24 settembre 2024
News
Long Covid, in bambini può durare 3 anni e impedire ritorno a normalità: lo studio
24 settembre 2024 | 14.22
LETTURA: 3 minuti
Da uno studio internazionale su 1.300 pazienti in età pediatrica, pubblicato su ‘eClinical Medicine’ (gruppo ‘The Lancet’) e coordinato dai pediatri di Fondazione Policlinico Gemelli Irccs-Università Cattolica del Sacro Cuore, emergono nuove evidenze sulle conseguenze dell’infezione da Sars-CoV-2 nei bambini e nei ragazzi . In alcuni, il “Long Covid può durare fino a tre anni con conseguenze sulla vita scolastica e sulle attività abituali. I vaccini sembrano avere un effetto protettivo (ma dipende dal numero di dosi somministrate e dall’età dei pazienti) sul Long Covid, sulle reinfezioni e sulle complicanze autoimmuni di questa malattia”. Condotto su circa 1.300 pazienti di età compresa tra 0 e 18 anni, seguiti presso l’ambulatorio del Post-Covid pediatrico del Gemelli.
La ricerca si è focalizzata sui casi di Long Covid pediatrico comparsi dopo la prima infezione o dopo le reinfezioni e sulla loro durata. Obiettivo del lavoro era “descrivere le caratteristiche del Long Covid nei pazienti in età pediatrica, di valutare la presenza di fattori in grado di predire il rischio di sviluppare Long Covid e di valutare il ruolo del vaccino nel prevenire il Long Covid, il rischio di reinfezioni o la comparsa di malattie autoimmuni”.
“In questo lavoro – commenta Danilo Buonsenso, corresponding author, docente di Pediatria all’Università Cattolica e dirigente medico dell’Unità Operativa Complessa di Pediatria della Fondazione Policlinico Universitario Agostino Gemelli Irccs – abbiamo documentato l’andamento dell’infezione da Sars-CoV-2 in età pediatrica fino a trentasei mesi successivi alla prima infezione”.
“Sul fronte Long Covid – prosegue Buonsenso – abbiamo confermato i dati dei nostri precedenti studi, aggiungendo però nuove informazioni. Da questa nuova ricerca infatti emerge che, sebbene la maggior parte dei pazienti guarisca dal Covid-19, alcuni continuano a presentare sintomi ascrivibili al Long Covid, fino a 3 anni di distanza dall’infezione iniziale. Questo conferma l’importanza delle potenziali conseguenze di questo virus nei bambini. Molti di quelli seguiti per 3 anni dopo l’infezione iniziale non sono riusciti a riprendere la routine di tutti i giorni, con conseguenze negative sulla capacità di frequentare regolarmente la scuola o di svolgere le classiche attività extra-scolastiche, a causa dei sintomi debilitanti riportati”.
Il Covid, insomma, può avere conseguenze importanti e durature anche sui più piccoli. Ma il vaccino è in grado di proteggere anche dal ‘dopo’ fase acuta dell’infezione e cioè dal Long Covid e dalle altre complicanze? “Nel nostro studio – spiega Buonsenso – la vaccinazione si è dimostrata un fattore protettivo contro il Long Covid anche se, come abbiamo evidenziato, questo effetto ‘scudo’ varia a seconda del numero di dosi ricevute o dall’età del paziente e questo aggiunge ulteriori informazioni e offre materia di riflessione, rispetto a quanto noto finora”.
Un altro dato emerso dallo studio è che il rischio di presentare una forma grave di Covid-19, nel caso di una reinfezione che compaia nei 24-36 mesi successivi alla prima infezione, è estremamente basso. “Va detto tuttavia – rimarca il pediatra – che, anche se raro, è possibile sviluppare il Long Covid anche a seguito di una reinfezione . Inoltre, i bambini con Long Covid sono a maggior rischio di presentare infezioni sintomatiche”. Come già evidenziato negli adulti infine, dallo studio pubblicato su ‘eClinical Medicine’ emerge anche che l’infezione dovuta al virus originale è risultata associata a un rischio maggiore di sviluppare malattie autoimmuni, nei mesi successivi all’infezione acuta.
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Editore: Associazione Reportage - Direttore responsabile: Annamaria Persico
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n.initCustomEvent(e,t.bubbles,t.cancelable,t.detail),n}e.prototype=window.Event.prototype,window.CustomEvent=e}}(),function(e){e[e.Pending=0]="Pending",e[e.Loaded=1]="Loaded",e[e.Failed=2]="Failed"}(State$1||(State$1={}));class Provider{constructor(e){this.timeoutSeconds=5,this.handlePixelEvent=e=>{switch(this.state){case State$1.Failed:break;case State$1.Pending:setTimeout((()=>this.handlePixelEvent(e)),100);break;case State$1.Loaded:this.onPixelEvent(e)}},this.watch=()=>{switch(this.state){case State$1.Loaded:case State$1.Failed:break;case State$1.Pending:this.isLoaded()?this.state=State$1.Loaded:this.isTimedOut()?this.state=State$1.Failed:setTimeout(this.watch,50)}},this.config=e,this.identifier&&this.identifier.length>0?(this.state=State$1.Pending,this.timeoutAt=new Date,this.timeoutAt.setSeconds(this.timeoutAt.getSeconds()+this.timeoutAfter()),this.injectPixel()):this.state=State$1.Failed}get identifier(){var e;return null===(e=this.config)||void 0===e?void 0:e.key}get pixelEvents(){var e;return null===(e=this.config)||void 0===e?void 0:e.pixel_events}injectPixel(){this.injectedAt||(this.injectedAt=new Date,this.inject(),this.watch())}inject(){const e=document.createElement("script");e.text=this.script,document.head.appendChild(e)}isTimedOut(){return+new Date>=+this.timeoutAt}timeoutAfter(){return this.timeoutSeconds}selectPixelEvents(e){if(Array.isArray(this.pixelEvents))return this.pixelEvents.filter((t=>"term-view"===t.trigger&&"visit"===e||(!(!["term-click","ad-view"].includes(t.trigger)||"ctr"!==e)||"ad-click"===t.trigger&&"click"===e)))}}class Facebook extends Provider{get script(){return`!function(f,b,e,v,n,t,s){if(f.fbq)return;n=f.fbq=function(){n.callMethod?n.callMethod.apply(n,arguments):n.queue.push(arguments)};if(!f._fbq)f._fbq=n;n.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0;t.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window, document,'script','https://connect.facebook.net/en_US/fbevents.js');fbq('init', '${this.identifier}');`}onPixelEvent(e){this.selectPixelEvents(e).forEach((e=>{e&&(e.custom?window.fbq("trackCustom",e.event):window.fbq("track",e.event))}))}isLoaded(){return!!window.fbq}}class Outbrain extends Provider{get script(){return`!function(_window, _document) {var OB_ADV_ID = '${this.identifier}';if (_window.obApi) {var toArray = function(object) {return Object.prototype.toString.call(object) === '[object Array]' ? object : [object];};_window.obApi.marketerId = toArray(_window.obApi.marketerId).concat(toArray(OB_ADV_ID));return;}var api = _window.obApi = function() {api.dispatch ? api.dispatch.apply(api, arguments) : api.queue.push(arguments);};api.version = '1.1';api.loaded = true;api.marketerId = OB_ADV_ID;api.queue = [];var tag = _document.createElement('script');tag.async = true;tag.src = '//amplify.outbrain.com/cp/obtp.js';tag.type = 'text/javascript';var script = _document.getElementsByTagName('script')[0];script.parentNode.insertBefore(tag, script);}(window, document);`}onPixelEvent(e){this.selectPixelEvents(e).forEach((e=>{e&&window.obApi("track",e.event)}))}isLoaded(){return!!window.obApi}}class Revcontent extends Provider{get script(){return""}inject(){const e=document.createElement("script");e.src="https://assets.revcontent.com/master/rev.js",document.head.appendChild(e)}onPixelEvent(e){this.selectPixelEvents(e).forEach((e=>{e&&window.rev("event",e.event)}))}isLoaded(){return!!window.rev}}class Taboola extends Provider{get script(){return"window._tfa = window._tfa || [];!function (t, f, a, x) {if (!document.getElementById(x)) {t.async = 1;t.src = a;t.id=x;f.parentNode.insertBefore(t, f);}}(document.createElement('script'),document.getElementsByTagName('script')[0],'//cdn.taboola.com/libtrc/unip/1451879/tfa.js','tb_tfa_script');"}onPixelEvent(e){this.selectPixelEvents(e).forEach((e=>{e&&window._tfa.push({notify:"event",name:e.event,id:e.pixel_id})}))}isLoaded(){return Array.isArray(window._tfa)}}class Tiktok extends Provider{constructor(e,t){super(e),this.useAltTikTokEventsForAdsPlatformUser=t}get script(){return`!function (w, d, t) {w.TiktokAnalyticsObject=t;var ttq=w[t]=w[t]||[];ttq.methods=["page","track","identify","instances","debug","on","off","once","ready","alias","group","enableCookie","disableCookie"],ttq.setAndDefer=function(t,e){t[e]=function(){t.push([e].concat(Array.prototype.slice.call(arguments,0)))}};for(var i=0;i
{e&&window.ttq.instance(this.identifier).track(e.event)}))}isLoaded(){return!!window.ttq}}const ADS_PARAM$1="?caf",MESSAGE_PREFIX="FSXDC,.aCS:",ALLOWED_ORIGINS=["https://www.google.com","https://www.adsensecustomsearchads.com","https://syndicatedsearch.goog","https://googleadservices.com"];class Pixels{static build(e){const t=unpackPHPArrayObject(e,"pixel_tracking_data");if(t)return t.useAltTikTokEventsForAdsPlatformUser=e.is_ads,new Pixels(t)}constructor(e){this.onPixelEvent=e=>{const{detail:{type:t}}=e;switch(t){case"visit":case"ctr":case"click":this.providers.forEach((e=>e.handlePixelEvent(t)))}},this.providers=[new Facebook(e.facebook),new Tiktok(e.tiktok,e.useAltTikTokEventsForAdsPlatformUser),new Taboola(e.taboola),new Revcontent(e.revcontent),new Outbrain(e.outbrain)]}listenForEvents(){document.addEventListener("pixel",(e=>{this.onPixelEvent(e)}));window.onmessage=e=>{const{origin:t,data:n}=e;ALLOWED_ORIGINS.includes(t)&&(null==n?void 0:n.startsWith(MESSAGE_PREFIX))&&window.location.search.startsWith(ADS_PARAM$1)&&document.dispatchEvent(new CustomEvent("pixel",{detail:{type:"click"}}))}}dispatchEvent(e){document.dispatchEvent(new CustomEvent("pixel",{detail:e}))}}var State;!function(e){e[e.Pending=0]="Pending",e[e.Loaded=1]="Loaded",e[e.Failure=2]="Failure",e[e.TimedOut=3]="TimedOut",e[e.Errored=4]="Errored"}(State||(State={}));const CAF_SCRIPT_SRC=`https://www.google.com/adsense/domains/caf.js?${GOOGLE_MV3_URL_PARAMS}`,TIMEOUT_SCRIPTS=Number(GOOGLE_CAF_TIMEOUT_SCRIPTS),TIMEOUT_CALLBACKS=Number(GOOGLE_CAF_TIMEOUT_CALLBACKS);class StateMachine{constructor(){this.state=State.Pending}transitionTo(e){this.state=e}transitionFromPendingTo(e){this.done||(this.state=e)}get loaded(){return this.state===State.Loaded}get timedOut(){return this.state===State.TimedOut}get done(){return this.state!==State.Pending}}class Ads{constructor(e,t){this.state={script:new StateMachine,blocks:new StateMachine},this.blocksLoaded=[],this.injectScriptTags=()=>__awaiter(this,void 0,void 0,(function*(){return new Promise((e=>{const t=document.createElement("script");t.type="text/javascript",t.src=CAF_SCRIPT_SRC,t.addEventListener("load",(()=>e(!0))),t.addEventListener("error",(()=>e(!1))),document.body.appendChild(t),TIMEOUT_SCRIPTS>0&&setTimeout((()=>e(!1)),TIMEOUT_SCRIPTS)}))})),this.onPageLoaded=(e,t)=>{if(this.pageLoaded={requestAccepted:e,status:t},this.state.script.done)return;const n=null==t?void 0:t.error_code;n?(this.state.script.transitionTo(State.Failure),this.failureReason=`caf_pageloaderror_${n}`):this.state.script.transitionTo(State.Loaded)},this.onBlockLoaded=(e,t,n,i)=>{this.blocksLoaded.push({containerName:e,adsLoaded:t,isExperimentVariant:n,callbackOptions:i}),this.state.blocks.done||(t?this.state.blocks.transitionTo(State.Loaded):this.blocksLoaded.length>=this.blocks.length&&(this.state.blocks.transitionTo(State.Failure),this.failureReason=`caf_adloadfail_${e}`))},this.onTimeout=()=>{this.state.script.transitionFromPendingTo(State.TimedOut),this.state.blocks.transitionFromPendingTo(State.TimedOut)},this.blocks=e,this.options=t}get loaded(){return this.state.script.loaded&&!this.blocksLoaded.map((e=>e.adsLoaded)).includes(!1)}waitForBlocks(){return __awaiter(this,void 0,void 0,(function*(){return new Promise((e=>{const t=()=>{const n=performance.now();if(this.state.blocks.done)return this.cafLoadTime=Math.round(n-this.cafStartTime),void e();const i=this.blocksLoaded.map((e=>e.adsLoaded));i.includes(!1)||i.length>=this.blocks.length?e():setTimeout(t,50)};t()}))}))}inject(){return __awaiter(this,void 0,void 0,(function*(){try{const e=yield this.injectScriptTags();return this.cafStartTime=performance.now(),e&&void 0!==window.google?(new window.google.ads.domains.Caf(Object.assign(Object.assign({},this.options),{pageLoadedCallback:this.onPageLoaded,adLoadedCallback:this.onBlockLoaded}),...this.blocks),TIMEOUT_CALLBACKS>0&&setTimeout(this.onTimeout,TIMEOUT_CALLBACKS),yield new Promise((e=>{const t=()=>{this.state.script.done?e():setTimeout(t,10)};t()}))):void this.state.script.transitionTo(State.Failure)}catch(e){return void(this.error=e.toString())}}))}toCallbacks(){return{adLoadedCallback:this.blocksLoaded.slice(-1)[0],pageLoadedCallback:this.pageLoaded,cafTimedOut:this.state.script.timedOut||this.state.blocks.timedOut,cafLoadedMs:this.cafLoadTime,googleAdsFailure:!!this.failureReason}}toContext(){const e={cafScriptWasLoaded:this.state.script.loaded,cafScriptLoadTime:this.cafLoadTime,callbacks:this.toCallbacks};return this.error&&(e.js_error={message:this.error}),this.state.script.loaded||(e.zeroclick={reason:"googleAdsFailure"}),e}mockFailedState(){this.state.blocks.transitionTo(State.Failure),this.state.script.transitionTo(State.Failure)}}class TagManager{constructor(e){this.injected=!1,this.identifier=e}inject(){if(this.injected)return;if(!this.identifier)return;if("TEST"===this.identifier)return;const e=document.createElement("script");e.setAttribute("src",`https://www.googletagmanager.com/gtag/js?id=${this.identifier}`),document.head.appendChild(e),this.track(),this.injected=!0}track(){this.push("js",new Date),this.push("config",this.identifier)}push(e,t){window.dataLayer||(window.dataLayer=[]),window.dataLayer.push(arguments)}}const ADS_PARAM="caf",ADS_TRACKING_URL="_tr",BLOCKS_TYPE="ads",BLOCKS_CONTAINER="rs",KNOWN_CAF_PARAMS=["caf","query","afdToken","pcsa","nb","nm","nx","ny","is","clkt"];class Google{static build({pageOptions:e,preferredLanguage:t,blocks:n,googleAnalytics:i},s,a,o){let r={};e&&(r=Object.assign({},e),r.hl||(r.hl=t));let d=null==e?void 0:e.resultsPageBaseUrl;d||(d=window.location.origin);return new Google(s.uuid,n,r,i,d,o)}constructor(e,t,n,i,s,a){this._blocks=t,this._pageOptions=n,this.uuid=e,this._baseURL=new URL(s),this._signature=a,this.ads=new Ads(this.blocks,this.pageOptions),this.tagManager=new TagManager(i)}injectTagManager(){this.tagManager.inject()}injectAds(){return __awaiter(this,void 0,void 0,(function*(){yield this.ads.inject()}))}waitForBlocks(){return __awaiter(this,void 0,void 0,(function*(){return this.ads.waitForBlocks()}))}get blocks(){return(this._blocks||[]).filter((e=>this.wantsToServeAds?e.type===BLOCKS_TYPE:e.container===BLOCKS_CONTAINER)).map((e=>{const t=this.baseURL;new URLSearchParams(window.location.search).forEach(((e,n)=>{t.searchParams.has(n)||t.searchParams.append(n,e)}));const n=Object.assign({},e);if(n.resultsPageBaseUrl=t.toString(),this.wantsToServeAds){const e=new URLSearchParams;e.append("click","true"),e.append("session",this.uuid);const t=Object.assign({},this._signature);delete t.ad_loaded_callback,delete t.caf_loaded_ms,delete t.caf_timed_out,delete t.flex_rule,delete t.frame,delete t.js_error,delete t.no_ads_redirect,delete t.page_headers,delete t.page_request,delete t.page_loaded_callback,delete t.popup,delete t.screen_resolution,delete t.user_has_ad_blocker,delete t.user_preference,delete t.user_supports_darkmode,delete t.user_using_darkmode,delete t.zeroclick,e.append("signature",encode(t)),n.clicktrackUrl=`${TRACKING_DOMAIN}${ADS_TRACKING_URL}?${e.toString()}`}return n}))}get baseURL(){const e=new URL(this._baseURL.origin);return e.searchParams.append(ADS_PARAM,"1"),this._baseURL.searchParams.forEach(((t,n)=>{e.searchParams.append(n,t)})),e}get pageOptions(){const e=Object.assign({},this._pageOptions);return Object.keys(this._pageOptions).forEach((t=>{t.startsWith("bodis")&&delete e[t]})),e}get cannotLoadAds(){return!this.ads.loaded}get wantsToServeAds(){return new URLSearchParams(window.location.search).has(ADS_PARAM)}get adsMode(){return this.ads.loaded&&this.wantsToServeAds}get adsReady(){return this.wantsToServeAds&&!this.cannotLoadAds}get noAdsRedirectUrl(){const e=new URLSearchParams(window.location.search);return KNOWN_CAF_PARAMS.forEach((t=>e.delete(t))),`${window.location.origin}?${e.toString()}`}get callbacks(){return this.ads.toCallbacks()}toContext(){return Object.assign({blocks:this.blocks,pageOptions:this.pageOptions},this.ads.toContext())}}class CookieConsentManager{constructor(){this.injectScriptTag=()=>__awaiter(this,void 0,void 0,(function*(){return new Promise((e=>{const t=document.createElement("script");t.setAttribute("src",COOKIE_CONSENT_JS_URL),t.addEventListener("load",(()=>this.awaitConsent(e))),t.addEventListener("error",(()=>e(!1))),document.head.appendChild(t)}))}))}inject(){return __awaiter(this,void 0,void 0,(function*(){this.injected||!COOKIE_CONSENT_JS_URL||isLocal()||(this.injected=yield this.injectScriptTag())}))}awaitConsent(e){let t=0;const n=setInterval((()=>{t+=1,20===t&&(clearInterval(n),e(!0)),void 0!==window.__tcfapi&&(window.addEventListener("ConsentActivity",(t=>{const{detail:{status:n}}=t;n&&e(!0)})),clearInterval(n))}),50)}}class App{main(){var e,t;return __awaiter(this,void 0,void 0,(function*(){if(this.parkResponse=decode(),this.findDomainResponse=yield getFindDomain(),!this.findDomainResponse)throw new Error("Domain failed to load.");this.pixels=Pixels.build(this.findDomainResponse),null===(e=this.pixels)||void 0===e||e.listenForEvents(),this.adblock=new Adblock,yield this.adblock.inject(),this.google=Google.build(this.findDomainResponse,this.parkResponse,this.adblock,buildSignature({context:this.context,callbacks:null===(t=this.google)||void 0===t?void 0:t.callbacks},"click")),this.google.injectTagManager();const n=Parking.build(this.findDomainResponse,this.google);Render.prerender(n),this.cookieConsentManager=new CookieConsentManager,yield this.cookieConsentManager.inject();let i=Failed.cannotPark(this.findDomainResponse);if(i)return void(yield this.transitionToFailed(i));yield this.google.injectAds();let s=Disabled.build(this.findDomainResponse,this.adblock.state);if(s)return void(yield this.transitionToDisabled(s));const a=this.adblock.hasAdblocker();a&&this.adblock.handleAdblocked();const o=Sales.build(this.findDomainResponse);if(o)return void(yield this.transitionToSales(o));this.eligibleForZeroClick&&(this.zeroClickResponse=yield getZeroClick(this.context));const r=Redirect.build(this.findDomainResponse,this.zeroClickResponse,this.google);if(r)yield this.transitionToRedirect(r);else{if(a)return s=Disabled.build(this.findDomainResponse,this.adblock.state),void(yield this.transitionToDisabled(s));i=Failed.noSponsors(this.google),i?yield this.transitionToFailed(i):yield this.transitionToParking(n)}}))}transitionToParking(e){return __awaiter(this,void 0,void 0,(function*(){this.state=e,Render.template(e),Render.revealPage(),yield this.google.waitForBlocks(),yield this.track()}))}transitionToRedirect(e){return __awaiter(this,void 0,void 0,(function*(){this.state=e;const t=this.track();Render.revealPage(),yield waiter(e.delay,(e=>Render.loading(e))),yield t,window.location.href=e.url,log(`➡ Redirecting [${e.url}]`)}))}transitionToFailed(e){return __awaiter(this,void 0,void 0,(function*(){this.state=e,Render.message(e.message),Render.revealPage(),yield this.track()}))}transitionToSales(e){return __awaiter(this,void 0,void 0,(function*(){this.state=e,e.init(this.context),yield this.track()}))}transitionToDisabled(e){return __awaiter(this,void 0,void 0,(function*(){this.state=e,Render.message(e.message),Render.revealPage(),yield this.track()}))}track(){var e;return __awaiter(this,void 0,void 0,(function*(){if(!this.state.track)return Promise.resolve();try{const t=this.state.trackingType;return null===(e=this.pixels)||void 0===e||e.dispatchEvent({type:t}),trackVisit({context:this.context,callbacks:this.google.callbacks},t)}catch(e){return}}))}get eligibleForZeroClick(){const{cannotPark:e,canZeroClick:t,zeroClick:n}=this.findDomainResponse,{cannotLoadAds:i,wantsToServeAds:s}=this.google;return this.adblock.state!==Blocking.BLOCKED&&(!!t&&(!!e||(!(!i||s)||!!(null==n?void 0:n.reason))))}get context(){var e,t,n,i;const s=this.findDomainResponse,a=this.parkResponse,o=null===(e=this.state)||void 0===e?void 0:e.toContext(),r=null===(t=this.adblock)||void 0===t?void 0:t.toContext(),d=null===(n=this.google)||void 0===n?void 0:n.toContext(),c=browserState(),l=Object.assign(Object.assign({},null===(i=this.findDomainResponse)||void 0===i?void 0:i.zeroClick),this.zeroClickResponse);return Object.assign(Object.assign(Object.assign(Object.assign(Object.assign(Object.assign(Object.assign({app_version:APP_VERSION},s),a),r),d),o),c),{zeroClick:l})}init(){return __awaiter(this,void 0,void 0,(function*(){try{window.__parkour=this,yield this.main()}catch(e){console.error("app",e);const t=Failed.fromError(e);this.state=t,Render.message(t.message),Render.revealPage()}}))}}(new App).init(),exports.App=App}));