rate in children remains low, the pursuit of this systematic PCR strategy in children would probably prove to be very unprofitable while representing a significant human and financial cost for the community. "This is why" the availability of rapid diagnostic tests for SARS-CoV-2 (especially saliva), even less sensitive but allowing rapid decisions to be taken for the majority of patients, seems particularly important to us in pediatrics ".
Strengthening influenza vaccination
The second concern concerns vaccinations. “If SARS-CoV-2 continues to circulate this winter, it will necessarily be added to the usual seasonal viruses (RSV, influenza, rotavirus, etc.). Difficulties are to be expected for young children who are particularly affected by these viruses every winter, especially those living in communities. This is why they strongly support "a reinforcement of vaccination against influenza" as well as a "generalization of vaccination against rotavirus of small infants. "
Vaccination against rotavirus during a COVID-19 pandemic would indeed offer "two advantages": "drastically reduce episodes of gastroenteritis in small infants, and reduce the frequency in children of opportunities to suspect a Covid-19. "It turns out that" 15 to 30% of children hospitalized or seen in consultation for Covid-19 have digestive signs, including diarrhea, which makes the differential diagnosis very difficult with rotavirus gastroenteritis. "
Vaccinating against these diseases "would therefore represent a means of reducing consultations, emergency visits and hospitalizations at a time when the circulation of SARS-CoV-2 is likely to be intense again" summarize the pediatricians.
Risk of a “chaotic” re-entry
Finally, the third concern of these professionals is the risk of a “chaotic” return to school. "" It will be very difficult to avoid episodes of contamination by Sars-CoV-2 within communities (nurseries, schools, etc.). It is therefore necessary to clearly define the measures to be taken in the event of screening of a child or an adult carrying Sars-CoV-2 in a community. "
“To date, the feedback that we have, is to say the least anarchic: schools or nurseries have sometimes been closed due to the presence of a single person presenting a positive PCR (…) If clear and precise strategies do not are not defined, it seems to us that the start of the school year risks being chaotic with closures of classes or even schools not justified by health or epidemiological reasons, and in all cases highly deleterious for children and their learning. "
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