Detection of Covid-19 in Children in Early January 2020 in Wuhan, China

Long-Lived Immunity in SARS-CoV-2-Recovered Children and Its Neutralizing Capacity Against Omicron

SARS-CoV-2 infection is effectively controlled by humoral and cellular immune responses. However, the durability of immunity in children as well as the ability to neutralize variants of concern are unclear. Here, we assessed T cell and antibody responses in a longitudinal cohort of children after asymptomatic or mild COVID-19 over a 12-month period. Antigen-specific CD4 T cells remained stable over time, while CD8 T cells declined. SARS-CoV-2 infection induced long-lived neutralizing antibodies against ancestral SARS-CoV-2 (D614G isolate), but with poor cross-neutralization of omicron. Importantly, recall responses to vaccination in children with pre-existing immunity yielded neutralizing antibody activities against D614G and omicron BA.1 and BA.2 variants that were 3.9-fold, 9.9-fold and 14-fold higher than primary vaccine responses in seronegative children. Together, our findings demonstrate that SARS-CoV-2 infection in children induces robust memory T cells and antibodies that persist for more than 12 months, but lack neutralizing activity against omicron. Vaccination of pre-immune children, however, substantially improves the omicron-neutralizing capacity.

Post COVID-19 Condition in Children and Adolescents: An Emerging Problem

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection became a pandemic in 2020 and by March 2022 had caused more than 479 million infections and 6 million deaths worldwide. Several acute and long-term symptoms have been reported in infected adults, but it remains unclear whether children/adolescents also experience persistent sequelae. Hence, we conducted a review of symptoms and pathophysiology associated with post-coronavirus disease 2019 (post-COVID-19) condition in children and adolescents. We reviewed the scientific literature for reports on persistent COVID-19 symptoms after SARS-CoV-2 infection in both children/adolescents and adults from 1 January 2020 to 31 March 2022 (based on their originality and relevance to the broad scope of this review, 26 reports were included, 8 focused on adults and 18 on children/adolescents). Persistent sequelae of COVID-19 are less common in children/adolescents than in adults, possibly owing to a lower frequency of SARS-CoV-2 infection and to the lower impact of the infection itself in this age group. However, cumulative evidence has shown prolonged COVID-19 to be a clinical entity, with few pathophysiological associations at present. The most common post-COVID-19 symptoms in children/adolescents are fatigue, lack of concentration, and muscle pain. In addition, we found evidence of pathophysiology associated with fatigue and/or headache, persistent loss of smell and cough, and neurological and/or cardiovascular symptoms. This review highlights the importance of unraveling why SARS-CoV-2 infection may cause post-COVID-19 condition and how persistent symptoms might affect the physical, social, and psychological well-being of young people in the future.

Intestinal parasitic infections among patients referred to hospitals affiliated to Shiraz University of Medical Sciences, southern Iran: a retrospective study in pre- and post-COVID-19 pandemic

Intestinal parasitic infections (IPIs) are still a serious public health problem worldwide, particularly in developing countries. The COVID-19 pandemic has affected people's lifestyles and quality of life. Besides, the prevalence of IPIs is directly associated with environmental sanitation, overcrowding, and personal hygiene. Therefore, the current study aimed to determine the prevalence of IPIs among patients referred to hospitals affiliated to Shiraz University of Medical Sciences by reviewing the available data of hospital information system database in the pre- and post-COVID-19 pandemic. The total data of 13,686 patients referred to hospitals affiliated to Shiraz University of Medical Sciences, southern Iran were collected from March 2019 to March 2021. The overall prevalence of IPIs was found to be 4.4%, and Blastocystis spp. was the most common parasite. The prevalence of protozoan parasites (4.4%) was significantly higher than helminthic parasites (0.04%, P < 0.001). A significant association was observed between IPIs with age, gender, and year (P < 0.05). The prevalence of IPIs among those referred to hospitals before the COVID-19 pandemic was higher than those referred to hospitals during the COVID-19 pandemic (5.8% vs 2.8%), and the differences were statistically significant (P < 0.001). The odds of infection among people investigated during the COVID-19 pandemic was about 40% lower than those investigated before the COVID-19 pandemic (AOR: 0.60, 95% CI: 0.49-0.73, P < 0.001). Our results showed that the prevalence of IPIs has decreased during the COVID-19 pandemic. Improved sanitation, personal hygiene, and health education can be effective in reducing parasitic infections in the COVID-19 pandemic.

Comparison of Laboratory Data between Children with Kawasaki Disease and COVID-19

Background: Coronavirus disease 2019 (COVID-19) has been an emerging, rapidly evolving situation in China since late 2019 and has even become a worldwide pandemic. The first case of severe childhood novel coronavirus pneumonia in China was reported in March 2020 in Wuhan. The severity differs between adults and children, with lower death rates and decreased severity for individuals under the age of 20 years. Increased cases of Kawasaki disease (KD) have been reported from New York City and some areas of Italy and the U.K., with almost a 6–10 times increase when compared to previous years. We conducted this study to compare characteristics and laboratory data between KD and COVID-19 in children. Methods: We obtained a total of 24 children with COVID-19 from a literature review and 268 KD cases from our hospital via retrospective chart review. Results: We found that patients with KD have higher levels of white blood cells (WBCs), platelets, neutrophil percentage, C-reactive protein (CRP), procalcitonin, and aspartate aminotransferase (AST) and a higher body temperature, while patients with COVID-19 have a higher age, hemoglobin levels, and lymphocyte percentage. After performing multiple logistic regression analysis, we found that age, WBCs, platelets, procalcitonin, and AST are identical markers for distinguishing COVID-19 from KD in children. Conclusion: In this COVID-19 pandemic period, clinicians should pay attention to children with COVID-19 infection when high WBC, platelet, procalcitonin, and AST values are present in order to provide early diagnosis for KD or multisystem inflammatory syndrome in children (MIS-C).

Factors Affecting Multimodal Transport during COVID-19: A Thai Service Provider Perspective

Multimodal transport is a critical component in developing the international trade economy, and logistics service providers are a critical component in multimodal transport. However, the recent COVID-19 pandemic has seriously affected the transport system, especially in light of the ongoing rise in transportation costs which has increased firm operating costs. Furthermore, the COVID-19 pandemic has severely influenced the economic sector, resulting in decreased growth. This research aims to determine the priorities of the most important factors for developing and improving multimodal transport compared to pre-COVID-19 and during the COVID-19 outbreak. This research consisted of two stages. The first stage used bibliometric analysis to define multimodal transport dimensions and criteria based on the previous and current literature studies on multimodal transport and used confirmatory factor analysis (CFA) to verify the relationship between factors and multimodal transport. The second stage used the fuzzy best-worst method (FBW) combined benefit, opportunity, cost and risk (BOCR) to prioritize the improvement and development of multimodal transport during the COVID-19 crisis, which considers the perspective of logistics service providers in Thailand. These factors, when identified, would help policymakers design more efficient policies to improve and solve multimodal transport problems mainly caused by strict public health measures during COVID-19.

Pulmonary Lymphangitis Poses a Major Challenge for Radiologists in an Oncological Setting during the COVID-19 Pandemic

Due to the increasing number of COVID-19-infected and vaccinated individuals, radiologists continue to see patients with COVID-19 pneumonitis and recall pneumonitis, which could result in additional workups and false-positive results. Moreover, cancer patients undergoing immunotherapy may show therapy-related pneumonitis during imaging management. This is otherwise known as immune checkpoint inhibitor-related pneumonitis. Following on from this background, radiologists should seek to know their patients' COVID-19 infection and vaccination history. Knowing the imaging features related to COVID-19 infection and vaccination is critical to avoiding misleading results and alarmism in patients and clinicians.

Seroprevalence and risk factors of SARS-CoV-2 infection in an urban informal settlement in Nairobi, Kenya, December 2020

Introduction: Urban informal settlements may be disproportionately affected by the COVID-19 pandemic due to overcrowding and other socioeconomic challenges that make adoption and implementation of public health mitigation measures difficult. We conducted a seroprevalence survey in the Kibera informal settlement, Nairobi, Kenya, to determine the extent of SARS-CoV-2 infection.

Methods: Members of randomly selected households from an existing population-based infectious disease surveillance (PBIDS) provided blood specimens between 27 ^th November and 5 ^th December 2020. The specimens were tested for antibodies to the SARS-CoV-2 spike protein. Seroprevalence estimates were weighted by age and sex distribution of the PBIDS population and accounted for household clustering. Multivariable logistic regression was used to identify risk factors for individual seropositivity.  

Results: Consent was obtained from 523 individuals in 175 households, yielding 511 serum specimens that were tested. The overall weighted seroprevalence was 43.3% (95% CI, 37.4 – 49.5%) and did not vary by sex. Of the sampled households, 122(69.7%) had at least one seropositive individual. The individual seroprevalence increased by age from 7.6% (95% CI, 2.4 – 21.3%) among children (<5 years), 32.7% (95% CI, 22.9 – 44.4%) among children 5 – 9 years, 41.8% (95% CI, 33.0 – 51.1%) for those 10-19 years, and 54.9%(46.2 – 63.3%) for adults (≥20 years). Relative to those from medium-sized households (3 and 4 individuals), participants from large (≥5 persons) households had significantly increased odds of being seropositive, aOR, 1.98(95% CI, 1.17 – 1.58), while those from small-sized households (≤2 individuals) had increased odds but not statistically significant, aOR, 2.31 (95% CI, 0.93 – 5.74). 

Conclusion: In densely populated urban settings, close to half of the individuals had an infection to SARS-CoV-2 after eight months of the COVID-19 pandemic in Kenya. This highlights the importance to prioritize mitigation measures, including COVID-19 vaccine distribution, in the crowded, low socioeconomic settings.

COVID-19 and Mortality, Depression, and Suicide in the Polish Population

Aim

The study was aimed at assessing the mortality of the population, the occurrence of the phenomenon of depression and suicide before and during the COVID-19 pandemic.

Methods

Data on total mortality in Poland in 2017–2021 came from the report of the Ministry of Health. Data on the number of sick leave due to mental disorders were taken from the report of the ZUS (Social Insurance Institution in Poland). Data on the number of suicides came from police statistics.

Results

Increase in the number of deaths in Poland in 2021 compared to the 2017–2019 average – 26.86%. In 2018–2020, the greatest number of fatal suicides was recorded in the age group – 60–64 years (in 2018 N = 565; 10.90%; in 2020 N = 524; 10.15%).

Conclusions

In the years 2020-2021, an increase in mortality was observed in Poland compared to the previous years. Moreover, in 2020 there was an increase in sickness absence due to ICD-10 F.32 and an increase in the number of suicide attempts.

Imaging Findings in Pediatric COVID-19: A Review of Current Literature

The recent COVID-19 pandemic has afflicted over 200 million individuals to date, with many different organ systems involved. The pediatric involvement has been variable, but of note is the risk of cardiac disease in pediatric COVID-19 patients. We review here the cardiac involvement in pediatric patients with COVID-19. Several studies highlight a possible cardiotropic nature of SARS-CoV-2, and describe the disease severity in myocarditis, both symptomatic and occult, as well as MIS-C. We describe the expected clinical course of these patients and note the lack of long-term follow-up data and the concerning prevalence of continued abnormal findings on follow-up imaging. With this paucity of long-term cardiac data, we recommend consideration of advanced imaging for pediatric patients with cardiac symptoms and/or elevation of cardiac serum biomarkers.

COVID-19 in Neonates with Positive RT–PCR Test. Systematic Review

Background

Objective

Methods

Results

Conclusion

No Human Respiratory Syncytial Virus but SARS-CoV-2 in children under 5 years old referred to Children Medical Center in 2021, Tehran, Iran

Acute respiratory infections (ARIs) are one of the leading causes of illness and death among community members worldwide. Viral infections are the most common agents estimated to be involved in these patients. This study aimed to investigate the prevalence of human respiratory syncytial virus (hRSV) and severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) among children with ARIs. This study evaluated the presence of SARS‐CoV‐2 and hRSV in 168 throat and nasopharyngeal swab samples using real‐time RT‐PCR. All samples were collected from children under 5 years old with ARIs who attended Children's Medical Center, Tehran, Iran, and sent to the Iranian National Influenza Center with appropriate conditions in 2021. Chi‐square and Fisher's exact tests were used for comparison of the data of the prevalence of hRSV and SARS‐CoV‐2 infections among children. Of 168 patients examined, 95 (57%) were male and 73 (43%) female. Out of them, 47 (28%) cases were younger than 1 year old and 121 cases (72%) were 1–5 years old. The most common clinical manifestations of patients were cough (78%), nausea (31%), diarrhea (27%), and fever (18%). Among 168 patients, no hRSV was detected, while the SARS‐CoV‐2 genome was identified in 16 (9.5%) patients. Among 16 positive cases of SARS‐CoV‐2, 8 (50%) were under 1 year old and 8 positive cases were 1–5 years old. This study was performed at cold months of the year but due to the coronavirus disease 2019 pandemic and adherence to health protocols, school closures, and virtual classes, no cases of hRSV infections were identified.

The Impact of Job Stress and State Anger on Turnover Intention Among Nurses During COVID-19: The Mediating Role of Emotional Exhaustion

Based on the social exchange theory, the aim of this study is to identify the association between job stress state anger, emotional exhaustion and job turnover intention. This study postulates that job related stress and state anger among nurses during COVID-19 subsequently leads to their job turnover intentions. In addition, the study also aims to see the mediating role of emotional exhaustion between COVID-19-related job stress, state anger, and turnover intentions. The sample of this study is gathered from 335 registered nurses working in Pakistani hospitals dealing with COVID-19-related patients. The interrelationships between variables are checked by using structural equation modeling through AMOS. Key findings confirm that COVID-19-related job stress and state anger had a significant effect on nurses' turnover intentions. Furthermore, emotional exhaustion mediated the relationship between COVID-19-related job stress, state anger, and turnover intentions. There is a lack of research which has assessed the impact of Novel COVID-19-related job stress and state anger on nurses' turnover intentions in hospitals, providing empirical evidence from a developing country-Pakistan. This study offers managerial implications for hospital management and health policymakers. Moreover, nursing managers need to pay attention to nurses' turnover intentions who are facing the issue at the front line as patients receive their initial treatment from nurses in the COVID-19 outbreak.

Trends in clinical presentation of children with COVID-19: a systematic review of individual participant data

BACKGROUND

There are sparse patient-level data available for children with novel coronavirus disease (COVID-19). Therefore, there is an urgent need for an updated systematic literature review that analyzes individual children rather than aggregated data in broad age groups.

METHODS

Six databases (MEDLINE, Scopus, Web of Science, CINAHL, Google Scholar, medRxiv) were searched for studies indexed from January 1 to May 15, 2020, with MeSH terms: children, pediatrics, COVID-19, SARS-CoV-2. 1241 records were identified, of which only unique papers in English with individual patient information and documented COVID-19 testing were included. This review of 22 eligible studies followed Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data guidelines.

RESULTS

A total of 123 patients from five countries were identified. 46% were females. The median age was 5 years (IQR = 8). At presentation, 62% had a fever, 32% had a cough, 58% had a single symptom, and 21% were asymptomatic. Abnormal chest imaging was seen in 62% (65/105) of imaged and 76.9% (20/26) of asymptomatic children. A minority of children had elevated platelets, CRP, lactate dehydrogenase, and D-dimer.

CONCLUSION

Data from this independent participant data systematic review revealed that the majority of children with COVID-19 presented with either no symptoms or a single, non-respiratory symptom.

IMPACT

This systematic review revealed that the majority of children with COVID-19 presented with either no symptoms or a single, non-respiratory symptom. By using an independent participant data approach, this analysis underscores the challenge of diagnosing COVID-19 in pediatric patients due to the wide variety of symptoms and seemingly poor correlation of imaging findings with symptomatic disease. The data presented from individual patients from case series or cohort studies add more granularity to the current description of pediatric COVID-19.

Construction of SARS-CoV-2 virus-like particles in plant

The pandemic of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused a public health emergency, and research on the development of various types of vaccines is rapidly progressing at an unprecedented development speed internationally. Some vaccines have already been approved for emergency use and are being supplied to people around the world, but there are still many ongoing efforts to create new vaccines. Virus-like particles (VLPs) enable the construction of promising platforms in the field of vaccine development. Here, we demonstrate that non-infectious SARS-CoV-2 VLPs can be successfully assembled by co-expressing three important viral proteins membrane (M), envelop (E) and nucleocapsid (N) in plants. Plant-derived VLPs were purified by sedimentation through a sucrose cushion. The shape and size of plant-derived VLPs are similar to native SARS-CoV-2 VLPs without spike. Although the assembled VLPs do not have S protein spikes, they could be developed as formulations that can improve the immunogenicity of vaccines including S antigens, and further could be used as platforms that can carry S antigens of concern for various mutations.

Self-Reported Dietary Choices and Oral Health Care Needs during COVID-19 Quarantine: A Cross-Sectional Study

The COVID-19 pandemic significantly impacted the healthcare system, including dentistry. However, it is not entirely clear whether affected patients' willingness for regular dental visits and preventive behaviors with regards oral hygiene and diet. This is essential to understanding the potential effects of the COVID-19 pandemic on the acceleration of dental issues in the future. It was aimed at checking the level of dental visit avoidance, self-reported oral health needs, and dietary changes. This cross-sectional questionnaire study conducted in Poland (n = 2574; mean age 44.4 ± 15.6; female 56.3%) assessed nutritional habits and dental care changes during the COVID-19 pandemic. As demonstrated, nearly half of the responders (47.1%) avoided regular dental visits, while only 0.5% used online consultations. Fears related to potential cross-contamination in dental offices dropped from 25% to 11.4% and were associated with increased BMI and age (p < 0.05). Sweet snacking/drinking confirmed 19.1%/33.2% subjects. Self-reported oral health care needs (tooth stain, calculus, gingivitis, loss of fillings) were related to frequent snacking and poor oral hygiene (p < 0.05). The study highlights that pandemic periods are covered by eating and drinking changes combined with inadequate hygiene and dental care impose health complaints in the oral cavity. This can magnify both nutritional and interrelated oral health issues, highlighting the need to implement preventive and mitigation measures.

The Status of Pediatric Patients With Hematologic Malignancy During COVID-19 Pandemic in Wuhan City, China

Data regarding the epidemiologic characteristics and clinical features of pediatric hematologic patients are limited in this corona virus disease 2019 (COVID-19) crisis. We investigated the status of 113 pediatric hematologic patients in Wuhan union hospital during the COVID-19 pandemic from January 23 to March 10, 2020. All the patients had routine blood and biochemical examination, as well as chest computed tomography scans, and the nucleic acid, immunoglobulin G-immunoglobulin M combined antibodies tests for SARS-CoV-2. After admission, all patients were single-room isolated for 5 to 7 days. The results showed that only 1 (0.88%) child with leukemia was confirmed to have SARS-CoV-2 infection and 15 (13.2%) children were considered as suspected cases. Comparing to the nonsuspected patients, the suspected cases had lower white blood cell count, hemoglobin level, neutrophil count, serum calcium ion level and serum albumin concentration, as well as higher levels of C-reactive protein. All the suspected cases were ruled out of SARS-CoV-2 infection by twice negative tests for the virus. Therefore, the incidence of SARS-CoV-2 infection in hematologic malignancy children was low during the COVID-19 pandemic in China. COVID-19 got early detected and the virus spread out in the ward was effectively blocked by increasing test frequency and using single-room isolation for 5 to 7 days after admission.

COVID-19 in Pediatrics: A Systematic Review of Current Knowledge and Practice

INTRODUCTION

SARS-CoV-2 is the novel coronavirus that causes severe acute respiratory syndrome and could afflict individuals from all walks of life. Children are usually asymptomatic or represent non-specific mild to moderate symptoms; therefore, they often remain undiagnosed and could be potential reservoirs and silent carriers of the virus. Despite the global attention to COVID-19 and its importance in public health, some clinical and paraclinical aspects of this disease in children are still unclear. Thus, we conducted a comprehensive systematic review of available literature to reflect on the current knowledge and practice of the disease among children.

METHODS

This study was a systematic review of current evidence conducted in October 2020. We performed a systematic search using the keywords in online databases. The investigation adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to ensure the reliability and validity of extracted literature and results.

RESULTS

We selected and reviewed 23 most related studies out of 1744 identified papers in an initial online search based on the inclusion and exclusion criteria of the present review; of whom 13 were original research studies, and 10 were letters to the editors, commentaries, viewpoints, consensus statements, and perspectives. Although due to the origin of the current pandemic, China was the country with the most publications (12 articles), data from several countries have been included in this review.

CONCLUSION

COVID-19 can also affect children and cause systemic disease with several internal organ involvements. However, the prevalence, severity, and diversity of the symptoms in children are less than in adults. Cough and fever appear to be some of the most common symptoms, followed by other symptoms such as gastrointestinal manifestations. Comorbidities increase the risk of severe COVID-19 in children, and those without underlying conditions are very unlikely to suffer from severe disease. Mental health issues such as anxiety and depression due to the isolated situation caused by pandemics are common findings in children of early ages and should be seriously considered in current practice.

SARS-CoV-2 Infection and Racial Disparities in Children: Protective Mechanisms and Severe Complications Related to MIS-C

A novel coronavirus has resulted in a pandemic with over 176 million confirmed cases and over 3.8 million recorded deaths. In the USA, SARS-CoV-2 infection has a significant burden on minority communities, especially Hispanic and Black communities, which are overrepresented in cases compared to their percentage in the population. SARS-CoV-2 infection can manifest differently in children and adults, with children tending to have less severe disease. A review of current literature was performed to identify the hypothesized protective immune mechanisms in children, and to describe the rare complication of multisystem inflammatory syndrome in children (MIS-C) that has been documented in children post-SARS-CoV-2 infection. Epidemiologic data and case studies have indicated that children are less susceptible to more severe clinical features of SARS-CoV-2 infection, a finding that may be due to differences in the cytokine response generated by the innate immune system, high amounts of ACE-2 which maintain homeostatic functions by preventing inflammation, and trained immunity acquired from regular vaccinations. Despite these protective mechanisms, children are still susceptible to severe complications, such as MIS-C. The racial disparities seen in MIS-C are extremely apparent, and certain populations are more affected. Most specifically, 33% of MIS-C patients are Hispanic/Latino, and 30% Black. Current studies published on MIS-C do not detail whether certain symptoms are more present in certain racial/ethnic groups. Knowledge of these disparities could assist health care professionals with devising appropriate strategies for post-acute SARS-CoV-2 infection follow-up in children as well as vaccine distribution in specific communities to help slow the spread of SARS-CoV-2 infection, and ultimately reduce the potential for complications such as MIS-C.

Knowledge, Attitudes, and Perception of Parents toward Dental Treatment of Children during the COVID-19 Outbreak

This study aimed to evaluate the knowledge of parents regarding the coronavirus outbreak and to assess the change in attitude and perception toward dental treatment during the coronavirus (COVID-19) pandemic. A structured questionnaire (on google format) containing 13 questions was used, and each question had 2 or 3 possible answers. The parents/guardians of children (aged 3–14 years) who were school-going were eligible to participate in this study. A total of 800 parents/guardians were interviewed on google reporting format from June to December 2020. A simple random sampling technique was used to select 800 parents/guardians of children, aged 3–14 years, studying in different schools in Chandigarh. According to the survey, a total of 86% of respondents said that they paid high attention to COVID-19 and explained it to their children; 97% reported that they emphasized the importance of hand hygiene and sanitation during the outbreak; 72% admitted that the outbreak has made them more conscious of the importance of maintaining good oral health and hygiene, to avoid visiting the dentist and 84% felt that the routine dental check-ups and appointments should be avoided during the COVID-19 outbreak; almost half of the respondents (47%) thought that the dental environment was a potential source of infection to their kids; 37% felt getting treatment at a dental setup may expose their child to risks of COVID-19; 71% said they would take their child to a dental department if he/she had a severe toothache. Approximately 46% of the respondents expressed confidence about the preventive measures taken in the dental department to ensure safe treatment for their children. In conclusion, all respondents were concerned about COVID-19 and most of them had talked about it with their children often. In addition, a considerable percentage of them showed apprehensions about the preventive measures being taken at the dental operatory and thought that the dental environment could be more dangerous than other environments.

Clinical impact of COVID-19 on Turkish children with neurological and neuromuscular diseases: One center experience

This study aims to explore the effects of new type of coronavirus disease (COVID-19) in children with neurological and/or neuromuscular diseasesA retrospective study was conducted at State Hospital of Denizli. Pediatric patients diagnosed with COVID-19 who were hospitalized between March 18, 2020 and January 18, 2021 were included in the study. Children were divided into two groups: those with (group I) and without neurological and /or neuromuscular disorders (group II).Male cases were more than female cases in group I. The difference between group I and group II was significant in terms of seizure (47.3%; 1.7%), dyspnea (36.8%, 6.2%) and number of days with fever (2.6 ± 1.9; 1.58 ± 1.42) (P < .01, P < .01, P = .02). Hypoxemia (7, 11; 36.8%, 4.5%) and abnormal auscultation findings (8, 44; 42.1%, 18.1%) were more common in children in group I, hypertension was more common in group II (0, 8; 0%, 3.3%). Lung involvement of COVID-19 was found to be more severe in group I (P = .04). The frequency of hospitalization in the intensive care unit (P < .01) and application of noninvasive mechanical ventilation (NIMV) (P < .01); the number of days followed-up in the intensive care (P < .01) and in the hospital (P = .02) of the patients in group I were higher than those in group II.It is recognized that children with underlying neurological and/or neuromuscular diseases are severely affected by COVID-19.

Comparison of Clinical Findings in SARS-CoV-2 with Other Respiratory Viruses in Critically Ill Children during the COVID-19 Pandemic

OBJECTIVES

The aim of this study was to compare the clinical and laboratory findings in SARS-CoV-2 (COVID-19) with those of other respiratory viruses in critically ill children.

METHODS

It is a single center retrospective descriptive study conducted in a 32-bed pediatric intensive care unit (PICU). Our study was performed in Ankara City Hospital, Ankara, Turkey, between 1 March 2020, and 1 March 2021. Demographic and clinical characteristics of the patients were collected and we recorded the antibiotic use, antiviral treatments, respiratory and extracorporeal supports, PICU stay and survival rates.

RESULTS

A total of 202 pediatric patients who tested positive for either COVID-19 or for another respiratory virus panel (RVP) were included in the study. Seventy-two patients were COVID-19 positive. The median age of COVID-19 positive patients and RVP positive patients was 97 and 17 months, respectively. Hypoxia was much more common in patients with RVP than in COVID-19 patients. Low oxygen saturation in arterial blood (SaO2), increased oxygen saturation index (OSI) and fraction of inspired oxygen (FiO2) needs were more significant in RVP patients than in COVID-19 patients. Respiratory support therapies, such as high-flow nasal cannula and non-invasive ventilation (NIV), were used more frequently in RVP patients than in COVID-19 patients.

CONCLUSION

It is important to distinguish between COVID-19 and RVP cases in order to prioritize intensive care needs in these patients. In addition, non-Covid diseases should not be left aside in the pandemic and appropriate care should be provided to them.

Chest X-ray lung imaging features in pediatric COVID-19 and comparison with viral lower respiratory infections in young children

RATIONALE

Chest radiography (CXR) is a noninvasive imaging approach commonly used to evaluate lower respiratory tract infections (LRTIs) in children. However, the specific imaging patterns of pediatric coronavirus disease 2019 (COVID-19) on CXR, their relationship to clinical outcomes, and the possible differences from LRTIs caused by other viruses in children remain to be defined.

METHODS

This is a cross-sectional study of patients seen at a pediatric hospital with polymerase chain reaction (PCR)-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 95). Patients were subdivided in infants (0-2 years, n = 27), children (3-10 years, n = 27), and adolescents (11-19 years, n = 41). A sample of young children (0-2 years, n = 68) with other viral lower respiratory infections (LRTI) was included to compare their CXR features with the subset of infants (0-2 years) with COVID-19.

RESULTS

Forty-five percent of pediatric patients with COVID-19 were hospitalized and 20% required admission to intensive care unit (ICU). The most common abnormalities identified were ground-glass opacifications (GGO)/consolidations (35%) and increased peribronchial markings/cuffing (33%). GGO/consolidations were more common in older individuals and perihilar markings were more common in younger subjects. Subjects requiring hospitalization or ICU admission had significantly more GGO/consolidations in CXR (p < .05). Typical CXR features of pediatric viral LRTI (e.g., hyperinflation) were more common in non-COVID-19 viral LRTI cases than in COVID-19 cases (p < .05).

CONCLUSIONS

CXR may be a complemental exam in the evaluation of moderate or severe pediatric COVID-19 cases. The severity of GGO/consolidations seen in CXR is predictive of clinically relevant outcomes. Hyperinflation could potentially aid clinical assessment in distinguishing COVID-19 from other types of viral LRTI in young children.

Association between cardiometabolic risk factors and COVID-19 susceptibility, severity and mortality: a review

The novel coronavirus, which began spreading from China Wuhan and gradually spreaded to most countries, led to the announcement by the World Health Organization on March 11, 2020, as a new pandemic. The most important point presented by the World Health Organization about this disease is to better understand the risk factors that exacerbate the course of the disease and worsen its prognosis. Due to the high majority of cardio metabolic risk factors like obesity, hypertension, diabetes, and dyslipidemia among the population over 60 years old and higher, these cardio metabolic risk factors along with the age of these people could worsen the prognosis of the coronavirus disease of 2019 (COVID-19) and its mortality. In this study, we aimed to review the articles from the beginning of the pandemic on the impression of cardio metabolic risk factors on COVID-19 and the effectiveness of COVID-19 on how to manage these diseases. All the factors studied in this article, including hypertension, diabetes mellitus, dyslipidemia, and obesity exacerbate the course of Covid-19 disease by different mechanisms, and the inflammatory process caused by coronavirus can also create a vicious cycle in controlling these diseases for patients.

The cardiovascular aspect of COVID-19

The coronavirus disease-2019 (COVID-19), an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2), has hit the world very hard by affecting millions of people across countries hence posing a major health threat on a global scale. This novel virus is thought to enter and cause infection in its host through the attachment of its structural protein known as the S-glycoprotein to angiotensin-converting enzyme 2 (ACE2). Given the rapid spread of COVID-19 with its consequences globally, it is mandatory that health caregivers and researchers across all disciplines abreast themselves with the potential effects that this novel virus may have on their fields and the medical society at large. During the infection, the cardiovascular system is affected by unknown pathomechanistic processes, hence accounting for an increased prevalence of cardiovascular diseases (CVDs) among COVID-19 patients. As cardiovascular researchers, we are more concerned about the cardiovascular aspect of SARS-CoV-2/COVID-19. Hence, this concise review addresses these aspects where CVD as a risk factor of COVID-19, the prevalence of CVDs in COVID-19, and the potential cardiovascular disorders which may evolve owing to COVID-19 are discussed. A better understanding of these issues will be pivotal to improve cardiovascular health during this SARS-CoV-2/COVID-19 pandemic and beyond.

Viral load and rebound in children with coronavirus disease 2019 during the first outbreak in Daegu city

BACKGROUND

Viral load and shedding duration are highly associated with the transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. However, limited studies have reported on viral load or shedding in children and adolescents infected with sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

PURPOSE

This study aimed to investigate the natural course of viral load in asymptomatic or mild pediatric cases.

METHODS

Thirty-one children (<18 years) with confirmed SARS-CoV-2 infection were hospitalized and enrolled in this study. Viral loads were evaluated in nasopharyngeal swab samples using real-time reverse transcription polymerase chain reaction (E, RdRp, N genes). cycle threshold (Ct) values were measured when patients met the clinical criteria to be released from quarantine.

RESULTS

The mean age of the patients was 9.8 years, 18 (58%) had mild disease, and 13 (42%) were asymptomatic. Most children were infected by adult family members, most commonly by their mothers. The most common symptoms were fever and sputum (26%), followed by cough and runny nose. Nine patients (29%) had a high or intermediate viral load (Ct value≤30) when they had no clinical symptoms. Viral load showed no difference between symptomatic and asymptomatic patients. Viral rebounds were found in 15 cases (48%), which contributed to prolonged viral detection. The mean duration of viral detection was 25.6 days. Viral loads were significantly lower in patients with viral rebounds than in those with no rebound (E, P=0.003; RdRp, P=0.01; N, P=0.02).

CONCLUSION

Our study showed that many pediatric patients with coronavirus disease 2019 (COVID-19) experienced viral rebound and showed viral detection for more than 3 weeks. Further studies are needed to investigate the relationship between viral rebound and infectiousness in COVID-19.

The Spectrum of Antibiotic Prescribing During COVID-19 Pandemic: A Systematic Literature Review

Objectives: Over the last decades, there has been a significant increase in antimicrobial prescribing and consumption associated with the development of patients' adverse events and antimicrobial resistance (AMR) to the point of becoming a global priority. This study aims at evaluating antibiotic prescribing during COVID-19 pandemic from November 2019 to December 2020. Materials and Methods: A systematic review was conducted primarily through the NCBI database, using PRISMA guidelines to identify relevant literature for the period between November 1, 2019 and December 19, 2020, using the keywords: COVID-19 OR SARS-Cov-2 AND antibiotics restricted to the English language excluding nonclinical articles. Five hundred twenty-seven titles were identified; all articles fulfilling the study criteria were included, 133 through the NCBI, and 8 through Google Scholar with a combined total of 141 studies. The patient's spectrum included all ages from neonates to elderly with all associated comorbidities, including immune suppression. Results: Of 28,093 patients included in the combined studies, 58.7% received antibiotics (16,490/28,093), ranging from 1.3% to 100% coverage. Antibiotics coverage was less in children (57%) than in adults with comorbidities (75%). Broad-spectrum antibiotics were prescribed presumptively without pathogen identifications, which might contribute to adverse outcomes. Conclusions: During the COVID-19 pandemic, there has been a significant and wide range of antibiotic prescribing in patients affected by the disease, particularly in adults with underlying comorbidities, despite the paucity of evidence of associated bacterial infections. The current practice might increase patients' immediate and long-term risks of adverse events, susceptibility to secondary infections as well as aggravating AMR.

Investigating preventive health behaviors against COVID-19 in elementary school students' parents: A cross-sectional study from Tehran - Capital of Iran

BACKGROUND

Parents act as a role model for children in showing health behaviors. This study investigated factors affecting the preventive behavior in elementary school students' parents based on protection motivation theory (PMT).

MATERIALS AND METHODS

This cross-sectional study was conducted in Tehran (Iran) in 2020. Multistage sampling was used to choose 660 elementary school students' parents. The data collection instrument was a multi-sectional questionnaire, including sections on demographic characteristics, PMT constructs, self-reported health, and information sources related to COVID-19. In this study, descriptive statistics (mean and standard deviation) and analytical statistical methods (Pearson correlation and path analysis) were used to analyze the data. The range of Cronbach's alpha of the study instrument varied from 0.71 to 0.97.

RESULTS

The results of the current study revealed significant association between all PMT constructs and preventive behaviors. Knowledge from both direct and indirect paths was related to preventive behaviors (B = 0.76). Preventive behaviors had the strongest, direct relationship with age (B = 0.76). Based on the final fitted model, knowledge had the greatest impact on preventive behaviors through indirect and direct routes.

CONCLUSION

Knowledge was the most important variable which influenced preventive behavior, and it should be noticed in prevention programs.

What you need to know about children's COVID-19: a systematic review

The aim of the systematic review is to describe clinical features of coronavirus disease 2019 (COVID-19) in children with a focus on the possible reasons why children are less susceptible to COVID-19 and whether their immune response works better than adults. The three research questions below were determined. (1) Why do pediatric COVID-19 cases have milder clinical symptoms than adults? (2) What are clinical manifestations, diagnosis, and treatment of COVID-19 in children? (3) How long lasts viral shedding after recovery? We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Abstracts of Reviews of Effects, as well as foreign literature with English translations. Extra information and data have been collected from Google Scholar and the American Society for Microbiology. Information on patients' age, comorbidities, methods of treatment, and effects on mortality and morbidity were extracted. It is concluded that children are less susceptible to COVID-19 than adults and that the symptoms in children are less severe than in adults. A low incidence of COVID-19 in children and milder disease than in adults might be attributed to many theories and reasons; however, the mechanisms involved are not fully understood.

COVID-19 treatment in children: A systematic review and meta-analysis

Background

Exact information about the efficacy of various medications proposed by regulatory bodies in children with COVID-19 is limited due to the lack of controlled trials in the existing literature.

Methods

Different electronic databases (MEDLINE, EMBASE, Web of Science, COCHRANE CENTRAL, LitCovid, medRxiv, and bioRxiv) were searched for articles describing the management of COVID-19 cases in children with 18 shortlisted medications. Prospective/retrospective studies/case series (with at least 20 cases) reporting COVID-19 in patients aged ≤14 years were searched to collect information regarding clinical details and severity of participants, medications used, and outcome. The pooled estimate of these parameters across studies was performed using a random-effect or fixed-effect meta-analysis depending on the degree of heterogeneity.

Results

From a total of 5794 records, 97 studies/case series (8243 patients) fulfilled the eligibility criteria and were included in this systematic review. A total of 21% children received at least one medication specifically used for COVID-19. While antivirals were used in 15.3% of children, remedesivir was the most commonly used antiviral drug in 6.2% of included children without many reports of serious adverse effects. There was a more prevalent use of anti-inflammatory medications including corticosteroids (27.8%, P = 0.01). Total 91% of severe cases described in literature in children received some anti-inflammatory medications. Among them, corticosteroids (17%) and Intravenous immune globulin (IVIG) (17.5%) were the most predominant followed by interferon (4.2%), tocilizumab (1.5%), and anakinra (0.8%). The most predominant therapy among multisystem inflammatory syndrome in children (MIS-C) cases were IVIG (81%), followed by aspirin (67%), corticosteroids (64%), inotropes (62%), and anticoagulation (56%, mostly low molecular weight heparin, LMWH). Overall mortality was only 1.3%, but when we analyzed separately including only cases with moderate and severe disease, the mortality rate was 4.6%.

Conclusion

Among pharmacological modalities, anti-inflammatory agents like corticosteroids and antivirals like remdesivir have the most promising evidence for severe cases of pediatric COVID-19. Intravenous immunoglobulin and other anti-inflammatory/immunomodulatory agents like anakinra, aspirin, and anticoagulants have important therapeutic role in cases with MIS-C. Most of the mild cases recover with conservative treatment only.

Caregivers' intentions to COVID-19 vaccination for their children in China: a cross-sectional survey

Chinese caregivers' intentions to allow their children to be vaccinated against coronavirus disease 2019 (COVID-19) is unknown. We explored the intention rate of Chinese caregivers to allow their children to be vaccinated and examined potential influencing factors and underlying reasons for their unwillingness or hesitation. From November 30, 2020, to January 31, 2021, we conducted a cross-sectional survey of 3703 caregivers in six representative provinces in China. We assessed intention rates and correlates of caregivers' intentions to vaccinate children against COVID-19, using descriptive analyses and a multiple logistic regression analysis, respectively. In the study sample, about 84.0% of caregivers intended to get their children vaccinated for COVID-19 if the vaccine was available. In particular, 92.2% of caregivers who were willing to be vaccinated themselves for COVID-19 intended to have their children vaccinated, yet among caregivers who were unwilling (or uncertain) whether to be vaccinated, only 41.1% intended to have their children vaccinated. Older age, lower education level, and perceived safety and effectiveness of the COVID-19 vaccine were associated with increased odds of caregivers intending to have their children vaccinated. Of the six provinces included in the study, residence in a province other than Hubei increased the likelihood that caregivers would choose not to have their children vaccinated. We found a relatively high vaccination rate (84.0%) among caregivers by using a cross-sectional sample in China. Concerted efforts are needed to address caregivers' concerns about vaccine safety, especially among caregivers who do not intend to be vaccinated themselves.

Computed tomography findings in 3,557 COVID-19 infected children: a systematic review

Background

Although it was assumed in the early stages of the coronavirus disease 2019 (COVID-19) outbreak that the novel coronavirus infection was uncommon among children, the number of infected children has since been increasing significantly. Real-time polymerase chain reaction (RT-PCR) is the gold standard modality for the diagnosis of COVID-19 infection. In adults, chest CT is performed as an adjunct for identifying suspected COVID-19 cases along with patients' management and follow-up. However, CT findings in COVID-19 children studies have shown a diverse incidence of abnormal CT and finding patterns that made CT scan necessity to have remained controversial. The aim of the present review was to comprehensively determine the imaging findings of chest CT scans of confirmed COVID-19-infected pediatric patients through a systematic review of the available published studies.

Methods

A systematic literature search was performed in the PubMed, Embase, Scopus, and Web of Science core collection databases (four databases including SSCI, SCIE, AHCI, and ESCI) to find original articles containing chest CT findings in children with COVID-19 through May 7, 2021. This review included 81 articles published in English that in total included 3,557 pediatric patients.

Results

This review included 81 articles published in English that in total included 3,557 pediatric patients. Among the total confirmed coronavirus-infected cases (via RT-PCR test), two-thirds had abnormal chest CT findings; among these patients, 549 (37.8%) had bilateral lung involvement, and 475 (32.7%) had unilateral disease. Regarding the types of lung lesions, ground glass opacities were observed in 794 (54.7%) of patients, and consolidation was observed in 10.2%; moreover, halo sign, discrete pulmonary nodules, interstitial abnormalities or reticulations, and vascular thickening shadows were reported in 7.4%, 2.6%, 9.7% and 1.7% of the patients, respectively.

Discussion

This review revealed that chest CT scan manifestations in majority of COVID-19 positive children are mild, so regarding the risk of radiation exposure, it is reasonable to confine CT scan to individual cases that its benefits outweigh the risks.

Study on IoT for SARS-CoV-2 with healthcare: present and future perspective

The ever-evolving and contagious nature of the Coronavirus (COVID-19) has immobilized the world around us. As the daily number of infected cases increases, the containment of the spread of this virus is proving to be an overwhelming task. Healthcare facilities around the world are overburdened with an ominous responsibility to combat an ever-worsening scenario. To aid the healthcare system, Internet of Things (IoT) technology provides a better solution-tracing, testing of COVID patients efficiently is gaining rapid pace. This study discusses the role of IoT technology in healthcare during the SARS-CoV-2 pandemics. The study overviews different research, platforms, services, products where IoT is used to combat the COVID-19 pandemic. Further, we intelligently integrate IoT and healthcare for COVID-19 related applications. Again, we focus on a wide range of IoT applications in regards to SARS-CoV-2 tracing, testing, and treatment. Finally, we effectively consider further challenges, issues, and some direction regarding IoT in order to uplift the healthcare system during COVID-19 and future pandemics.

Risk factors and prediction nomogram model for psychosocial and behavioural problems among children and adolescents during the COVID-19 pandemic: A national multicentre study: Risk Factors of Childhood Psychosocial Problems

BACKGROUND

We aimed to explore the risk profiles attributable to psychosocial and behavioural problems during the coronavirus disease 2019 pandemic. To this end, we created a risk-prediction nomogram model.

METHODS

A national multicentre study was conducted through an online questionnaire involving 12,186 children (6-11 years old) and adolescents (12-16 years old). Respondents' psychosocial and behavioural functioning were assessed using the Achenbach Child Behaviour Checklist (CBCL). Data were analysed using STATA software and R-language.

RESULTS

The positive detection rate of psychological problems within Wuhan was greater than that outside Wuhan for schizoid (P = 0.005), and depression (P = 0.030) in children, and for somatic complaints (P = 0.048), immaturity (P = 0.023), and delinquent behaviour (P = 0.046) in adolescents. After graded multivariable adjustment, seven factors associated with psychological problems in children and adolescents outside Wuhan were parent-child conflict (odds ratio (OR): 4.94, 95% confidence interval (95% CI): 4.27-5.72), sleep problems (OR: 4.05, 95% CI: 3.77-4.36), online study time (OR: 0.41, 95% CI: 0.37-0.47), physical activity time (OR: 0.510, 95% CI: 0.44-0.59), number of close friends (OR: 0.51, 95% CI: 0.44-0.6), time spent playing videogames (OR: 2.26, 95% CI: 1.90-2.69) and eating disorders (OR: 2.71, 95% CI: 2.35-3.11) (all P < 0.001). Contrastingly, within Wuhan, only the first four factors, namely, parent-child conflict (5.95, 2.82-12.57), sleep problems (4.47, 3.06-6.54), online study time (0.37, 0.22-0.64), and physical activity time (0.42, 0.22-0.80) were identified (all P < 0.01). Accordingly, nomogram models were created with significant attributes and had decent prediction performance with C-indexes over 80%.

LIMITATION

A cross-sectional study and self-reported measures.

CONCLUSIONS

Besides the four significant risk factors within and outside Wuhan, the three additional factors outside Wuhan deserve special attention. The prediction nomogram models constructed in this study have important clinical and public health implications for psychosocial and behavioural assessment.

iCOPE With COVID-19: A Brief Telemental Health Intervention for Children and Adolescents During the COVID-19 Pandemic

The COVID-19 pandemic has prompted extensive disruptions to the daily lives of children and adolescents worldwide, which has been associated with an increase in anxiety and depressive symptoms in youth. However, due to public health measures, in-person psychosocial care was initially reduced, causing barriers to mental health care access. This study investigated the feasibility, acceptability and preliminary effectiveness of iCOPE with COVID-19, a brief telemental health intervention for children and adolescents to address anxiety symptoms. Sessions were provided exclusively using videoconferencing technology. Feasibility and acceptability were measured with client satisfaction data. The main outcome measure for effectiveness was anxiety symptom severity measured using the Screen for Child Anxiety and Related Disorders (SCARED). Results indicated that the treatment was well accepted by participants. Significant reductions in anxiety were noted for social anxiety, and were observed to be trending towards a mean decrease for total anxiety. The findings suggest that this brief telemental health intervention focused on reducing anxiety related to COVID-19 is acceptable and feasible to children and adolescents. Future research using a large sample and with a longer follow-up period could inform whether symptom decreases are sustained over time.

Outcomes of multisystem inflammatory syndrome in children temporally related to COVID-19: a longitudinal study

To study the clinical, laboratory characteristics and outcomes of multisystem inflammatory syndrome in children (MIS-C) temporally related to coronavirus disease 2019 (COVID-19) in a resource-limited setting. All children meeting the World Health Organization case definition of MIS-C were prospectively enrolled. Baseline clinical and laboratory parameters were compared between survivors and non-survivors. Enrolled subjects were followed up for 4-6 weeks for evaluation of cardiac outcomes using echocardiography. The statistical data were analyzed using the stata-12 software. Thirty-one children with MIS-C were enrolled in an 11-month period. Twelve children had preexisting chronic systemic comorbidity. Fever was a universal finding; gastrointestinal and respiratory manifestations were noted in 70.9% and 64.3%, respectively, while 57.1% had a skin rash. Fifty-eight percent of children presented with shock, and 22.5% required mechanical ventilation. HSP like rash, gangrene and arthritis were uncommon clinical observations.The median duration of hospital stay was 9 (6.5-18.5) days: four children with preexisting comorbidities succumbed to the illness. The serum ferritin levels (ng/ml) [median (IQR)] were significantly higher in non-survivors as compared to survivors [1061 (581, 2750) vs 309.5 (140, 720.08), p value = 0.045]. Six patients had coronary artery involvement; five recovered during follow-up, while one was still admitted. Twenty-six children received immunomodulatory drugs, and five improved without immunomodulation. The choice of immunomodulation (steroids or intravenous immunoglobulin) did not affect the outcome. Most children with MIS-C present with acute hemodynamic and respiratory symptoms.The outcome is favorable in children without preexisting comorbidities.Raised ferritin level may be a poor prognostic marker. The coronary outcomes at follow-up were reassuring.

A case series of pediatric COVID-19 with complicated symptoms in Iran

People in different age groups are susceptible to SARS-CoV-2 infection as a newly emerging virus. However, the clinical course, symptoms and disease outcome vary from case to case. Although COVID-19 is usually milder in children than adults, some studies reported nonspecific symptoms. Here, we report eight pediatric cases of COVID-19 admitted in the Taleghani Children Hospital in Gorgan city, north of Iran, with complicated symptoms. The current case series poses several challenges to the pediatricians regarding the pediatric cases of COVID-19. As most literature relating to adults are not always transferable to children, clinicians should be warned about such presentations among children with COVID-19.

A poor and delayed anti-SARS-CoV2 IgG response is associated to severe COVID-19 in children

Background

Most children and youth develop mild or asymptomatic disease during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, a very small number of patients suffer severe Coronavirus induced disease 2019 (COVID-19). The reasons underlying these different outcomes remain unknown.

Methods

We analyzed three different cohorts: children with acute infection (n=550), convalescent children (n=138), and MIS-C (multisystem inflammatory syndrome in children, n=42). IgG and IgM antibodies to the spike protein of SARS-CoV-2, serum-neutralizing activity, plasma cytokine levels, and the frequency of circulating Follicular T helper cells (cTfh) and plasmablasts were analyzed by conventional methods.

Findings

Fifty-eight percent of the children in the acute phase of infection had no detectable antibodies at the time of sampling while a seronegative status was found in 25% and 12% of convalescent and MIS-C children, respectively. When children in the acute phase of the infection were stratified according disease severity, we found that contrasting with the response of children with asymptomatic, mild and moderate disease, children with severe COVID-19 did not develop any detectable response. A defective antibody response was also observed in the convalescent cohort for children with severe disease at the time of admission. This poor antibody response was associated to both, a low frequency of cTfh and a high plasma concentration of inflammatory cytokines.

Interpretation

A weak and delayed kinetic of antibody response to SARS-CoV-2 together with a systemic pro-inflammatory profile characterize pediatric severe COVID-19. Because comorbidities are highly prevalent in children with severe COVID-19, further studies are needed to clarify their contribution in the weak antibody response observed in severe disease.

Funding

National Agency for Scientific and Technological Promotion from Argentina (IP-COVID-19-0277 and PMO-BID-PICT2018-2548).

Clinical overview for pediatric population with SARS-CoV-2 and care: review

OBJECTIVE

To identify in the scientific literature the clinical overview of the pediatric population that tested positive for SARS-CoV-2 and care recommendations and recommendations among children who tested positive for SARS-CoV-2 in the scientific literature.

METHOD

Rapid review based on the guidelines of the Joana Briggs Institute: elaboration of the research question, structured search of the literature in April 2020, in nine databases, selection and critical analysis of the eighteen primary studies (using two instruments to assess methodological quality), elaboration of the synthesis, incorporation of suggestions and dissemination.

RESULT

The most frequent clinical overview was respiratory, gastrointestinal symptoms and fever. The images showed irregular frosted glass opacification. It is recommended to screen the pediatric population and family members who show signs and symptoms and to adopt isolation for more than fourteen days.

CONCLUSION

The clinical overview in pediatric population is varied, not exclusively with respiratory symptoms, and a significant number of asymptomatic patients. The importance of new investigations is highlighted, such as randomized clinical trial or cohort studies, identifying their participation in the transmission of COVID-19.

Yisaipu® Provide AS Patients With an Economical Therapeutic Option While Original Biologicals are More Advantageous in the COVID-19 Epidemic Situation

Objectives: Anti-tumor necrosis factor (TNF) agents have been regarded as the most effective treatment for ankylosing spondylitis (AS) so far. However, economic factors limited the prescription of original biologicals in China. Yisaipu® is a biosimilar for etanercept as pre fill syringes (PFS), which has entered China's national medical insurance catalog for more than 10 yr and was widely used because it greatly reduced the economic burden of AS patients. Yisaipu® is provided subcutaneous injection in hospital setting only. We collected clinical data of AS patients before, during and after COVID-19 epidemic, in an attempt to investigate the advantages and disadvantages of original biologicals and Yisaipu® during regular follow up and COVID-19 epidemic. Methods: AS patients who received original biologicals or Yisaipu® in our department for more than 1 yr were included in our study. General data, demographic characteristics, disease activity, quality of life and medical compliance were collected from regular visits. The patients were followed up through telephone interviews from April 20th to 27th, 2020 about the overall impact of the COVID-19 epidemic. Results: There was no significant difference in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score-CRP (ASDAS-CRP) between the two groups. Health Assessment Questionnaire for Spondyloarthropathies (HAQ-s) showed that Yisaipu® group was superior to original biological group in terms of eating, gripping and driving. In addition, the medical cost of Yisaipu® was lower than that of original biologicals. The overall impact of the COVID-19 epidemic on patients of original biological group was comparatively smaller than that on Yisaipu® group. Conclusions: Yisaipu® provided AS patients with an economical selection during regular follow-up, while original biologicals had certain advantages in the COVID-19 epidemic setting, including a longer time interval between two drug administrations and the self-injection dose form of medication.

[Clinical manifestations of COVID-19 in children]

The neurological symptoms of COVID-19 in children (in Dyurtyuli area, Republic of Bashkortostan) are analyzed and brief review of the literature is undertaken in the paper. 137 children underwent swab test for COVID-19. The disease was diagnosed in 9 of them. Only respiratory symptoms were observed in 3 children, a combination of respiratory with anosmia or/and headache - in 3, asymptomatic form - in another 3. A case of a 7-years old girl suffering from COVID-19 with respiratory symptoms as well as anosmia and headache is presented. According to the review of the literature, COVID - 19 in children is usually milder than in adults, but in some cases may lead to neurological consequences. Multisystem inflammatory syndrome may lead to the development symptoms of encephalopathy (altered mental status, headache) and stroke. Autoimmune complications such as Gillian-Barre syndrome develop simultaneously or after resolving of the infectious process. The development of viral meningoencephalitis in COVID-19 is questionable.

An overview of the COVID-19 complications in paediatric population: A pandemic dilemma

AIM

The primary objective of this article is to understand the various complications caused by the coronavirus in the paediatric population.

METHOD

An electronic search was conducted using PubMed and incorporated forward and backward research methods on clinical trials, case reports, case series, guidelines and reports from the centre for disease control and prevention (CDC), and the keywords included COVID-19, paediatrics, multisystem inflammatory syndrome in children (MIS-C), complications, acute kidney injury and heart failure. Secondary resources included one study from preprint servers (www.preprints.org), last search 8 May 2021, with notion of nonpeer review status. Data were collected and analysed to stay current with the most recent alerts and guidelines for the best care for children during the COVID-19 pandemic.

RESULTS

Evaluation and analysis of literature revealed MIS-C to be the most prevalent followed by neurological complications. Whereas the least prevalent were septic shock and ophthalmic complications.

CONCLUSION

Even though COVID-19 is known to be a less severe in the paediatric population, the complications of the virus have caused a great deal of stress to the paediatric patients' parents and paediatricians worldwide, and hence, emphasis should be given to the management of coronavirus complications in paediatrics.

Clinical and laboratory findings of COVID-19: A systematic review and meta-analysis

BACKGROUND/PURPOSE

The aim of this study was to systematically review all COVID-19 publications to summarize the clinical features, assess comorbidities, prevalence, and disease outcomes.

METHODS

Included were all COVID-19 published studies between January 1 to July 20, 2020. The random effect model was used to calculate the pooled prevalence and corresponding 95% confidence interval (CI). Publication bias was assessed using the funnel plot for the standard error by logit event.

RESULTS

The mean age of the patients was 46.8 years (95% CI, 41.0-52.6) and males comprised 54.0% (95% CI, 51.3-56.7). Total co-morbidities prevalence was 29.5% (95% CI, 19.0-36.6), with diabetes mellitus being the most prevalent 13.8% (95% CI, 8.7-21.1), followed by hypertension 11.7% (95% CI, 5.7-22.6), and cardiovascular disease 9.7% (95% CI, 6.5-14.2). The most common clinical manifestations were fever, 82.0% (95% CI, 67.7-90.8), cough 54.3% (95% CI, 45.5-62.9), fatigue 30.2% (95% CI, 23.3-38.1), sputum 28.5% (95% CI, 21.2-37.2), sore throat 21.7% (95% CI, 14.6-31.0), and headache 11.0% (95% CI, 7.9-15.2). The most common COVID-19 serious complications were RNA Anemia 98.2% (95% CI, 96.2-99.2), hospitalization 83.7% (95% CI, 76.0-89.3), bilateral pneumonia 70.9% (95% CI, 58.2-81.0); of those hospitalized 43.5% (95% CI, 24.9-64.2) were discharged. Fatality accounted for 10.5% (95% CI 6.8-16.1).

CONCLUSION

Patients infected with COVID-19 coronavirus showed a wide range of clinical presentation with non-specific symptoms.

Seroprevalence and risk factors of SARS-CoV-2 infection in an urban informal settlement in Nairobi, Kenya, December 2020

Introduction: Urban informal settlements may be disproportionately affected by the COVID-19 pandemic due to overcrowding and other socioeconomic challenges that make adoption and implementation of public health mitigation measures difficult. We conducted a seroprevalence survey in the Kibera informal settlement, Nairobi, Kenya, to determine the extent of SARS-CoV-2 infection. Methods: Members of randomly selected households from an existing population-based infectious disease surveillance (PBIDS) provided blood specimens between 27th November and 5th December 2020. The specimens were tested for antibodies to the SARS-CoV-2 spike protein. Seroprevalence estimates were weighted by age and sex distribution of the PBIDS population and accounted for household clustering. Multivariable logistic regression was used to identify risk factors for individual seropositivity.   Results: Consent was obtained from 523 individuals in 175 households, yielding 511 serum specimens that were tested. The overall weighted seroprevalence was 43.3% (95% CI, 37.4 – 49.5%) and did not vary by sex. Of the sampled households, 122(69.7%) had at least one seropositive individual. The individual seroprevalence increased by age from 7.6% (95% CI, 2.4 – 21.3%) among children (<5 years), 32.7% (95% CI, 22.9 – 44.4%) among children 5 – 9 years, 41.8% (95% CI, 33.0 – 51.1%) for those 10-19 years, and 54.9%(46.2 – 63.3%) for adults (≥20 years). Relative to those from medium-sized households (3 and 4 individuals), participants from large (≥5 persons) households had significantly increased odds of being seropositive, aOR, 1.98(95% CI, 1.17 – 1.58), while those from small-sized households (≤2 individuals) had increased odds but not statistically significant, aOR, 2.31 (95% CI, 0.93 – 5.74).  Conclusion: In densely populated urban settings, close to half of the individuals had an infection to SARS-CoV-2 after eight months of the COVID-19 pandemic in Kenya. This highlights the importance to prioritize mitigation measures, including COVID-19 vaccine distribution, in the crowded, low socioeconomic settings.

Convalescent COVID-19 Patients Without Comorbidities Display Similar Immunophenotypes Over Time Despite Divergent Disease Severities

COVID-19, the disease caused by SARS-CoV-2 infection, can assume a highly variable disease course, ranging from asymptomatic infection, which constitutes the majority of cases, to severe respiratory failure. This implies a diverse host immune response to SARS-CoV-2. However, the immunological underpinnings underlying these divergent disease courses remain elusive. We therefore set out to longitudinally characterize immune signatures of convalescent COVID-19 patients stratified according to their disease severity. Our unique convalescent COVID-19 cohort consists of 74 patients not confounded by comorbidities. This is the first study of which we are aware that excludes immune abrogations associated with non-SARS-CoV-2 related risk factors of disease severity. Patients were followed up and analyzed longitudinally (2, 4 and 6 weeks after infection) by high-dimensional flow cytometric profiling of peripheral blood mononuclear cells (PBMCs), in-depth serum analytics, and transcriptomics. Immune phenotypes were correlated to disease severity. Convalescence was overall associated with uniform immune signatures, but distinct immune signatures for mildly versus severely affected patients were detectable within a 2-week time window after infection.

The Clinical Characteristics of Fever-Ward Pediatric Patients with a Definite Epidemiological History During the Early COVID-19 Epidemic Period

OBJECTIVE

The number of children presenting with coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 infection is increasing, and we aimed to assess the clinical characteristics of pediatric patients with a definite epidemiological history during the early COVID-19 epidemic.

METHODS

Retrospective analysis was performed on the clinical data of children admitted to the fever ward of Xiangyang Central Hospital in Hubei province between January 1, 2020 and March 17, 2020. According to definite epidemiological history, patients with SARS-CoV-2 nucleic acid test (NAT) positive detection were grouped as confirmed cases, and patients with two consecutive negative NATs were grouped as suspected cases. We compared the clinical characteristics of the two groups.

RESULTS

A total of 47 (47/127, 37%) cases had a definite epidemiological history, of which 32 (68.1%) were suspected, with a median age of 5.5 years (interquartile range [IQR]: 0.7-10.3), and 15 (31.9%) were confirmed, with a median age of 9 years (IQR: 4-14). Statistically significant differences in age, family cluster of infection, and numbers of patients with clinical symptoms and fever (P<0.05) were found between the two groups, but no statistically significant differences in leucocyte and lymphocyte counts were observed (P>0.05). Significant differences were found in the computed tomography (CT) manifestation of ground glass opacity (GGO) between the two groups (P<0.05).

CONCLUSION

Children of older age and from family clusters of infection were more easily diagnosed as having COVID-19. GGO changes on chest CT was more likely in confirmed cases. Although obvious clinical manifestations increase our awareness of COVID-19, children without manifestations of fever or cough should not be ignored as they may be asymptomatic carriers.

A Single-Center (Sibiu, Romania), Retrospective Study (March-November 2020) of COVID-19 Clinical and Epidemiological Features in Children

The aim of this study was to describe and analyze epidemiological and clinical features of children screened for COVID-19 at Sibiu Pediatric Clinical Hospital during the first 9 months (March-November) of coronavirus disease pandemic in Romania. A total of 203 pediatric patients with a confirmed diagnosis of COVID-19 were included in the study. The median age of the patients was 121 (IQR 18-181) months and 52.22% had mild clinical type with pneumonia, 35.47% were moderate cases, 3.94% severe cases, 0.99% critically ill cases and 7.39% were asymptomatic. The most common symptoms were fever (n = 130, 64.03%), nasal congestion (n = 138, 67.98%), cough (n = 128, 63.05%) followed by sore throat (n = 64, 31.52%), rhinorrhea (n = 63, 31.03%), fatigue (n = 57, 28.07%), headache (n = 47, 23.15%), diarrhea (n = 39, 19.21%), vomiting (n = 32, 15.76%), myalgia (n = 24, 11.82%), abdominal pain (n = 22, 10.83%). A higher proportion of infants with severe or critical disease was encountered with lymphopenia (n = 9, 90%), neutrophilia (n = 5, 50%), leukocytosis (n = 5, 50%) compared with asymptomatic infants (n = 10, 66.67%, n = 1, 6.67%, n = 3, 20%) or mild (n = 53, 50%, n = 19, 17.92%, n = 15, 14.15%) and moderate (n = 37, 51.39%, n = 9, 12.50%, n = 6, 8.33%) cases (p = 0.095, p = 0.042, p = 0.034). Pediatric patients generally had mild or moderate type of COVID-19, and the critically ill cases were rare. In our study, frequent symptoms were observed in both the systemic and respiratory systems, ear, nose and throat system, and less from gastrointestinal system, central nervous system or ocular system. Additionally, there is an increase in liver and myocardial enzyme levels with an increase in disease severity. Understanding the clinical and laboratory characteristics of pediatric patients is important for diagnosis, management and effective control of the disease.

SARS-CoV-2 and pediatric solid organ transplantation: Current knowns and unknowns

The COVID-19 pandemic has proven to be a challenge in regard to the clinical presentation, prevention, diagnosis, and management of SARS-CoV-2 infection among children who are candidates for and recipients of SOT. By providing scenarios and frequently asked questions encountered in routine clinical practice, this document provides expert opinion and summarizes the available data regarding the prevention, diagnosis, and management of SARS-CoV-2 infection among pediatric SOT candidates and recipients and highlights ongoing knowledge gaps requiring further study. Currently available data are still lacking in the pediatric SOT population, but data have emerged in both the adult SOT and general pediatric population regarding the approach to COVID-19. The document provides expert opinion regarding prevention, diagnosis, and management of SARS-CoV-2 infection among pediatric SOT candidates and recipients.