Coronavirus infection is transmitted through close contact between an infected and a healthy individual. The longer the infectious period, the higher the likelihood that an infected person will transmit the virus to others. Infected children can no longer be vaccinated, and the range of available antiviral drugs is more limited than for adults. Therefore, coronavirus persists in the nasopharynx of infected children longer than in adults, thereby facilitating its spread.
China was the epicentre of COVID-19. Even three years after the start of the pandemic, Chinese physicians continue to search for ways to contain the infection. Building on previous studies, researchers investigated whether treatment of children with nasal interferon alpha-2b (IFN-α2b) could help slow the pandemic.
Study Rationale
Previous studies had demonstrated the safety and efficacy of nasal interferon alpha-2b in children with mild to moderate COVID-19. The safety profile was based on the fact that the nasal formulation exerts a local antiviral effect at the site of infection and does not affect the body systemically.
It was also known that inhaled IFN-α2b therapy in adults reduces viral shedding without serious adverse effects. Researchers noted that early administration – within 5 days of symptom onset – of nasal IFN-α2b lowers levels of proinflammatory proteins and improves lung condition.
Another essential prerequisite for conducting the study was that the dominant strain in China at that time was Omicron, which predominantly replicates in the upper respiratory tract.
Study Design
The study included children aged 1 to 14 years with mild or moderate COVID-19. Disease severity was determined according to National Institutes of Health recommendations. Therefore, children with comorbidities, respiratory failure, septic shock, or multiple organ dysfunction were excluded. Participants were divided into two groups.
The experimental group received nasal interferon alpha-2b in addition to standard treatment. Each dose contained 8,300 IU of IFN-α2b. Interferon therapy was administered for three days and initiated no later than 5 days after the onset of COVID-19 symptoms.
The total daily dose depended on the child’s age:
- Children aged 1–2 years received 1 dose in each nostril, 3 times per day.
- Children aged 3–7 years received 1 dose in each nostril, 4 times daily.
- Children older than 7 years received 2 doses in each nostril 4 times per day.
The control group received only standard treatment, including ibuprofen if body temperature exceeded 37.5°C. In cases of severe vomiting or dehydration, patients received oral rehydration salts or intravenous fluids.
Nasal swabs were collected daily from all participants for PCR testing for coronavirus. The primary outcome was the time until PCR testing showed viral clearance.
Study Results
Additional treatment with interferon alpha-2b reduced the duration of detectable coronavirus on the nasal mucosa by nearly one day on average across all pediatric subgroups.
The most pronounced effect – a reduction of approximately 1.5 days – was observed in the following subgroups:
- children aged 1–2 years;
- unvaccinated children;
- children with moderate disease severity.
Another important finding was the absence of serious adverse events in the experimental group. Only mild side effects were reported, including fatigue, short-term fever, gastrointestinal disturbances, and weight loss.
The researchers concluded that early-stage treatment of children with nasal IFN-α2b significantly accelerates viral clearance and eliminates a potential source of household transmission.
Conclusions
The range of COVID-19 treatment options for children is more limited than for adults. As a result, the coronavirus persists longer in children, who remain infectious for a longer period. Reducing the duration of infectiousness helps limit the spread of infection. Nasal interferon alpha-2b is effective and safe for children. The drug successfully suppresses the virus locally at the site of infection – in the nose – without systemic effects. As a result, the infectious period is shortened by 1–1.5 days.
Reference
Interferon-α-2b Nasal Spray for Treating SARS-CoV-2 Omicron Variant-Infected Children
