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Aparicio C, Willis ZI, Nakamura MM, Wolf J, Little C, Maron GM, Sue PK, Anosike BI, Miller C, Bio LL, Singh P, James SH, Oliveira CR. Risk Factors for Pediatric Critical COVID-19: A Systematic Review and Meta-Analysis. J Pediatric Infect Dis Soc 2024; 13:352-362. [PMID: 38780125 DOI: 10.1093/jpids/piae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 05/21/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Risk stratification is a cornerstone of the Pediatric Infectious Diseases Society COVID-19 treatment guidance. This systematic review and meta-analysis aimed to define the clinical characteristics and comorbidities associated with critical COVID-19 in children and adolescents. METHODS Two independent reviewers screened the literature (Medline and EMBASE) for studies published through August 31, 2023, that reported outcome data on patients aged ≤21 years with COVID-19. Critical disease was defined as an invasive mechanical ventilation requirement, intensive care unit admission, or death. Random-effects models were used to estimate pooled odds ratios (OR) with 95% confidence intervals (CI), and heterogeneity was explored through subgroup analyses. RESULTS Among 10,178 articles, 136 studies met the inclusion criteria for review. Data from 70 studies, which collectively examined 172,165 children and adolescents with COVID-19, were pooled for meta-analysis. In previously healthy children, the absolute risk of critical disease from COVID-19 was 4% (95% CI, 1%-10%). Compared with no comorbidities, the pooled OR for critical disease was 3.95 (95% CI, 2.78-5.63) for the presence of one comorbidity and 9.51 (95% CI, 5.62-16.06) for ≥2 comorbidities. Key risk factors included cardiovascular and neurological disorders, chronic pulmonary conditions (excluding asthma), diabetes, obesity, and immunocompromise, all with statistically significant ORs > 2.00. CONCLUSIONS While the absolute risk for critical COVID-19 in children and adolescents without underlying health conditions is relatively low, the presence of one or more comorbidities was associated with markedly increased risk. These findings support the importance of risk stratification in tailoring pediatric COVID-19 management.
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Affiliation(s)
- Camila Aparicio
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Zachary I Willis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Mari M Nakamura
- Antimicrobial Stewardship Program and Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Joshua Wolf
- Department of Infectious Diseases, St. Jude Children's Research Hospital and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Cordell Little
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gabriela M Maron
- Department of Infectious Diseases, St. Jude Children's Research Hospital and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Paul K Sue
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Brenda I Anosike
- Department of Pediatrics, The Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Christine Miller
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Laura L Bio
- Department of Pharmacy, Lucile Packard Children's Hospital, Stanford, California, USA
| | - Prachi Singh
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Scott H James
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Carlos R Oliveira
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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Chávez-Pacheco JL, Castillejos-López M, Hernández-Regino LM, Velasco-Hidalgo L, Zapata-Tarres M, Correa-Carranza V, Rosario-Méndez G, Barrientos-Ríos R, Aquino-Gálvez A, Torres-Espíndola LM. Challenges in Treating Pediatric Cancer Patients during the COVID-19 Pandemic: Balancing Risks and Care. Viruses 2024; 16:690. [PMID: 38793571 PMCID: PMC11125850 DOI: 10.3390/v16050690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
The COVID-19 pandemic has resulted in millions of fatalities worldwide. The case of pediatric cancer patients stands out since, despite being considered a population at risk, few studies have been carried out concerning symptom detection or the description of the mechanisms capable of modifying the course of the COVID-19 disease, such as the interaction and response between the virus and the treatment given to cancer patients. By synthesizing existing studies, this paper aims to expose the treatment challenges for pediatric patients with COVID-19 in an oncology context. Additionally, this updated review includes studies that utilized the antiviral agents Remdesivir and PaxlovidTM in pediatric cancer patients. There is no specific treatment designed exclusively for pediatric cancer patients dealing with COVID-19, and it is advisable to avoid self-medication to prevent potential side effects. Managing COVID-19 in pediatric cancer patients is indeed a substantial challenge. New strategies, such as chemotherapy application rooms, have been implemented for children with cancer who were positive for COVID-19 but asymptomatic since the risk of disease progression is greater than the risk of complications from SARS-CoV-2.
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Affiliation(s)
- Juan Luis Chávez-Pacheco
- Pharmacology Laboratory, National Institute of Pediatrics, Mexico City 04530, Mexico; (J.L.C.-P.); (L.M.H.-R.); (V.C.-C.); (G.R.-M.)
| | - Manuel Castillejos-López
- Epidemiology and Infectology, National Institute of Respiratory Diseases, Mexico City 14080, Mexico;
| | - Laura M. Hernández-Regino
- Pharmacology Laboratory, National Institute of Pediatrics, Mexico City 04530, Mexico; (J.L.C.-P.); (L.M.H.-R.); (V.C.-C.); (G.R.-M.)
| | | | - Marta Zapata-Tarres
- Head of Research Coordination at Mexican Social Security Institute Foundation, Mexico City 06600, Mexico;
| | - Valeria Correa-Carranza
- Pharmacology Laboratory, National Institute of Pediatrics, Mexico City 04530, Mexico; (J.L.C.-P.); (L.M.H.-R.); (V.C.-C.); (G.R.-M.)
| | - Guillermo Rosario-Méndez
- Pharmacology Laboratory, National Institute of Pediatrics, Mexico City 04530, Mexico; (J.L.C.-P.); (L.M.H.-R.); (V.C.-C.); (G.R.-M.)
| | - Rehotbevely Barrientos-Ríos
- Cytogenetics Laboratory, Department of Human Genetics, National Institute of Pediatrics, Mexico City 04530, Mexico;
| | - Arnoldo Aquino-Gálvez
- Molecular Biology Laboratory, Pulmonary Fibrosis Department, National Institute of Respiratory Diseases, Mexico City 14080, Mexico
| | - Luz María Torres-Espíndola
- Pharmacology Laboratory, National Institute of Pediatrics, Mexico City 04530, Mexico; (J.L.C.-P.); (L.M.H.-R.); (V.C.-C.); (G.R.-M.)
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Nawi MA, Lau SCD, Chin ST, Teh KH, Ho LSB, Alias H. Caring for a child with cancer during COVID-19 pandemic: an assessment of the parents' perception and stress level. Front Public Health 2024; 12:1223362. [PMID: 38655523 PMCID: PMC11036860 DOI: 10.3389/fpubh.2024.1223362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Background The emergence of COVID-19 pandemic has led to heightened fear and uncertainty among parents of children with cancer. This study was conducted to evaluate the parental perceptions toward effects of COVID-19 infection to children with cancer, determine their stress level and factors contributing to high stress level during the pandemic. Methods This cross-sectional study was conducted in three paediatric oncology centres in Malaysia from September 2020 until December 2022. A total of 167 parents were recruited. Parents completed a set of questionnaires to assess their perception on effect of COVID-19 infection to children with cancer and COVID Stress Scale (CSS) to assess the parents' stress level. Results Patients' mean age at study entry was 8.75 years (SD 4.38). Ninety-one (54.5%) patients were still on active treatment. More than 80% of the parents obtained information regarding COVID-19 infection from mass media and social networking. Fear of their children contracting COVID-19 infection was high especially among patients who were still on treatment. Forty-nine (29.3%) parents were significantly affected by the pandemic leading to loss of job or monthly income. Twenty-nine (17.4%) patients required treatment modification during the pandemic. The median total score for CSS was 78.0 (IQR 25th 64.0; 75th 95.0). Ninety-one (54.5%) respondents were very/extremely stressed based on the CSS scores. Components with high scores were xenophobia (median score 18.0; IQR 25th 13.0, 75th 22.0), fear of danger (median score 17.0; IQR 25th 14.0, 75th 20.0) and contamination fears (median score 16.0; IQR 25th 12.0, 75th 19.0). Lower household income was associated with higher stress level (p = 0.006). Conclusion Our study demonstrated high awareness regarding risk of COVID-19 infection among parents of oncology children. Half of the parents had high stress level, with low household income identified as a factor associated with high stress level.
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Affiliation(s)
- Muhamad Aizat Nawi
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Sie Chong Doris Lau
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Shi Tying Chin
- Department of Paediatrics, Sarawak General Hospital, Kuching, Malaysia
| | - Kok Hoi Teh
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
| | - Lee Sue Betty Ho
- Department of Paediatrics, Sarawak General Hospital, Kuching, Malaysia
| | - Hamidah Alias
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Aparicio C, Willis ZI, Nakamura MM, Wolf J, Little C, Maron GM, Sue PK, Anosike BI, Miller C, Bio LL, Singh P, James SH, Oliveira CR. Risk Factors for Pediatric Critical COVID-19: A Systematic Review and Meta-Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.17.24301452. [PMID: 38293040 PMCID: PMC10827273 DOI: 10.1101/2024.01.17.24301452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Background Risk stratification is a cornerstone of the Pediatric Infectious Diseases Society COVID-19 treatment guidance. This systematic review and meta-analysis aimed to define the clinical characteristics and comorbidities associated with critical COVID-19 in children and adolescents. Methods Two independent reviewers screened the literature (Medline and EMBASE) for studies published through August 2023 that reported outcome data on patients aged ≤21 years with COVID-19. Critical disease was defined as an invasive mechanical ventilation requirement, intensive care unit admission, or death. Random effects models were used to estimate pooled odds ratios (OR) with 95% confidence intervals (CI), and heterogeneity was explored through subgroup analyses. Results Among 10,178 articles, 136 studies met the inclusion criteria for review. Data from 70 studies, which collectively examined 172,165 children and adolescents with COVID-19, were pooled for meta-analysis. In previously healthy children, the absolute risk of critical disease from COVID-19 was 4% (95% CI, 1%-10%). Compared with no comorbidities, the pooled OR for critical disease was 3.95 (95% CI, 2.78-5.63) for presence of one comorbidity and 9.51 (95% CI, 5.62-16.06) for ≥2 comorbidities. Key risk factors included cardiovascular and neurological disorders, chronic pulmonary conditions (excluding asthma), diabetes, obesity, and immunocompromise, all with statistically significant ORs >2.00. Conclusions While the absolute risk for critical COVID-19 in children and adolescents without underlying health conditions is relatively low, the presence of one or more comorbidities was associated with markedly increased risk. These findings support the importance of risk stratification in tailoring pediatric COVID-19 management.
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Affiliation(s)
- Camila Aparicio
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Zachary I. Willis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Mari M. Nakamura
- Antimicrobial Stewardship Program and Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA
| | - Joshua Wolf
- Department of Infectious Diseases, St. Jude Children’s Research Hospital and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Cordell Little
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Gabriela M. Maron
- Department of Infectious Diseases, St. Jude Children’s Research Hospital and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Paul K. Sue
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Brenda I. Anosike
- Department of Pediatrics, The Children’s Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY
| | - Christine Miller
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Laura L. Bio
- Department of Pharmacy, Lucile Packard Children’s Hospital, Stanford, CA
| | - Prachi Singh
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Scott H. James
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | - Carlos R. Oliveira
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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5
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Chen C, Fang J, Chen S, Rajaofera MJN, Li X, Wang B, Xia Q. The efficacy and safety of remdesivir alone and in combination with other drugs for the treatment of COVID-19: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:672. [PMID: 37814214 PMCID: PMC10563317 DOI: 10.1186/s12879-023-08525-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 08/09/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Remdesivir is considered to be a specific drug for treating coronavirus disease 2019. This systematic review aims to evaluate the clinical efficacy and risk of remdesivir alone and in combination with other drugs. RESEARCH DESIGN AND METHODS The PubMed, Embase, SCIE, Cochrane Library, and American Clinical trial Center databases were searched up to 1 April 2022 to identify. Randomized controlled trials (RCTs) and observational studies comparing the efficacy of remdesivir monotherapy and combination therapy with that of control drugs. RESULTS Ten RCTs and 32 observational studies were included in the analysis. Regarding the primary outcome, remdesivir use reduced mortality in patients with severe COVID-19 (RR = 0.57, 95% CI (0.48,0.68)) and shortened the time to clinical improvement (MD = -2.51, 95% CI (-2.75, -2.28)). Regarding other clinical outcomes, remdesivir use was associated with improved clinical status (RR = 1.08, 95%CI (1.01, 1.17)). Regarding safety outcomes, remdesivir use did not cause liver or kidney damage (RR = 0.87, 95%CI (0.68, 1.11)) (RR = 0.88, 95%CI (0.70,1.10)). Compared with remdesivir alone, remdesivir combined with other drugs (e.g., steroids, favipiravir, and convalescent plasma) had no effect on mortality. CONCLUSION The use of remdesivir can help to reduce the mortality of patients with severe COVID-19 and shorten the time to clinical improvement. There was no benefit of remdesivir combination therapy for other clinical outcomes. TRIAL REGISTRATION PROSPERO registration number: CRD42022322859.
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Affiliation(s)
- Chuizhe Chen
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, NHC Key Laboratory of Tropical Disease Control, School of Tropical Medicine and The Second Affiliated Hospital, Hainan Medical University, Haikou, China
- Department of Pathology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Junde Fang
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, NHC Key Laboratory of Tropical Disease Control, School of Tropical Medicine and The Second Affiliated Hospital, Hainan Medical University, Haikou, China
- The First Clinical College, Hainan Medical University, Haikou, China
| | - Shu Chen
- Department of Pathology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Mamy Jayne Nelly Rajaofera
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, NHC Key Laboratory of Tropical Disease Control, School of Tropical Medicine and The Second Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Xuemiao Li
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, NHC Key Laboratory of Tropical Disease Control, School of Tropical Medicine and The Second Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Bo Wang
- Department of Pathology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China.
| | - Qianfeng Xia
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, NHC Key Laboratory of Tropical Disease Control, School of Tropical Medicine and The Second Affiliated Hospital, Hainan Medical University, Haikou, China.
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6
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Katato GK, Sitaula P, Gupte A, Al-Antary ET. The Impact of COVID-19 on Pediatric Malignancy Diagnosis and Treatment: Never the Same but Lessons Learned. Vaccines (Basel) 2023; 11:vaccines11030667. [PMID: 36992251 DOI: 10.3390/vaccines11030667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic affected the pediatric oncology population globally. Over the course of 2 years, increasing reports have been made to better understand this entity and its pathologic complications on these patients. The pandemic has allowed healthcare providers, hospital systems, and leading oncologic societies to quickly adapt and formulate new guidelines for the effective understanding, management, and treatment of patients with pediatric malignancy.
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Affiliation(s)
- Ghadir K Katato
- Division of Hematology/Oncology, Children's Hospital of Michigan, Detroit, MI 48201, USA
- Department of Pediatrics, Central Michigan University College of Medicine, Mt Clemons, MI 48603, USA
| | - Prasiksha Sitaula
- Division of Hematology/Oncology, Children's Hospital of Michigan, Detroit, MI 48201, USA
- Department of Pediatrics, Central Michigan University College of Medicine, Mt Clemons, MI 48603, USA
| | - Avanti Gupte
- Division of Hematology/Oncology, Children's Hospital of Michigan, Detroit, MI 48201, USA
- Department of Pediatrics, Central Michigan University College of Medicine, Mt Clemons, MI 48603, USA
- Pediatric Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Barbara Ann Karmanos Cancer Center, Children's Hospital of Michigan, Detroit, MI 48201, USA
| | - Eman T Al-Antary
- Division of Hematology/Oncology, Children's Hospital of Michigan, Detroit, MI 48201, USA
- Department of Pediatrics, Central Michigan University College of Medicine, Mt Clemons, MI 48603, USA
- Pediatric Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Barbara Ann Karmanos Cancer Center, Children's Hospital of Michigan, Detroit, MI 48201, USA
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7
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Valerie IC, Prabandari AASM, Wati DK. Ferritin in pediatric critical illness: a scoping review. Clin Exp Pediatr 2023; 66:98-109. [PMID: 36229027 PMCID: PMC9989723 DOI: 10.3345/cep.2022.00654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/17/2022] [Indexed: 11/27/2022] Open
Abstract
This scoping review aimed to elucidate and summarize the predictive role of serum ferritin in critical pediatric illness. The Preferred Reporting Items for Systematic reviews and Meta-Analyses methodology was employed to conduct a scoping review of 5 databases (MEDLINE, CENTRAL, ProQuest, ScienceDirect, and Epistemonikos) from the date of inception through January 24, 2022. Primary research studies involving subjects aged <18 years and serum ferritin levels were screened and reviewed independently following an a priori defined protocol. Of the 1,580 retrieved studies, 66 were analyzed. Summary statistics of serum ferritin levels for overall and condition-specific studies were reported in 30 (45.4%) and 47 studies (71.2%), respectively. The normal range was defined in 16 studies (24.2%), whereas the threshold was determined in 43 studies (65.1%). A value of <500 ng/mL was most often the upper limit of the normal range. Serum ferritin as a numerical variable (78.9%) was usually significantly higher (80.8%) in the predicted condition than in controls, while as a categorical variable with preset thresholds, ferritin was a significant predictor in 84.6% of studies. A total of 22 predictive thresholds predicted mortality (12 of 46 [26.1%]), morbidity (18 of 46 [39.1%]), and specific (16 of 46 [34.8%]) outcomes in 15 unique conditions. Increased precision in serum ferritin measures followed by close attention to the threshold modeling strategy and reporting can accelerate the translation from evidence to clinical practice.
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Affiliation(s)
- Ivy Cerelia Valerie
- Department of Child Health, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Bali, Indonesia
| | | | - Dyah Kanya Wati
- Department of Child Health, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Bali, Indonesia
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8
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Ong RYL, Seah VXF, Chong CY, Thoon KC, Tan NWH, Li J, Nadua KD, Soh SY, Seng MSF, Pham TNA, Yung CF, Kam KQ. A cohort study of COVID-19 infection in pediatric oncology patients plus the utility and safety of remdesivir treatment. Acta Oncol 2023; 62:53-57. [PMID: 36661030 DOI: 10.1080/0284186x.2023.2169079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Rina Yue Ling Ong
- Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore
| | - Valerie Xue Fen Seah
- Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chia Yin Chong
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Koh Cheng Thoon
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Natalie Woon Hui Tan
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jiahui Li
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Karen Donceras Nadua
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Shui Yen Soh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Haematology/Oncology Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Michaela Su-Fern Seng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Haematology/Oncology Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Thi Ngoc Anh Pham
- Nursing Clinical Services, Division of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chee Fu Yung
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kai-Qian Kam
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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9
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Dandachi I, Aljabr W. Prognosis of COVID-19 in the middle eastern population, knowns and unknowns. Front Microbiol 2022; 13:974205. [PMID: 36118201 PMCID: PMC9471247 DOI: 10.3389/fmicb.2022.974205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/09/2022] [Indexed: 01/08/2023] Open
Abstract
Since its emergence in China in 2019, the SARS-CoV-2 virus has affected all countries worldwide. The virus is easily transmitted from one person to another via infected aerosols or contaminated surfaces. Unlike its counterparts, the prognosis of COVID-19 ranges from asymptomatic to critical disease or death. Several factors play a role in determining the severity of the disease in infected patients. Among others, is the pre-existence of an underlying medical condition such as diabetes, cancer, and others. Furthermore, although children are less prone to the severe form of the COVID-19 disease, they require attention due to the report of many atypical presentations of the infection, post-asymptomatic exposure. In the Middle East, little is known about the prognosis of the SARS-CoV-2 infection in high-risk categories, notably patients with diabetes, cancer, and pregnant women. The aim of this review is to summarize the current knowledge about this group of population in the middle eastern region as well as to highlight the gap in the literature. We have found that the majority of the papers were from the Gulf countries. Although, few studies were conducted; high-risk patients appear to have an increased risk of morbidity and mortality from COVID-19 compared to their counterparts. Higher levels of inflammatory markers, C-reactive protein, erythrocyte sedimentation rate, D-dimer, and ferritin levels were also observed. Children are often asymptomatic or present with atypical presentations. More studies should be conducted to determine the clinical biomarkers of COVID-19 in high-risk categories to help in patient risk stratification and management in the middle eastern population.
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10
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Madney Y, Shalaby L, Hammad M, Elanany M, Hassan R, Youssef A, Abdo I, Zaki A, Khedr R. COVID-19-Associated Pulmonary Fungal Infection among Pediatric Cancer Patients, a Single Center Experience. J Fungi (Basel) 2022; 8:jof8080850. [PMID: 36012838 PMCID: PMC9409978 DOI: 10.3390/jof8080850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 12/12/2022] Open
Abstract
Patients with COVID-19 are at risk of developing secondary complications such as invasive pulmonary aspergillosis and mucormycosis. This is a retrospective study including all cancer children diagnosed with COVID-19-associated pulmonary fungal infection (CAPFI) during the period 2020–2021. A total of 200 patients were diagnosed with COVID-19, out of which 21 (10%) patients were diagnosed with CAPFI, 19 patients (90%) with COVID-aspergillosis (CAPA), and 2 (10%) patients with COVID-mucormycosis (CAM). Patients with CAPFI were classified using the “2020 ECMM/ISHAM consensus criteria”; proven in 2 (10%) patients, probable in 12 (57%), and possible in 7 (33%) patients. Although the hematological malignancy patients were already on antifungal prophylaxis, breakthrough fungal infection was reported in 16/21 (75%), 14 (65%) patients had CAPA while on echinocandin prophylaxis, while 2 (10%) patients had CAM while on voriconazole prophylaxis. Overall mortality was reported in 8 patients (38%) while CAPFI-attributable mortality was reported in 4 patients (20%). In conclusion, clinicians caring for pediatric cancer patients with COVID-19 should consider invasive pulmonary fungal infection, even if they are on antifungal prophylaxis, especially with worsening of the clinical chest condition. A better understanding of risk factors for adverse outcomes may improve clinical management in these patients.
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Affiliation(s)
- Youssef Madney
- Pediatric Oncology Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
- Correspondence:
| | - Lobna Shalaby
- Pediatric Oncology Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Mahmoud Hammad
- Pediatric Oncology Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Mervat Elanany
- Clinical Pathology Department, Faculty of Medicine, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Reem Hassan
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Ayda Youssef
- Radiodiagnosis Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Ibrahim Abdo
- Clinical Pharmacology Department, Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Abeer Zaki
- Clinical Research Department, Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Reham Khedr
- Pediatric Oncology Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
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11
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Majeed A, Wright T, Guo B, Arora RS, Lam CG, Martiniuk AL. The Global Impact of COVID-19 on Childhood Cancer Outcomes and Care Delivery - A Systematic Review. Front Oncol 2022; 12:869752. [PMID: 35463381 PMCID: PMC9023072 DOI: 10.3389/fonc.2022.869752] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background Childhood cancer represents a leading cause of death and disease burden in high income countries (HICs) and low-and-middle income countries (LMICs). It is postulated that the current COVID-19 pandemic has hampered global development of pediatric oncology care programs. This systematic review aimed to comprehensively review the global impact of COVID-19 on childhood cancer clinical outcomes and care delivery. Methods A systematic search was conducted on PubMed, Embase, Medline, and the African Medical Index from inception to November 3, 2021 following PRISMA guidelines. A manual search was performed to identify additional relevant studies. Articles were selected based on predetermined eligibility criteria. Findings The majority of studies reported patients with cancer and COVID-19 presenting as asymptomatic (HICs: 33.7%, LMICs: 22.0%) or with primary manifestations of fever (HICs: 36.1%, LMICs: 51.4%) and respiratory symptoms (HICs: 29.6%, LMICs: 11.7%). LMICs also reported a high frequency of patients presenting with cough (23.6%) and gastrointestinal symptoms (10.6%). The majority of patients were generally noted to have a good prognosis; however the crude mortality rate was higher in LMICs when compared to HICs (8.0% vs 1.8%). Moreover, the pandemic has resulted in delays and interruptions to cancer therapies and delays in childhood cancer diagnoses in both HICs and LMICs. However, these findings were disproportionately reported in LMICs, with significant staff shortages, supply chain disruptions, and limited access to cancer therapies for patients. Conclusions The COVID-19 pandemic has resulted in delays and interruptions to childhood cancer therapies and delays in childhood cancer diagnoses, and disproportionately so within LMICs. This review provides lessons learned for future system-wide disruptions to care, as well as provides key points for moving forward better with care through the remainder of this pandemic. Systematic Review Registration CRD42021266758, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=266758
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Affiliation(s)
- Amna Majeed
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tom Wright
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Biqi Guo
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ramandeep S Arora
- Department of Medical Oncology, Max Super-Specialty Hospital, New Delhi, India
| | - Catherine G Lam
- Department of Global Pediatric Medicine and Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Alexandra L Martiniuk
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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12
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El-Qushayri AE, Benmelouka AY, Dahy A, Hashan MR. COVID-19 outcomes in paediatric cancer: A large scale pooled meta-analysis of 984 cancer patients. Rev Med Virol 2022; 32:e2344. [PMID: 35247015 PMCID: PMC9111056 DOI: 10.1002/rmv.2344] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 12/19/2022]
Abstract
We aimed to study the outcomes of COVID‐19 in paediatric cancer patients. On 26 October 2021, we did a systematic search for relevant articles in seven electronic databases followed by manual search. We included cancer patients aged ≤18 years. Event rates and the 95% confidence interval (95%CI) were used to report the results. We included 21 papers after screening of 2759 records. The pooled rates of hospitalisation, intensive care unit (ICU) admission and mortality were 44% (95%CI: 30–59), 14% (95%CI: 9–21) and 9% (95%CI: 6–12), respectively. Moreover, subgroup analysis revealed that high income countries had better COVID‐19 outcomes compared to upper middle income countries and lower middle income countries in terms of hospitalisation 30% (95%CI: 17–46), 60% (95%CI: 29–84) and 47% (95%CI: 36–58), ICU admission 7% (95%CI: 1–32), 13% (95%CI: 7–23) and 18% (95%CI: 6–41), and mortality 3% (95%CI: 2–5), 12% (95%CI: 8–18) and 13% (95%CI: 8–20), in order. In general, absence of specific pharmacologic intervention to prevent infection with the scarcity of vaccination coverage data among paediatric groups and its impact, high priority caution is required to avoid SARS‐CoV‐2 infection among paediatric cancer patients. Furthermore, our results highlight the importance of promoting care facilities for this vulnerable population in low and middle income regions to ensure quality care among cancer patients during pandemic crisis.
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Affiliation(s)
| | | | | | - Mohammad Rashidul Hashan
- Bangladesh Civil Service, Ministry of Health and Family Welfare, Dhaka, Bangladesh.,Central Queensland University, Rockhampton, QLD, Australia
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13
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Schlage S, Lehrnbecher T, Berner R, Simon A, Toepfner N. SARS-CoV-2 in pediatric cancer: a systematic review. Eur J Pediatr 2022; 181:1413-1427. [PMID: 35006377 PMCID: PMC8744033 DOI: 10.1007/s00431-021-04338-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/05/2021] [Accepted: 11/30/2021] [Indexed: 12/20/2022]
Abstract
UNLABELLED The outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019 in Wuhan challenges pediatric oncologists in an unexpected way. We provide a comprehensive overview, which systematically summarizes and grades evidence (QoE) on SARS-CoV-2 infections in pediatric cancer patients at 1.5 years of pandemic. A systematic literature search in PubMed combined with an additional exploratory literature review in other international databases was conducted to identify studies on children (aged < 18 years) with a malignant disease and COVID-19 infections. In total, 45 reports on 1003 pediatric cancer patients with SARS-CoV-2 infections were identified out of 1397 reports analyzed. The clinical course of COVID-19 was reported mild or moderate in 358 patients (41.7%), whereas 11.1% of patients showed severe COVID-19. In 12.7% of patients, chemotherapy was postponed, whereas 19% of patients with different underlying malignancies received chemotherapy during SARS-CoV-2 infection. Twenty-five patients with SARS-CoV-2 infections died, potentially related to COVID-19. CONCLUSION Despite a favorable COVID-19 outcome in most pediatric cancer patients, the morbidity is reported higher than in children without comorbidities. However, no severe COVID-19 complications were associated to the continuation of chemotherapy in some cohort studies and reports on two patients. Therefore, the risk of cancer progress or relapse due to interruption of chemotherapy has carefully to be weighed against the risk of severe COVID-19 disease with potentially fatal outcome. WHAT IS KNOWN • Most of pediatric patients with malignant diseases show an asymptomatic, mild or moderate clinical course of SARS-CoV-2 infection. • Current need for a basis for decision-making, whether to stop or interrupt cancer treatment in a patient infected with SARS-CoV-2, and when to continue chemotherapy. WHAT IS NEW • Review results comprising over 1000 pediatric COVID-19 cancer patients confirm mild courses of SARS-CoV-2 infection in most patients but also show the attributable mortality is at least 10 times higher compared to reports on hospitalized children without comorbidities. • Review identifies that chemotherapy was continued despite SARS-CoV-2 positivity in 18% of patients with individual chemotherapy modification according to the clinical course of SARS-CoV-2 infection and existing comorbidities. On this basis, no severe COVID-19 complications were associated to the continuation of chemotherapy in several cohort studies and two case reports.
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Affiliation(s)
- Sandy Schlage
- Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Thomas Lehrnbecher
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Reinhard Berner
- Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Arne Simon
- Pediatric Oncology and Hematology, University Children’s Hospital, Homburg, Saar, Germany
| | - Nicole Toepfner
- Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany.
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