888 children have been hospitalized for one of these two causes since 2015. And the incidence has been increasing since 2020, undoubtedly linked to greater socio-economic difficulties, researchers estimate.
It was a forgotten disease, believed to be reserved for sailors in the past spending very long months at sea. But scurvy seems to be making a sad return in France: 888 children have been hospitalized for this reason over the last nine years, and the number of cases has increased by 35% since March 2020, marked by the beginnings of the Covid-19 pandemic associated with an increase in socio-economic difficulties, then inflation, calculate a team of French researchers. Severe malnutrition is up 20% in the same post-Covid period, estimate researchers from the Robert-Debré AP-HP hospital, Inserm, Paris Cité University and the pediatrics department of the Cayenne hospital in Guyana.
Scurvy is the extreme form of vitamin C, or ascorbic acid, deficiency. A vitamin essential for the assembly of collagen fibers, vital for the integrity of the skin, blood vessels and bones in particular; it also has a role in immunity and iron absorption. However, humans are unable to produce or store this vitamin C, so they must find it in their diet, mainly fruits and vegetables. Without sufficient intake, hemorrhages, healing disorders, but also defects in the immune system and iron absorption appear after 3 months. If the recommended vitamin C intake is 100 mg per day for an adult, scurvy only appears when they are well below this threshold, around 10 mg per day.
If the risk is known for people in great precariousness, the improvement in the living conditions of the population had made the disease almost disappear, apart from a few sporadic cases in individuals who are not particularly disadvantaged and never consume the slightest fruit or vegetable. But “The COVID-19 pandemic (…) has widened social inequalities and the major socio-geopolitical conflicts, such as the war in Ukraine, which followed (…) exacerbated them”write the researchers in the journal The Lancet Regional Health – Europe . In this context, the rise in the cost of food may have limited “access to fresh and varied foods” et “lead to increased rates of scurvy and malnutrition.”
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The authors questioned the Program for the Medicalization of Information Systems (PMSI), which makes it possible to measure the activity of hospital establishments in France. They looked for children under the age of 18 hospitalized for scurvy, or for severe malnutrition (not necessarily associated with vitamin C deficiency). They used as “low socio-economic status indicator” eligibility for Universal Health Coverage (CMU), based in particular on income thresholds. Their research was carried out over two periods: from the beginning of 2015 to March 2020, the start of the Covid-19 pandemic (i.e. 63 months), then from April 2020 to November 2023 (i.e. 44 months).
[L’augmentation du nombre de cas de scorbut] was more pronounced among children aged 5 to 10, with a cumulative increase of 200.8%
Results: during the first period, 352 children were hospitalized for scurvy and 74,278 for malnutrition; in the second period, there were 536 and 61,082 respectively. Among all, 4 children hospitalized for scurvy and 1059 children hospitalized for malnutrition died. The data collected shows a “change of slope” significant since the pandemic, with an increase of 1.9% per month. “This increase was more pronounced among children aged 5 to 10, with a cumulative increase of 201%, and among girls (cumulative increase of 66%)write the authors.
The situation is different for malnutrition: while severe forms have increased by 20%, moderate malnutrition has decreased by 11%. “The largest changes were seen among adolescents aged 11 to 17, who experienced a reduction in mild and moderate malnutrition, but an increase in severe malnutrition”observe the authors, who also find “a significant increase in the incidence of iron deficiency”.
An increase “correlated with variations in the general consumer price index”
Researchers also note, among children hospitalized for scurvy or malnutrition, an increase in the proportion of those whose parents benefit from CMU (+33% for scurvy, +16% for malnutrition). Furthermore, the incidence of scurvy, severe malnutrition and iron deficiency were “significantly and positively correlated with variations in the general consumer price index and the consumer price index for food products”.
Despite certain weaknesses of the study that the authors recognize, and in particular the fact that these results must be confirmed in other European countries which face the same socio-economic difficulties as France, “our results highlight the need to scale up food and social assistance programs”they emphasize. But also the need for “better clinical training (…) to ensure early detection of scurvy and proactive screening of populations at risk”.
