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Martella M, Peano A, Politano G, Onorati R, Gianino MM. Paediatric hospitalizations over three waves of COVID-19 (February 2020 to May 2021) in Italy: determinants and rates. PeerJ 2023; 11:e15492. [PMID: 37377787 PMCID: PMC10292193 DOI: 10.7717/peerj.15492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/10/2023] [Indexed: 06/29/2023] Open
Abstract
Background After a pneumonia outbreak in late 2019 in China, a new virus related to the Coronaviridae strain, called Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), was identified as the pathogen of an emerging disease known as COronaVIrus Disease 19 (COVID-19). Preliminary evidence outlines a higher prevalence in adults and lower susceptibility in children. However, recent epidemiologic research highlighted that transmissibility and susceptibility among children and adolescents become higher due to new virus variants. Infections among youth arises with mainly respiratory and gastrointestinal symptoms and malaise. Nevertheless, critical illness affects new-borns and fragile children, requiring hospitalization and possibly intensive care support. Aim of this study was to examine the impact of COVID-19 pandemic on hospital admissions among children and adolescents aged 0 to 17 years over three waves of COVID-19 (from February 2020 to May 2021) in Piedmont, a large Italian region, and to investigate the possible determinants of hospitalizations. Methods A meta-analysis for risk assessment was performed over three waves of COVID-19 (from February 2020 to May 2021). Data were extracted from the official Italian National Information System and ISTAT. Results Overall, 442 paediatric patients were enrolled and admissions concerned mostly the age group 0-4 years (60.2%). Trends of hospitalization showed a slight increase of paediatric admissions already in March 2020 and a rise during second and third waves (November 2020, March 2021). Paediatric age-grouped hospitalizations (0-4; 12-17; 5-11) reproduced an analogous trend. The children and adolescent hospitalization rate appeared lower than overall population with a moderate slope of increase in comparison with population slope. Monthly hospitalization rate (per 100,000) of children and adolescents aged 0-17 years reproduced the increasing trend of hospitalization numbers. This trend was influenced, in particular, by the trend of hospitalization rates for children aged 0-4 years. The meta-analysis for risk assessment showed a decreased likelihood of rescue of hospitalizations in female, 5-11 and 12-17 age groups. Conversely, the meta-analysis showed a positive association between foreign nationality and hospitalizations. Conclusions Our results show a comparable trend of paediatric hospital admissions for COVID-19 and of the entire population hospitalizations over three waves. COVID-19 hospital admissions increase with a bimodal age distribution and the most admissions are among patients aged ≤4 or 5-11 years. Significant predictive factors of hospitalization are identified.
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Affiliation(s)
- Manuela Martella
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Piedmont, Italy
| | - Alberto Peano
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Piedmont, Italy
| | - Gianfranco Politano
- Department of Control and Computer Engineering, University of Turin, Turin, Piedmont, Italy
| | - Roberta Onorati
- Epidemiology Unit, Local Health Authority TO3, Grugliasco (Turin), Piedmont, Italy
| | - Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Piedmont, Italy
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Warschburger P, Kamrath C, Lanzinger S, Sengler C, Wiegand S, Göldel JM, Weihrauch-Blüher S, Holl RW, Minden K. A prospective analysis of the long-term impact of the COVID-19 pandemic on well-being and health care among children with a chronic condition and their families: a study protocol of the KICK-COVID study. BMC Pediatr 2023; 23:130. [PMID: 36949465 PMCID: PMC10031163 DOI: 10.1186/s12887-023-03912-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/17/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND There is consistent evidence that the COVID-19 pandemic is associated with an increased psychosocial burden on children and adolescents and their parents. Relatively little is known about its particular impact on high-risk groups with chronic physical health conditions (CCs). Therefore, the primary aim of the study is to analyze the multiple impacts on health care and psychosocial well-being on these children and adolescents and their parents. METHODS We will implement a two-stage approach. In the first step, parents and their underage children from three German patient registries for diabetes, obesity, and rheumatic diseases, are invited to fill out short questionnaires including questions about corona-specific stressors, the health care situation, and psychosocial well-being. In the next step, a more comprehensive, in-depth online survey is carried out in a smaller subsample. DISCUSSION The study will provide insights into the multiple longer-term stressors during the COVID-19 pandemic in families with a child with a CC. The simultaneous consideration of medical and psycho-social endpoints will help to gain a deeper understanding of the complex interactions affecting family functioning, psychological well-being, and health care delivery. TRIAL REGISTRATION German Clinical Trials Register (DRKS), no. DRKS00027974. Registered on 27th of January 2022.
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Affiliation(s)
- Petra Warschburger
- Department of Psychology, Counseling Psychology, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany.
| | - Clemens Kamrath
- Center of Child and Adolescent Medicine, University of Giessen, Gießen, Germany
| | - Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Claudia Sengler
- Deutsches Rheuma-Forschungszentrum (DRFZ), Program Area Epidemiology, Berlin, Germany
| | - Susanna Wiegand
- Center for Social-Pediatric Care, Department of Pediatric Endocrinology and Diabetology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt- Universität zu Berlin, Berlin, Germany
| | - Julia M Göldel
- Department of Psychology, Counseling Psychology, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
| | - Susann Weihrauch-Blüher
- Department of Pediatrics I, Pediatric Endocrinology, University Hospital Halle/S, Halle/S, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Kirsten Minden
- Deutsches Rheuma-Forschungszentrum (DRFZ), Program Area Epidemiology, Berlin, Germany
- Department of Pediatric Respiratory Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt- Universität zu Berlin, Immunology and Critical Care Medicine at Charité University Hospital Berlin, Berlin, Germany
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Heudorf U, Gottschalk R, Walczok A, Tinnemann P, Steul K. [Children in the COVID-19 pandemic and the public health service (ÖGD) : Data and reflections from Frankfurt am Main, Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1559-1569. [PMID: 34705052 PMCID: PMC8548699 DOI: 10.1007/s00103-021-03445-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/30/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND The measures taken to combat the COVID-19 pandemic have severely restricted the opportunities for the development of children. This paper will discuss the reporting data of children and the public health department's activities against the background of the restrictions of school and leisure time offers as well as sports and club activities. MATERIALS AND METHODS Reporting data from Frankfurt am Main, Hesse, were obtained using a SURVStat query for the calendar weeks 10/2020-28/2021 and from SURVNet (until 30 June 2021). Contact persons (CP) of SARS-CoV‑2 positive persons from schools and daycare centers were screened for SARS-CoV‑2 by PCR test. These results and those of rapid antigen testing, which has been mandatory for schoolchildren since April 2021, are presented. RESULTS Until Easter break, the age-related seven-day incidence values per 100,000 for children 14 years of age and younger were lower than the overall incidence; it was only higher after rapid antigen-testing was mandatory for schoolchildren. Most children with SARS-CoV‑2 had no or mild symptoms; hospitalization was rarely required and no deaths occurred. Contact tracing in schools and daycare centers found no positive contacts in most cases and rarely more than two. Larger outbreaks did not occur. CONCLUSION SARS-CoV‑2 infections in children appear to be less frequent and much less severe than in adults. Hygiene rules and contact management have proven themselves effective during times with high incidences in the local population without mandatory rapid antigen testing - and even with a high proportion of variants of concern (alpha and delta variants) in Germany. Against this background, further restriction of school and daycare operations appears neither necessary nor appropriate.
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Affiliation(s)
- Ursel Heudorf
- Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt, Deutschland
| | - René Gottschalk
- Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt, Deutschland
| | - Antoni Walczok
- Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt, Deutschland
| | - Peter Tinnemann
- Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt, Deutschland
| | - Katrin Steul
- Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt, Deutschland.
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Busch C, Blickle M, Schmidt B, Sievers LK, Pfitzer C. SARS-CoV-2 in Pediatric Inpatient Care: Management, Clinical Presentation and Utilization of Healthcare Capacity. Healthcare (Basel) 2021; 9:healthcare9091190. [PMID: 34574965 PMCID: PMC8471439 DOI: 10.3390/healthcare9091190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022] Open
Abstract
This study scrutinizes management and clinical presentation of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) in pediatric inpatient care and evaluates the utilization of pediatric healthcare capacity during the pandemic. Within this retrospective cohort study, we systematically reviewed data of all 16,785 pediatric patients (<18 years admitted to our clinical center between January 2018 and June 2021). Data on SARS-CoV-2 test numbers, hospital admissions and clinical characteristics of infected patients were collected. Since January 2020, a total of 2513 SARS-CoV-2 tests were performed. In total, 36 patients had a positive test result. In total, 25 out of 36 SARS-CoV-2 positive children showed at least mild clinical symptoms while 11 were asymptomatic. Most common clinical symptoms were fever (60%), cough (60%) and rhinitis (20%). In parallel with the rising slope of SARS-CoV-2 in spring and fall 2020, we observed a slight decrease in the number of patients admitted to the pediatric department while the median duration of hospital treatment and intensive care occupancy remained unchanged. This study underlines that SARS-CoV-2 infected children most frequently exhibit an asymptomatic or mild clinical course. Noteworthy, the number of hospital admissions went down during the pandemic. The health and economic consequences need to be discussed within health care society and politics.
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Affiliation(s)
- Christine Busch
- St. Joseph Krankenhaus Berlin-Tempelhof GmbH, 12101 Berlin, Germany; (C.B.); (M.B.); (B.S.)
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, 13353 Berlin, Germany;
| | - Maximilian Blickle
- St. Joseph Krankenhaus Berlin-Tempelhof GmbH, 12101 Berlin, Germany; (C.B.); (M.B.); (B.S.)
| | - Beatrix Schmidt
- St. Joseph Krankenhaus Berlin-Tempelhof GmbH, 12101 Berlin, Germany; (C.B.); (M.B.); (B.S.)
| | - Laura Katharina Sievers
- Department of Internal Medicine I, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
- Correspondence:
| | - Constanze Pfitzer
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, 13353 Berlin, Germany;
- Clinic of Neonatology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Berlin Institute of Health, Charité, 10178 Berlin, Germany
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Green R, Webb D, Jeena PM, Wells M, Butt N, Hangoma JM, Moodley R(S, Maimin J, Wibbelink M, Mustafa F. Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa. Afr J Emerg Med 2021; 11:283-296. [PMID: 33912381 PMCID: PMC8063696 DOI: 10.1016/j.afjem.2020.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/08/2020] [Accepted: 11/15/2020] [Indexed: 12/24/2022] Open
Abstract
Fever is one of the most common reasons for unwell children presenting to pharmacists and primary healthcare practitioners. Currently there are no guidelines for assessment and management of fever specifically for community and primary healthcare workers in the sub-Saharan Africa region. This multidisciplinary consensus guide was developed to assist pharmacists and primary healthcare workers in sub-Saharan Africa to risk stratify and manage children who present with fever, decide when to refer, and how to advise parents and caregivers. Fever is defined as body temperature ≥ 37.5 °C and is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with self-limiting illness, it causes significant concern to both parents and attending healthcare workers. Clinical signs may be used by pharmacy staff and primary healthcare workers to determine level of distress and to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who could be managed conservatively at home. In children with warning signs, serious causes of fever that may need to be excluded include infections (including malaria), non-infective inflammatory conditions and malignancy. Simple febrile convulsions are not in themselves harmful, and are not necessarily indicative of serious infection. In the absence of illness requiring specific treatment, relief from distress is the primary indication for prescribing pharmacotherapy, and antipyretics should not be administered with the sole intention of reducing body temperature. Care must be taken not to overdose medications and clear instructions should be given to parents/caregivers on managing the child at home and when to seek further medical care.
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Affiliation(s)
- Robin Green
- Department Paediatrics and Child Health, University of Pretoria, South Africa
| | - David Webb
- Houghton House Group, Johannesburg, South Africa
| | - Prakash Mohan Jeena
- Department of Paediatrics & Child Health, University of KwaZulu Natal, Durban, South Africa
| | - Mike Wells
- Division of Emergency Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Jackie Maimin
- South African Pharmacy Council, Johannesburg, South Africa
| | | | - Fatima Mustafa
- Steve Biko Academic Hospital, Department of Paediatrics and Child Health, University of Pretoria, South Africa
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Heudorf U, Steul K, Walczok A, Gottschalk R. [Children and COVID-19-Data from mandatory reporting and results of contact person testing in daycare centers and schools in Frankfurt am Main, Germany, August-December 2020]. Monatsschr Kinderheilkd 2021; 169:322-334. [PMID: 33678906 PMCID: PMC7922714 DOI: 10.1007/s00112-021-01134-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/26/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND In face of the coronavirus disease 2019 (COVID-19) pandemic, the question that children are also drivers of this pandemic and that groups, classes, or the entire facility should be closed when severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurs in schools or daycare centers is always implied. These questions were investigated using the mandatory reporting data in Frankfurt am Main and the extensive testing of contact persons (CP) in schools and daycare centers after the occurrence of an index case. METHOD The reporting data were taken from SurvStat. The index cases from daycare centers and schools were isolated and the CPs were offered PCR testing for SARS-CoV‑2 on a voluntary basis, regardless of whether symptoms suggestive of SARS-CoV‑2 had occurred or not. Deep nasal/pharyngeal swabs were collected by paramedics on behalf of the public health department of the city of Frankfurt am Main, Germany, and tested according to established standards at two accredited institutes. RESULTS From March to 31 December 2020, 22,715 COVID-19 cases were reported in Frankfurt, including 1588 (7.6%) SARS-CoV‑2 detections in children 14 years and younger. Thus, approximately half as many SARS-CoV‑2 detections were reported in children up to 14 years of age than would have corresponded to their proportion in the population. In autumn 2020, the increase in incidence in children over the weeks followed the increase in incidence in the general population, the age-related incidence of children remained below the incidence in the general population.From week 35 to week 52, index cases were reported from 143 daycare centers and 75 schools. As a result, 7915 CPs were tested. In daycare centers, SARS-CoV‑2 was detected in 4.5% of adult CPs and 2.5% of child CPs and in schools SARS-CoV‑2 was detected in 0.9% of adult CPs and 2.5% of student CPs tested. On average, less than 1 CP tested positive per index case. The rate of positive findings increased with increasing incidence in the overall population. No major outbreak occurred. DISCUSSION Regarding the level and timing of age-related incidences among children in Frankfurt am Main, there was no evidence that children were the drivers of the pandemic. Only a small percentage of the examined CPs in schools and daycare centers tested positive for SARS-CoV‑2. In the absence of evidence of intense transmission in the facilities, CP attendance can/should continue under hygiene conditions and there is no need to close entire groups, classes, or even facilities.
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Affiliation(s)
- Ursel Heudorf
- MRE-Netz Rhein-Main, Frankfurt, c/o Gesundheitsamt Frankfurt am Main, Frankfurt, Deutschland
| | - Katrin Steul
- Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313 Frankfurt, Deutschland
| | - Antoni Walczok
- Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313 Frankfurt, Deutschland
| | - Rene Gottschalk
- Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313 Frankfurt, Deutschland
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Leung C. The younger the milder clinical course of COVID-19: Even in newborns? Pediatr Allergy Immunol 2021; 32:358-362. [PMID: 32931058 DOI: 10.1111/pai.13371] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/13/2020] [Accepted: 09/03/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Milder symptoms were observed in children with COVID-19. However, whether this also holds true for neonates is not known. METHODS The clinical data of a total of 3213 patients aged 2 years or below, including 749 neonates, in Brazil nationwide were studied. Comparisons were made between neonate and infant patients by conducting statistical tests. RESULTS Neonates appeared to bear more severe clinical courses. In addition to higher case fatality rates, newborns with COVID-19 had much shorter time from symptom onset to death and longer time from symptom onset to discharge. Dyspnoea, sore throat and cough were more prominent in neonate patients, suggestive of both upper and lower respiratory tract infection, as opposed to upper respiratory tract symptoms mostly observed in children. CONCLUSION Findings suggested that trained immunity provides a possible explanation because the innate immune system in newborns is not "well-trained" while that in adult tends to hyperactive.
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Affiliation(s)
- Char Leung
- Deakin University, Burwood, Vic, Australia
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Schäfer FM, Meyer J, Kellnar S, Warmbrunn J, Schuster T, Simon S, Meyer T, Platzer J, Hubertus J, Seitz ST, Knorr C, Stehr M. Increased Incidence of Perforated Appendicitis in Children During COVID-19 Pandemic in a Bavarian Multi-Center Study. Front Pediatr 2021; 9:683607. [PMID: 34026695 PMCID: PMC8138624 DOI: 10.3389/fped.2021.683607] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/12/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction: Since early 2020 the COVID-19 pandemic and statutory preventive reorganization of treatment capacities with cancellation of elective surgery as well as curfew regulations led to vastly decreased utilization of primary health care. Materials and Methods: To assess whether there are negative effects on pediatric acute care in Bavaria during the spring 2020 lockdown a state-wide retrospective multi-center study was performed to analyze the rate of perforated appendicitis during lockdown. Children who have been operated on during the corresponding period in 2018/19 served as control group. Results: Overall, 514 patients (292 boys, 222 girls) were included (2020: 176 patients; 2019: 181 patients; 2018: 157 patients). Median age was 11.2 years. Four hundred thirty-nine patients (85.4%) underwent laparoscopic surgery, 69 (13.4%) open surgery and 1.2% underwent conversion from laparoscopic to open surgery. In 2020 a perforation rate of 27.8% (49/176 patients) was found, in 2018-2019 perforation rate was 20.7% (70/338 patients, p = 0.0359, Cochran-Mantel-Haenszel-Test). Subgroup analysis showed that in younger patients (≤ 11.2 years), in 2020 perforation rate was significantly higher with 37.6% (32/85 patients), while 22.2% (39/176) in 2018/2019 (p = 0.014, Fisher's exact test).In boys perforation rate was significantly higher in 2020 with 35.0% (35/100 patients) compared to 21.4% in 2018-2019 (p = 0.0165, Fisher's exact test). Conclusion: During the period of curfew regulations in Bavaria the rate of perforated appendicitis in childhood increased significantly, especially in younger children and boys. Potentially this has to be attributed to delayed presentation to pediatric surgery care. Because of potential long-term sequelae of perforated appendicitis these adverse effects during curfew have to be taken into account for future political decision making to ensure reasonable patient care and avoid collateral damage in near-future or on-going pandemic situations.
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Affiliation(s)
- Frank-Mattias Schäfer
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Nuremberg, Germany
| | - Johannes Meyer
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Nuremberg, Germany
| | - Stephan Kellnar
- Department of Pediatric Surgery, Klinikum Dritter Orden, Munich, Germany
| | - Jakob Warmbrunn
- Department of Pediatric Surgery, Klinikum Schwabing, Technical University Munich, Munich, Germany
| | - Tobias Schuster
- Department of Pediatric Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Stefanie Simon
- Department of Pediatric Surgery and Pediatric Urology, Klinikum Nürnberg, Nuremberg, Germany
| | - Thomas Meyer
- Department of Pediatric Surgery, Pediatric Urology and Pediatric Trauma, Hospital for General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Julia Platzer
- Center for Pediatric and Adolescent Medicine, Children's Hospital St. Marien gGmbH, Landshut, Germany
| | - Jochen Hubertus
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital Munich, Munich, Germany
| | - Sigurd T Seitz
- Department of Pediatric Surgery, University Hospital, Friedrich-Alexander-Universität (FAU) Erlangen, Erlangen, Germany
| | - Christian Knorr
- Department of Pediatric Surgery and Pediatric Orthopedics, Barmherzige Brüder Hospital - St. Hedwig Regensburg, Regensburg, Germany
| | - Maximilian Stehr
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Nuremberg, Germany
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Dosanjh A. COVID 19 and Pediatric Asthma. J Asthma Allergy 2020; 13:647-648. [PMID: 33299331 PMCID: PMC7720423 DOI: 10.2147/jaa.s291796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Amrita Dosanjh
- Pediatric Respiratory; Rady Children's Hospital-San Diego, Department of Pediatrics, San Diego, CA, USA
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Heudorf U, Steul K, Gottschalk R. Sars-Cov-2 in children - insights and conclusions from the mandatory reporting data in Frankfurt am Main, Germany, March-July 2020. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc24. [PMID: 33214989 PMCID: PMC7656974 DOI: 10.3205/dgkh000359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction: From the beginning of the corona pandemic until August 19, 2020, more than 21,989,366 cases have been reported worldwide - 228,495 in Germany alone, including 12,648 children aged 0-14. In many countries, the proportion of infected children in the total population is comparatively low; in addition, children often have no or milder symptoms and are less likely to transmit the pathogen to adults than the other way round. Based on the registration data in Frankfurt am Main, Germany, the symptoms of children in comparison with adults and the likely routes of transmission are presented below. Materials and methods: The documentation of the mandatory reports includes personal data (name, date of birth, gender, place of residence), disease characteristics (date of report, date of onset of the disease, symptoms), possible contact persons (family, others) and i.a. possible activity or care in children's community facilities. All reports were viewed, especially with regard to likely transmission routes. Results: From March 1 to July 31, 2020, 1,977 infected people were reported, including 138 children between the ages of 0 and 14 years. Children had fewer and milder symptoms than adults. None of the children experienced severe respiratory symptoms or the need for ventilation. 62% of the children had no symptoms at all (19% adults), 5% of the children were hospitalized (24% adults), and none of the children died (3.8% adults). After excluding a cluster of 34 children from refugee accommodations and 14 children from a parish, 78% of the remaining 90 children had been infected by an adult within the family, and only 4% were likely to have a reverse transmission route. In 5.5% of cases, transmission in a community facility was likely. Discussion: The results of the registration data from Frankfurt am Main, Germany confirm the results published in other countries: Children are less likely to become infected, and if infected, their symptoms are less severe than in adults, and they are apparently not the main drivers of virus transmission. Therefore, scientific medical associations strongly recommend reopening schools.
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Affiliation(s)
- Ursel Heudorf
- Public Health Department of the City of Frankfurt am Main, Germany
| | - Katrin Steul
- Public Health Department of the City of Frankfurt am Main, Germany
| | - René Gottschalk
- Public Health Department of the City of Frankfurt am Main, Germany
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Manti S, Licari A, Montagna L, Votto M, Leonardi S, Brambilla I, Castagnoli R, Foiadelli T, Marseglia GL, Cardinale F, Caffarelli C, Tosca MA, Cravidi C, Duse M, Chiappini E. SARS-CoV-2 infection in pediatric population. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020003. [PMID: 33004773 PMCID: PMC8023063 DOI: 10.23750/abm.v91i11-s.10298] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
n December 2019, in Wuhan (Hubei, China), the first COVID-19 cases due to SARS-COV-2 had been reported. On July 1st 2020, more than 10.268.839 million people had developed the disease, with at least 506.064 deaths. At present, Italy is the third country considering the number of cases (n=240.760), after Spain, and the second for the cumulative number of deaths (n=249.271), after the United States. As regard pediatric COVID-19 cases, more than 4000 cases (have been reported; however, these figures are likely to be underestimated since they are influenced by the number of diagnostic tests carried out. Three pediatric deaths have been reported in Italy to date. We aimed to review the peculiar aspects of SARS-COV-2 infection in the pediatric population.
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Affiliation(s)
- Sara Manti
- 1UOC Broncopneumologia Pediatrica e Fibrosi Cistica, AOUP "Vittorio-Emanuele", San Marco Hospital, Università di Catania, Catania, Italy.
| | - Amelia Licari
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Lorenza Montagna
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Martina Votto
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Salvatore Leonardi
- UOC Broncopneumologia Pediatrica e Fibrosi Cistica, AOUP "Vittorio-Emanuele", San Marco Hospital, Università di Catania, Catania, Italy.
| | - Ilaria Brambilla
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Riccardo Castagnoli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Thomas Foiadelli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Gian Luigi Marseglia
- Pediatric Clinic Department of Pediatrics, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
| | - Fabio Cardinale
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria Consorziale-Policlinico, Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
| | - Carlo Caffarelli
- Clinica Pediatrica, Dipartimento di Medicina e Chirurgia, Università di Parma, Italy.
| | - Maria Angela Tosca
- Allergy Center, Department of Pediatrics, Istituto G. Gaslini, Genoa, Italy.
| | - Claudio Cravidi
- Agenzia Tutela della Salute, ATS (National Healthcare System), Pavia, Italy.
| | - Marzia Duse
- Department of Pediatrics, Sapienza University, Rome, Italy.
| | - Elena Chiappini
- Division of Paediatric Infectious Disease, Anna Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy..
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13
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Simon A, Huebner J, Berner R, Munro APS, Exner M, Huppertz HI, Walger P. Measures to maintain regular operations and prevent outbreaks of SARS-CoV-2 in childcare facilities or schools under pandemic conditions and co-circulation of other respiratory pathogens. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc22. [PMID: 32974120 PMCID: PMC7492754 DOI: 10.3205/dgkh000357] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
After the lockdown and the end of the summer holidays, day-cares and schools need to be reopened and (despite the continued circulation of the new coronavirus SARS-CoV-2) kept open. The need for opening up arises from the right of children to education, participation, support and care. This is possible if appropriate hygiene measures are implemented and community transmission remains stable. In addition, the safety of educators, teachers and carers must be a priority and needs to be addressed by appropriate measures. Finally, the needs of families must also be taken into account. The following document describes in detail how these objectives can be achieved.
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Affiliation(s)
- Arne Simon
- Pediatric Oncology and Hematology, Children's Hospital Medical Center, University Clinics, Homburg, Germany
| | - Johannes Huebner
- Division of Pediatric Infectious Diseases, Dr. von Hauner Children's Hospital, Munich University Hospital, Munich, Germany
| | - Reinhard Berner
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Alasdair P S Munro
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Martin Exner
- Institute of Hygiene and Public Health, University of Bonn, Bonn, Germany
| | | | - Peter Walger
- German Society of Hospital Hygiene, Berlin, Germany
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14
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Janda A, Schuetz C, Heeg M, Minden K, Hedrich CM, Kallinich T, Hinze C, Schulz A, Speth F. [COVID-19: treatment strategies of German-speaking pediatric rheumatologists : Results of an online survey]. Z Rheumatol 2020; 79:710-717. [PMID: 32809050 PMCID: PMC7432543 DOI: 10.1007/s00393-020-00854-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hintergrund Zuverlässige Daten zu Verlauf und Therapie von COVID-19 („corona virus disease 2019“) bei Kindern mit rheumatischen Erkrankungen unter Immunsuppression fehlen. Ziel der Arbeit Abbildung individueller Strategien der Mitglieder der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR) im Umgang mit COVID-19. Methodik Mittels Online-Umfrage wurden im Mai 2020 das Meinungsbild der GKJR-Mitglieder zum Umgang mit DMARDs („disease-modifying anti-rheumatic drugs“) bei COVID-19-Erkrankung sowie die Bereitschaft zum Einsatz spezieller Therapieansätze bei Patienten mit unterschiedlicher Schwere von COVID-19 erhoben. Ergebnisse Es nahmen 71 Kollegen (27,3 % aller befragten ärztlichen Mitglieder) an der Umfrage teil; davon hatten 28,2 % bereits Patienten mit COVID-19 betreut. Über 95 % der Teilnehmer lehnten eine präventive Anpassung der antirheumatischen Therapie im Rahmen der SARS-CoV-2-Pandemie ab. Bei ambulanten Patienten unter Immunsuppression mit nachgewiesener COVID-19-Erkrankung würden mehr als 50 % der Teilnehmer folgende Therapien aussetzen: intravenöse hoch dosierte Steroide, Cyclophosphamid, Anti-CD20-Antikörper, sowie eine BAFF-, CTLA-4-, TNF-α-Blockade. Hingegen würden nichtsteroidale Antiphlogistika, Hydroxychloroquin (HCQ), orale Steroide, Mycophenolat, IL-1-Blockade sowie Immunglobuline (Ig) von >70 % der Kollegen weiter fortgeführt. Bei stationären Patienten mit COVID-19 würden insgesamt 74,6 % der Kollegen eine COVID-19-gerichtete Therapie erwägen. Bei stabilem Verlauf unter O2-Therapie (Stufe I) würden am häufigsten HCQ (18,3 %), Azithromycin (16,9 %) und Ig (9,9 %) in Betracht gezogen. Bei drohendem (Stufe II) bzw. manifestem Zytokinsturm (Stufe III) würden am häufigsten Anakinra (40,8 % bei Stufe II bzw. 46,5 % bei Stufe III), Tocilizumab (26,8 % bzw. 40,8 %), Steroide (25,4 % bzw. 33,8 %) und Remdesivir (29,6 % bzw. 38,0 %) eingesetzt. Von vielen Kollegen wurde betont, dass die Therapiestrategie individuell und der klinischen Situation entsprechend angepasst werden soll. Diskussion Die Ergebnisse der Online-Umfrage sind vor dem Hintergrund einer aktuell in Deutschland niedrigen Prävalenz von COVID-19 zu sehen und spiegeln somit theoretische Überlegungen der Befragten wider. Da Kinder derzeit nicht im Fokus von prospektiven COVID-19-Studien stehen, scheint der kontinuierliche und kritische kollegiale Fachaustausch bei Therapieentscheidungen umso wichtiger zu sein.
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Affiliation(s)
- A Janda
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075, Ulm, Deutschland.
| | - C Schuetz
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - M Heeg
- Institut für Immundefizienz und Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - K Minden
- Charité Universitätsmedizin Berlin und Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Deutschland
| | - C M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool & Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, Großbritannien
| | - T Kallinich
- Charité Universitätsmedizin Berlin und Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Deutschland
| | - C Hinze
- Klinik für Pädiatrische Rheumatologie und Immunologie, Universitätsklinikum Münster, Münster, Deutschland
| | - A Schulz
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075, Ulm, Deutschland
| | - F Speth
- Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Sektion Pädiatrische Stammzelltransplantation und Immunologie, Abteilung Kinderrheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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15
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Challenges and management of neurological and psychiatric manifestations in SARS-CoV-2 (COVID-19) patients. Neurol Sci 2020; 41:2353-2366. [PMID: 32767055 PMCID: PMC7410516 DOI: 10.1007/s10072-020-04544-w] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/21/2020] [Indexed: 12/22/2022]
Abstract
COVID-19 is a pandemic caused by human coronavirus (HCoV) SARS-CoV-2, which originated in Wuhan, China, at the end of 2019 and spread globally during 2020. Due to the difficulty of clinical decision-making during this period, our study group reviewed current literature focusing on the neurological and psychiatric aspects of COVID-19. Despite the knowledge on this newly discovered virus which is constantly evolving, different pieces of evidence reported an association between COVID-19 and neurological symptoms like headache, dizziness, taste and smell disorders and complications involving the nervous system eventually triggered by the pathologic processes elicited by SARS-CoV-2. It seems that younger patients are less prone to develop severe forms of COVID-19. However, neurological signs have been reported in paediatric patients as well, and in some cases, the infection presented neurological sequelae. Furthermore, children with particular neurological diseases or treated with specific drugs (e.g. immune-suppressant therapies) must be carefully monitored during this pandemic. Neurologists should be aware of the main drug–drug interactions and the neurological side effects of COVID-19 treatments. Notably, adverse mental health impact has been reported in patients with SARS-CoV-2, which could be related either to the social strain or to the eventual neurotropic effects of the virus, which in other infections have been proven to promote the onset of psychiatric symptoms. Further, psychiatric population may be more vulnerable to the infection and at higher risk for adverse outcomes.
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Armann JP, Diffloth N, Simon A, Doenhardt M, Hufnagel M, Trotter A, Schneider D, Hübner J, Berner R. Hospital Admission in Children and Adolescents With COVID-19. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:373-374. [PMID: 32519943 DOI: 10.3238/arztebl.2020.0373] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/22/2020] [Accepted: 05/05/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Jakob Peter Armann
- Klinik und Poliklinik für Kinderund Jugendmedizin, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden; Gesundheitsverbund Landkreis Konstanz, Klinikum Singen, Zentrum für Kinderund Jugendgesundheit; Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar; Pädiatrische Infektiologie und Rheumatologie, Zentrum für Kinder und Jugendmedizin, Universitätsklinikum Freiburg; Klinik für Kinderund Jugendmedizin, Klinikum Dortmund gGmbH; Abteilung Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Klinikum der Ludwig-Maximilian-Universität München; Deutsche Gesellschaft für Pädiatrische Infektiologie e.V., Berlin
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17
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Alloway BC, Yaeger SK, Mazzaccaro RJ, Villalobos T, Hardy SG. Suspected case of COVID-19-associated pancreatitis in a child. Radiol Case Rep 2020; 15:1309-1312. [PMID: 32572339 PMCID: PMC7275143 DOI: 10.1016/j.radcr.2020.06.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/15/2022] Open
Abstract
The world has been challenged by SARS CoV-2, a new virus causing pneumonia and acute respiratory distress syndrome, with common symptoms of COVID-19 in pediatric patients including both respiratory and GI symptoms. There is a lack of literature implicating COVID-19 in pancreatitis, yet viruses are generally understood to be a cause of pancreatitis in children. We present a case of a previously well 7-year-old girl, who presented to the emergency department with a chief complaint of abdominal pain and anorexia. She was diagnosed with acute pancreatitis with an abnormal lipase, ultrasound, and computed tomography, and was found to be COVID-19 positive by polymerase chain reaction. Our case suggests that, in the current pandemic, consideration for SARS CoV-2 testing in children with gastrointestinal symptoms and pancreatitis may be considered. Additionally, this case highlights the need for appropriate personal protective equipment for providers, even when COVID is not initially on the differential.
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Affiliation(s)
- Brian C Alloway
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, USF Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown 18103, PA, USA
| | - Susan K Yaeger
- Division of Pediatric Emergency Medicine, Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, USF Morsani College of Medicine, Allentown, PA, USA
| | - Richard J Mazzaccaro
- Department of Pediatrics, Lehigh Valley Health Network/USF Morsani College of Medicine, Allentown, PA, USA
| | - Tibisay Villalobos
- Department of Pediatrics, Section of Infectious Disease, Lehigh Valley Health Network, USF Morsani College of Medicine, Allentown, PA, USA
| | - Steven G Hardy
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, USF Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown 18103, PA, USA
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Castro-Rodriguez JA, Forno E. Asthma and COVID-19 in children - a systematic review and call for data. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.05.04.20090845. [PMID: 32511474 PMCID: PMC7273242 DOI: 10.1101/2020.05.04.20090845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
RATIONALE Whether asthma constitutes a risk factor for COVID-19 is unclear. METHODS We performed a systematic literature search in three stages: First, we reviewed PubMed, EMBASE and CINAHL for systematic reviews of SARS-CoC-2 and COVID-19 in pediatric populations, and reviewed their primary articles; next, we searched PubMed for studies on COVID-19 or SARS-CoV-2 and asthma/wheeze, and evaluated whether the resulting studies included pediatric populations; lastly, we repeated the second search in BioRxiv.org and MedRxiv.org to find pre-prints that may have information on pediatric asthma. RESULTS In the first search, eight systematic reviews were found, of which five were done in pediatric population; after reviewing 67 primary studies we found no data on pediatric asthma as a comorbidity for COVID-19. In the second search, we found 25 results in PubMed, of which five reported asthma in adults, but none included data on children. In the third search, 14 pre-prints in MedRxiv were identified with data on asthma, but again none with pediatric data. We found only one report by the U.S. CDC stating that 40/345 (~11.5%) children with data on chronic conditions had "chronic lung diseases including asthma". CONCLUSION There is scarcely any data on whether childhood asthma (or other pediatric respiratory diseases) constitute risk factors for SARS-CoV-2 infection or COVID-19 severity. Studies are needed that go beyond counting the number of cases in the pediatric age range.
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Affiliation(s)
- Jose A Castro-Rodriguez
- Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, US
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19
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Reinhardt D. COVID-19: Rätsel um den Verlauf bei Kindern. MMW Fortschr Med 2020; 162:30. [PMID: 32405849 PMCID: PMC7220566 DOI: 10.1007/s15006-020-0467-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Auch ein halbes Jahr nach dem Auftauchen von SARS-CoV-2 weiß die Fachwelt wenig über den Verlauf der Infektion bei Kindern. Schwere Verläufe sind bei ihnen trotz normaler Ansteckungsraten offenbar sehr selten. Aber warum?
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20
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Reinhardt D. Schweres Asthma klingt in der Pubertät ab. MMW Fortschr Med 2020; 162:30. [PMID: 32016721 DOI: 10.1007/s15006-020-0097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Rathore V, Galhotra A, Pal R, Sahu KK. COVID-19 Pandemic and Children: A Review. J Pediatr Pharmacol Ther 2020; 25:574-585. [PMID: 33041712 PMCID: PMC7541032 DOI: 10.5863/1551-6776-25.7.574] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2020] [Indexed: 12/15/2022]
Abstract
The severe respiratory disease COVID-19 (coronavirus disease 2019) was first reported in late December 2019 in Wuhan City, China. Soon thereafter, the World Health Organization (WHO) officially declared it a pandemic. The adult population is highly affected by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2); however, infants and children are also not spared. Transmission in the pediatric population appears to be primarily from COVID-19-positive adults, largely from family contacts through droplets, direct contacts, and aerosols. There is also evidence of fecal-oral route of transmission. The incubation period of COVID-19 in children ranges from 2 to 10 days. Most children are asymptomatic. The most common symptoms amongst symptomatic children are fever and cough. Shortness of breath, sore throat, rhinorrhea, conjunctivitis, fatigue, and headache are other common symptoms. Diarrhea, vomiting, and abdominal pain are the common gastrointestinal symptoms that may be present with or without respiratory symptoms. Very few children are likely to develop severe disease.Supportive care is the mainstay of treatment. Though data are limited, antiviral therapies such as remdesivir, favipiravir, lopinavir/ritonavir, and other drugs like hydroxychloroquine/chloroquine have been used for severe COVID-19 cases, with remdesivir showing the greatest promise. A few children may develop an exaggerated immune response, characterized by exaggerated cytokine release and manifests with features similar to Kawasaki disease. The syndrome has been referred to by many names including pediatric inflammatory multisystem syndrome (PIMS) and more recently, as multisystem inflammatory syndrome in children (MIS-C); this life-threatening condition often requires a multidisciplinary team effort and use of immunomodulators.
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