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Quiroga R, Gastellu S, Fernández B, Ottaviani R, Zuccoli JR, Vallecorsa PD, Aliaga J, Barberia L. The impact of COVID-19 childhood and adolescent vaccination on mortality in Argentina. Vaccine 2024; 42:126037. [PMID: 38871572 DOI: 10.1016/j.vaccine.2024.06.005] [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: 03/03/2024] [Revised: 05/22/2024] [Accepted: 06/01/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Argentina authorized COVID-19 vaccination for adolescents 12 years and older in August 2021, and then for children three years and older in October 2021. Children aged 6 months-2 years received a two-dose regimen beginning July 2022. OBJECTIVE This study aims to analyze the impact of COVID-19 vaccination among children aged 0-17, considering vaccination status and mortality for the 2020-2022 period. METHODS We conducted a population-level analysis examining all-cause mortality, COVID-19 cases, deaths, and vaccination records. We compared outcomes with child mortality for diseases for which vaccination is compulsory, before and after each vaccine rollout. RESULTS A decrease in COVID-19-related deaths was observed in 2022 for pediatric age groups (3-11 and 12-17) with relatively higher vaccination coverage. However, no decrease was observed for the 0-2 year old age group, which had the longest delay in access to immunization and lowest vaccination coverage. When compared to unvaccinated populations in 2022, we observe an 8-15-fold reduction in cumulative death rates for pediatric populations vaccinated with 1 or more doses, and a 16-18-fold reduction for those vaccinated with 2 or more doses. Historical analysis shows that for diseases for which vaccination is now compulsory in many countries, pre-vaccine-rollout mortality was lower than COVID-19 deaths during 2020-2022. CONCLUSIONS AND RELEVANCE SARS-CoV-2 immunization was associated with reduced COVID-19 deaths for children and adolescents in Argentina. Our findings suggest that greater efforts should be undertaken to ensure wider COVID-19 vaccine coverage in children and adolescents, especially infants.
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Affiliation(s)
- Rodrigo Quiroga
- Instituto de Investigaciones en Físico-Química de Córdoba (INFIQC-CONICET), Córdoba, Argentina; Departamento de Química Teórica y Computacional, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Argentina.
| | - Sofía Gastellu
- Centro de Historia Social de la Justicia y el Gobierno, Laboratorio de Historias Conectadas, Universidad Nacional de Rosario, Consejo Nacional de Investigaciones Científicas y Técnicas (CEHISO-LAHISCO-UNR-CONICET), Rosario, Argentina
| | | | | | - Johanna Romina Zuccoli
- Centro de Investigaciones sobre Porfirinas y Porfirias (CIPYP-CONICET), Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Daniel Vallecorsa
- Departamento Coordinación BNCT, Comisión Nacional de Energía Atómica (CNEA), Buenos Aires, Argentina
| | - Jorge Aliaga
- Universidad Nacional de Hurlingham, Hurlingham, Argentina
| | - Lorena Barberia
- Departamento de Ciência Política, Universidade de São Paulo, São Paulo, Brazil.
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Oliveira EA, Oliveira MCL, Simões E Silva AC, Dias CS, Diniz LM, Colosimo EA, Mak RH, Vasconcelos MA, Pinhati CC, Galante SC, Veloso IY, Duelis FN, Martelli-Júnior H. A Population-Based Epidemiologic Study of Symptomatic SARS-CoV-2 Infections and Fatalities in Brazilian Children over 3 Years. J Pediatr 2024; 276:114267. [PMID: 39233114 DOI: 10.1016/j.jpeds.2024.114267] [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: 03/24/2024] [Revised: 08/05/2024] [Accepted: 08/26/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE To provide a comprehensive overview of the epidemiologic characteristics, outcomes, and risk factors of COVID-19-related deaths in children and adolescents in Brazil. STUDY DESIGN We conducted a population-based, retrospective cohort study that included all patients aged <18 years with laboratory-confirmed, symptomatic SARS-CoV-2 infection as registered in official Brazilian national surveillance systems for COVID-19 between February 2020 and February 2023. The primary outcome was COVID-19-related deaths. Odds ratios (ORs) of risk factors associated with death were estimated using multivariable logistic regression. RESULTS Over a 3-year period, 2 855 704 pediatric patients with symptomatic SARS-CoV-2 infection were registered in Brazil. Of these, 59 179 (2.1%) were hospitalized, 13 844 (0.48%) were admitted to the intensive care unit, and 4943 (0.17%) received mechanical ventilation. A total of 4740 (0.17%) patients had fatal outcomes. The case fatality rate increased to 7.9% among patients who required hospitalization; 2102 (44.3%) patients who died did not receive advanced critical support. Notably, 2 (65%, 95% CI 58-71) or 3 doses (86%, 95% CI 81-89) of the vaccine provided strong protection against death. The following adjusted covariates were significantly associated with increased odds of death: age (0-4 and 11-17 years), ethnicity (Brown and Indigenous), region (Northeast or North), dyspnea, nosocomial infection, and comorbidities. Conversely, living in the South or Central-West regions, admission in the later period of the pandemic, and receiving a vaccine were all associated with protection against death. CONCLUSIONS Our findings suggest that a complex interplay between individual factors and social inequities has shaped the impact of COVID-19 on Brazilian children and adolescents.
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Affiliation(s)
- Eduardo A Oliveira
- Health Sciences Postgraduate Program, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
| | - Maria Christina L Oliveira
- Health Sciences Postgraduate Program, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Ana Cristina Simões E Silva
- Health Sciences Postgraduate Program, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Cristiane S Dias
- Health Sciences Postgraduate Program, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Lilian M Diniz
- Health Sciences Postgraduate Program, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Enrico A Colosimo
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Robert H Mak
- Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, La Jolla, CA
| | - Mariana A Vasconcelos
- Health Sciences Postgraduate Program, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Clara C Pinhati
- Health Sciences Postgraduate Program, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Stella C Galante
- Health Sciences Postgraduate Program, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Isadora Y Veloso
- Health Sciences Postgraduate Program, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Fernanda N Duelis
- Health Sciences Postgraduate Program, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Hercílio Martelli-Júnior
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros, Minas Gerais, Brazil
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Pacheco AP, Laureano H, Schidlowski L, Ciorcero N, Zanatto T, Borgmann A, Fragoso G, Giamberardino AL, Dourado R, Anjos KD, João P, Assahide M, Silveira MC, Costa-Junior V, Giamberardino H, Prando C. COVID-19 in Brazilian Pediatric Patients: A Retrospective Cross-Sectional Study with a Predictive Model for Hospitalization. Life (Basel) 2024; 14:1083. [PMID: 39337867 PMCID: PMC11433062 DOI: 10.3390/life14091083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/20/2024] [Accepted: 08/20/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND This study was conducted to ascertain the most frequent symptoms of COVID-19 infection at first consultation in a pediatric cohort and to devise a predictive model for hospitalization. METHODS This is a retrospective cross-sectional study of 1028 Brazilian patients aged <18 years with SARS-CoV-2 infection in a single reference hospital in the first year of the pandemic. Clinical, demographic, laboratory, and disease spectrum data were analyzed via multivariate logistic regression modeling to develop a predictive model of factors linked to hospitalization. RESULTS The majority of our cohort were schoolchildren and adolescents, with a homogeneous distribution concerning sex. At first consultation, most patients presented with fever (64.1%) and respiratory symptoms (63.3%). We had 204 admitted patients, including 11 with Pediatric Multisystem Inflammatory Syndrome. Increased D-dimer levels were associated with comorbidities (p = 0.018). A high viral load was observed in patients within the first two days of symptoms (p < 0.0001). Our predictive model included respiratory distress, number and type of specific comorbidities, tachycardia, seizures, and vomiting as factors for hospitalization. CONCLUSIONS Most patients presented with mild conditions with outpatient treatment. However, understanding predictors for hospitalization can contribute to medical decisions at the first patient visit.
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Affiliation(s)
- Ana Paula Pacheco
- Programa de Pós-Graduação em Biotecnologia Aplicada à Saúde da Criança e do Adolescente, Faculdades Pequeno Príncipe, Curitiba 80230-020, PR, Brazil
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
- Serviço de Epidemiologia e Controle de Infecção Hospitalar, Hospital Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
| | - Henrique Laureano
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
| | - Laire Schidlowski
- Programa de Pós-Graduação em Biotecnologia Aplicada à Saúde da Criança e do Adolescente, Faculdades Pequeno Príncipe, Curitiba 80230-020, PR, Brazil
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
| | - Natalia Ciorcero
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
- Faculdades Pequeno Príncipe, Curitiba 80230-020, PR, Brazil
| | - Thalita Zanatto
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
- Faculdades Pequeno Príncipe, Curitiba 80230-020, PR, Brazil
| | - Ariela Borgmann
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
- Medical School, Faculdades Pequeno Príncipe, Curitiba 80230-020, PR, Brazil
| | - Gabrielle Fragoso
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
- Medical School, Faculdades Pequeno Príncipe, Curitiba 80230-020, PR, Brazil
| | | | - Renata Dourado
- Laboratório Genômico, Hospital Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
| | - Karine Dos Anjos
- Serviços Diagnósticos, Hospital Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
| | - Paulo João
- Unidade de Terapia Intensiva, Hospital Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
| | - Marina Assahide
- Serviço de Infectologia Pediátrica, Hospital Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
| | - Maria Cristina Silveira
- Unidade de Terapia Intensiva e Pronto Atendimento, Hospital Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
| | - Victor Costa-Junior
- Serviço de Infectologia Pediátrica, Hospital Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
| | - Heloisa Giamberardino
- Serviço de Epidemiologia e Controle de Infecção Hospitalar, Hospital Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
- Centro de Vacinas, Hospital Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
| | - Carolina Prando
- Programa de Pós-Graduação em Biotecnologia Aplicada à Saúde da Criança e do Adolescente, Faculdades Pequeno Príncipe, Curitiba 80230-020, PR, Brazil
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
- Serviço de Alergia e Imunologia, Hospital Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
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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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5
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Castilho NL, Martelli DRB, Machado RA, Cunha ZA, dos Reis C, Queiroz PR, de Sá Silva D, Oliveira EA, Coletta RD, Martelli-Júnior H. Frequency of Oral Lesions, Olfactory, and Gustatory Disorders and Xerostomia in Patients with COVID-19. Dent J (Basel) 2024; 12:179. [PMID: 38920880 PMCID: PMC11203208 DOI: 10.3390/dj12060179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/18/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
COVID-19, a respiratory illness with a global impact on millions, has recently been linked to manifestations affecting various bodily systems, including the oral cavity. Studies highlight oral issues, like ulcers, blisters, and white patches, alongside olfactory and gustatory dysfunction, influencing an individual's quality of life. In this context, our study aimed to assess the frequency of oral lesions, olfactory and gustatory disorders, and xerostomia resulting from COVID-19. An observational study was conducted with 414 patients to evaluate the frequency of oral symptoms resulting from COVID-19. Patients were diagnosed with mild symptoms and evaluated through clinical examination of the oral cavity and a questionnaire to assess functional alterations. The findings showed that 139 out of 414 patients presented clinical manifestations, with oral lesions being the most prevalent (19.1%), followed by gustatory disorders (18.1%), xerostomia (14.2%), and olfactory dysfunction (14%). The most prevalent oral lesions were ulcerations (n = 51), candidiasis (n = 8), and erythema or red plaques (n = 7). Unfortunately, 50 (12.1%) patients died during this study. Therefore, oral lesions, olfactory and gustatory dysfunctions, and xerostomia are common symptoms associated with COVID-19.
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Affiliation(s)
- Natália Lopes Castilho
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (UNIMONTES), Montes Claros 39400-000, Brazil; (N.L.C.); (Z.A.C.)
| | - Daniella R. Barbosa Martelli
- Health Science/Primary Care Postgraduate Program, Department of Oral Medicine and Oral Pathology, Dental School, State University of Montes Claros (UNIMONTES), Montes Claros 39400-000, Brazil; (D.R.B.M.); (H.M.-J.)
| | - Renato Assis Machado
- Department of Oral Diagnosis and Graduate Program in Oral Biology, School of Dentistry, University of Campinas, Piracicaba 13414-018, Brazil;
| | - Zêus Araujo Cunha
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (UNIMONTES), Montes Claros 39400-000, Brazil; (N.L.C.); (Z.A.C.)
| | - Claudiojanes dos Reis
- Mário Ribeiro Clinical Hospital, School of Medicine, Funorte University Center, Montes Claros 39401-222, Brazil; (C.d.R.); (P.R.Q.); (D.d.S.S.)
| | - Priscila Regina Queiroz
- Mário Ribeiro Clinical Hospital, School of Medicine, Funorte University Center, Montes Claros 39401-222, Brazil; (C.d.R.); (P.R.Q.); (D.d.S.S.)
| | - Dayane de Sá Silva
- Mário Ribeiro Clinical Hospital, School of Medicine, Funorte University Center, Montes Claros 39401-222, Brazil; (C.d.R.); (P.R.Q.); (D.d.S.S.)
| | - Eduardo Araujo Oliveira
- Health Sciences Postgraduate Program, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte 30310-580, Brazil;
- Department of Pediatrics, Rady Children’s Hospital, University of California, San Diego, CA 92093, USA
| | - Ricardo D. Coletta
- Department of Oral Diagnosis and Graduate Program in Oral Biology, School of Dentistry, University of Campinas, Piracicaba 13414-018, Brazil;
| | - Hercílio Martelli-Júnior
- Health Science/Primary Care Postgraduate Program, Department of Oral Medicine and Oral Pathology, Dental School, State University of Montes Claros (UNIMONTES), Montes Claros 39400-000, Brazil; (D.R.B.M.); (H.M.-J.)
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Bishop K, Meiring S, Tempia S, von Gottberg A, Wolter N, Kleynhans J, Moosa F, du Plessis M, Moyes J, Makhasi M, Chuene B, Samuels A, Dawood H, Reubenson G, Zar H, Quan V, Cohen C, Walaza S. Risk Factors for Severe COVID-19 Among Children and Adolescents Enrolled in Acute Respiratory Infection Sentinel Surveillance in South Africa, 2020-2022. Influenza Other Respir Viruses 2024; 18:e13300. [PMID: 38666359 PMCID: PMC11046310 DOI: 10.1111/irv.13300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Identifying children at risk for severe COVID-19 disease from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may guide future mitigation interventions. Using sentinel surveillance data, we aimed to identify risk factors for SARS-CoV-2-associated hospitalisation among patients aged ≤ 18 years with respiratory illness. METHODS From April 2020 to March 2022, patients meeting study case definitions were enrolled at four outpatient influenza-like illness (ILI) and five inpatient severe respiratory infection (SRI) surveillance sites and tested for SARS-CoV-2 infection using polymerase chain reaction (PCR). Each ILI clinic shared a catchment area with its corresponding SRI hospital. Potential risk factors for SARS-CoV-2-associated hospitalisation were analysed using multivariable logistic regression by comparing inpatient versus outpatient SARS-CoV-2 cases. RESULTS Of 4688 participants aged ≤ 18 years, 4556 (97%) with complete PCR and HIV data were included in the analysis. Among patients with ILI and SRI, 92/1145 (8%) and 154/3411 (5%) tested SARS-CoV-2 positive, respectively. Compared to outpatients, hospitalised SARS-CoV-2 cases were associated with age < 6 months ([adjusted odds ratio (aOR) 8.0, 95% confidence interval (CI) 2.7-24.0] versus 1-4 years); underlying medical condition other than HIV [aOR 5.8, 95% CI 2.3-14.6]; laboratory-confirmed Omicron BA.1/BA.2 or Delta variant ([aOR 4.9, 95% CI 1.7-14.2] or [aOR 2.8, 95% CI 1.1-7.3] compared to ancestral SARS-CoV-2); and respiratory syncytial virus coinfection [aOR 6.2, 95% CI 1.0-38.5]. CONCLUSION Aligning with previous research, we identified age < 6 months or having an underlying condition as risk factors for SARS-CoV-2-associated SRI hospitalisation and demonstrated the potential of sentinel surveillance to monitor COVID-19 in children.
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Affiliation(s)
- Kate Bishop
- Division of Public Health Surveillance and ResponseNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
| | - Susan Meiring
- Division of Public Health Surveillance and ResponseNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
- School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- MassGenicsDuluthGeorgiaUSA
- Influenza ProgramCenters for Disease Control and PreventionPretoriaSouth Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
- School of Pathology, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
- School of Pathology, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
- School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Fahima Moosa
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
| | - Mignon du Plessis
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
| | - Mvuyo Makhasi
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
| | - Boitumelo Chuene
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
| | - Aaron M. Samuels
- Influenza ProgramCenters for Disease Control and PreventionPretoriaSouth Africa
- Influenza DivisionNational Center for Immunization and Respiratory Diseases, Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Halima Dawood
- Infectious Diseases Unit, Department of MedicineGreys HospitalPietermaritzburgKwaZulu‐NatalSouth Africa
| | - Gary Reubenson
- Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - Vanessa Quan
- Division of Public Health Surveillance and ResponseNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
- School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
- DST/NRF Vaccine Preventable DiseasesRespiratory and Meningeal Pathogens Research Unit (RMPRU)JohannesburgSouth Africa
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Milan MJD, Molina AJR, Ong-Lim ALT, Uy MEV, Uy HG. Factors Associated with Adverse Outcomes among SARS-CoV-2 Positive Children in a Tertiary Government COVID-19 Referral Hospital in the Philippines. ACTA MEDICA PHILIPPINA 2024; 58:73-89. [PMID: 38882911 PMCID: PMC11168956 DOI: 10.47895/amp.v58i7.8392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background and Objective Pediatric COVID-19 epidemiology and factors associated with adverse outcomes - mortality, need for invasive mechanical ventilation, and ICU admission, are largely unstudied. We described the clinico-demographic characteristics of Filipino pediatric COVID-19 patients and determined the factors associated with adverse outcomes. Methods This is a retrospective cohort study of 180 hospitalized SARS-CoV-2-confirmed cases 0-18 years old from April 2020 to August 2021 in a tertiary COVID-19 referral hospital in Manila, National Capital Region. Crude associations were determined using chi-squared or Fisher's exact tests; and medians were compared using the Mann-Whitney test. Factors predictive of mortality were determined using Cox proportional hazards regression analysis. The survivor functions were depicted in graphs. Results About 41.67% had mild disease, 58.33% were males, 39.4% aged 0-4 years, and 69.44% had at least one comorbidity. About 9.44% died (adjusted 9.2 persons per 1000 patient-days, 95% CI 5.5%-15.2%), 17.78% needed invasive mechanical ventilation, and 20% needed ICU admission. Independently, severe-critical COVID-19 (HRc 11.51, 95% CI 3.23, 41.06), retractions (HRc 10.30, 95% CI 3.27, 32.47), alar flaring (HRc 4.39, 95% CI 1.53, 12.58), cyanosis (HRc 4.39, 95% CI 1.72, 14.11), difficulty of breathing (HRc 7.99, 95% CI 2.25, 28.71), poor suck/appetite (HRc 4.46, 95% CI 1.59, 12.40), ferritin (HRc 1.01, 95% CI 1.00, 1.01), IL-6 (HRc 1.01, 95% CI 1.00, 1.01), aPTT (HRc 1.05, 95% CI 1.01, 1.10), IVIg (HRc 4.00, 95% CI 1.07, 14.92) and corticosteroid (HRc 6.01, 95% CI 2.04, 17.67) were significant hazards for mortality. In adjusted Cox analysis, only retractions (HRa 34.96, 95% CI 3.36, 363.79), seizure (HRa 9.98, 95% CI 1.76, 56.55), and corticosteroids (HRa 8.21, 95% CI 1.12, 60.38) were significantly associated with mortality while alar flaring appeared to be protective (HRa 0.10, 95% CI 0.01, 0.95). Several clinical characteristics were consistently associated with adverse outcomes. Conclusions Majority of hospitalized pediatric COVID-19 patients were very young, males, had mild disease, and had at least one comorbidity. Mortality, invasive mechanical ventilation, and ICU admission were relatively low. Except for alar flaring which appeared to be protective, retractions, seizure, and use of corticosteroids were associated with adverse outcomes.
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Affiliation(s)
- Mark Jason Dc Milan
- Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila
| | - Al Joseph R Molina
- Expanded Hospital Research Office, Philippine General Hospital, University of the Philippines Manila
| | - Anna Lisa T Ong-Lim
- Division of Infectious and Tropical Diseases, Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila
| | - Ma Esterlita V Uy
- Division of Newborn Medicine, Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila
| | - Herbert G Uy
- Division of Pediatric Critical Care, Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila
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8
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de Farias ECF, Pavão Junior MJC, de Sales SCD, do Nascimento LMPP, Pavão DCA, Pinheiro APS, Pinheiro AHO, Alves MCB, Ferraro KMMM, Aires LFQ, Dias LG, Machado MMM, Serrão MJD, Gomes RR, de Moraes SMP, Moura GMG, de Sousa AMB, Pontes GCL, Carvalho RDFP, Silva CTC, Lemes G, da C G Diniz B, Chermont AG, de Almeida KFS, Saraty SB, Maia MLF, Lima MRC, Carvalho PB, de B Braga R, de O Harada K, Justino MCA, Clemente G, Terreri MT, Monteiro MC. Factors associated to mortality in children with critical COVID-19 and multisystem inflammatory syndrome in a resource-poor setting. Sci Rep 2024; 14:5539. [PMID: 38448485 PMCID: PMC10918095 DOI: 10.1038/s41598-024-55065-x] [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: 08/17/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
SARS-CoV-2 infection in children is usually asymptomatic/mild. However, some patients may develop critical forms. We aimed to describe characteristics and evaluate the factors associated to in-hospital mortality of patients with critical COVID-19/MIS-C in the Amazonian region. This multicenter prospective cohort included critically ill children (1 mo-18 years old), with confirmed COVID-19/MIS-C admitted to 3 tertiary Pediatric Intensive Care Units (PICU) in the Brazilian Amazon, between April/2020 and May/2023. The main outcome was in-hospital mortality and were evaluated using a multivariable Cox proportional regression. We adjusted the model for pediatric risk of mortality score version IV (PRISMIV) score and age/comorbidity. 266 patients were assessed with 187 in the severe COVID-19 group, 79 included in the MIS-C group. In the severe COVID-19 group 108 (57.8%) were male, median age was 23 months, 95 (50.8%) were up to 2 years of age. Forty-two (22.5%) patients in this group died during follow-up in a median time of 11 days (IQR, 2-28). In the MIS-C group, 56 (70.9%) were male, median age was 23 months and median follow-up was 162 days (range, 3-202). Death occurred in 17 (21.5%) patients with a median death time of 7 (IQR, 4-13) days. The mortality was associated with higher levels of Vasoactive Inotropic-Score (VIS), presence of acute respiratory distress syndrome (ARDS), higher levels of Erythrocyte Sedimentation Rate, (ESR) and thrombocytopenia. Critically ill patients with severe COVID-19 and MIS-C from the Brazilian Amazon showed a high mortality rate, within 12 days of hospitalization.
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Affiliation(s)
- Emmerson C F de Farias
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil.
- Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, 7th Floor, St. Bernal do Couto, 988 - Umarizal, Belém, PA, 66055-080, Brazil.
| | - Manoel J C Pavão Junior
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Susan C D de Sales
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Luciana M P P do Nascimento
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Dalila C A Pavão
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Anna P S Pinheiro
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Andreza H O Pinheiro
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Marília C B Alves
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Kíssila M M M Ferraro
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Larisse F Q Aires
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Luana G Dias
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Mayara M M Machado
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Michaelle J D Serrão
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Raphaella R Gomes
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Sara M P de Moraes
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Gabriella M G Moura
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Adriana M B de Sousa
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Gabriela C L Pontes
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Railana D F P Carvalho
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Cristiane T C Silva
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Guilherme Lemes
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Bruna da C G Diniz
- Division of Pediatric Intensive Care, Department of Pediatrics, Fundação Santa Casa de Misericórdia do Pará, Belém, PA, Brazil
| | - Aurimery G Chermont
- Medical School, Medical Science Institute, Federal University of Pará/UFPA, Belém, PA, Brazil
| | - Kellen F S de Almeida
- Medical School, Medical Science Institute, Federal University of Pará/UFPA, Belém, PA, Brazil
| | - Salma B Saraty
- Division of Pediatric Intensive Care, Department of Pediatrics, Pronto Socorro Municipal Mário Pinotti's Hospital, Belém, PA, Brazil
| | - Mary L F Maia
- Division of Pediatric Intensive Care, Department of Pediatrics, Pronto Socorro Municipal Mário Pinotti's Hospital, Belém, PA, Brazil
| | - Miriam R C Lima
- Division of Pediatric Intensive Care, Department of Pediatrics, Pronto Socorro Municipal Mário Pinotti's Hospital, Belém, PA, Brazil
| | - Patricia B Carvalho
- Division of Pediatric Intensive Care, Departament of Pediatrics, Fundação Hospital das Clínicas Gaspar Viana, Belém, PA, Brazil
| | - Renata de B Braga
- Division of Pediatric Intensive Care, Departament of Pediatrics, Fundação Hospital das Clínicas Gaspar Viana, Belém, PA, Brazil
| | - Kathia de O Harada
- Division of Pediatric Intensive Care, Departament of Pediatrics, Fundação Hospital das Clínicas Gaspar Viana, Belém, PA, Brazil
| | - Maria C A Justino
- Instituto Evandro Chagas, Virology Section, Health Surveillance Secretariat, Brazilian Ministry of Health, Ananindeua, PA, Brazil
| | - Gleice Clemente
- Division of Pediatric Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Maria Teresa Terreri
- Division of Pediatric Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marta C Monteiro
- Pharmaceutical Science Post-Graduation Program and Neuroscience and Cell Biology Graduate Program, Health Science Institute, Federal University of Pará/UFPA, Belém, PA, Brazil
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9
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Kulkarni D, Ismail NF, Zhu F, Wang X, del Carmen Morales G, Srivastava A, Allen KE, Spinardi J, Rahman AE, Kyaw MH, Nair H. Epidemiology and clinical features of SARS-CoV-2 infection in children and adolescents in the pre-Omicron era: A global systematic review and meta-analysis. J Glob Health 2024; 14:05003. [PMID: 38419461 PMCID: PMC10902805 DOI: 10.7189/jogh.14.05003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Methods We searched MEDLINE, Embase, Global Health, CINAHL, China National Knowledge Infrastructure, Wanfang, CQvip, and the World Health Organization (WHO) COVID-19 global literature databases for primary studies recruiting children aged ≤18 years with a diagnosis of SARS-CoV-2 infection confirmed either by molecular or antigen tests. We used the Joanna Briggs Institute critical appraisal tools to appraise the study quality and conducted meta-analyses using the random effects model for all outcomes except for race/ethnicity as risk factors of SARS-CoV-2 infection. Results We included 237 studies, each reporting at least one of the study outcomes. Based on data from 117 studies, the pooled SARS-CoV-2 positivity rate was 9.30% (95% confidence interval (CI) = 7.15-11.73). Having a comorbidity was identified as a risk factor for SARS-CoV-2 infection (risk ratio (RR) = 1.33; 95% CI = 1.04-1.71) based on data from 49 studies. Most cases in this review presented with mild disease (n = 50; 52.47% (95% CI = 44.03-60.84)). However, 20.70% of paediatric SARS-CoV-2 infections were hospitalised (67 studies), 7.19% required oxygen support (57 studies), 4.26% required intensive care (93 studies), and 2.92% required assisted ventilation (63 studies). The case fatality ratio (n = 119) was 0.87% (95% CI = 0.54-1.28), which included in-hospital and out-of-hospital deaths. Conclusions Our data showed that children were at risk for SARS-CoV-2 infections and severe outcomes in the pre-Omicron era. These findings underscore the need for effective vaccination strategies for the paediatric population to protect against the acute and long-term sequelae of COVID-19. Registration PROSPERO: CRD42022327680.
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Affiliation(s)
- Durga Kulkarni
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Nabihah Farhana Ismail
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
- Communicable Disease Control Unit, Public Health Department, Johor State, Malaysia
| | - Fuyu Zhu
- Schol of Public Health, Nanjing Medical University, China
| | - Xin Wang
- Schol of Public Health, Nanjing Medical University, China
| | | | | | | | | | - Ahmed Ehsanur Rahman
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
- International Centre for Diarrhoeal Diseases Research, Bangladesh
| | | | - Harish Nair
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
- Schol of Public Health, Nanjing Medical University, China
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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10
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Sahli S, Størdal K. Systematic review of socioeconomic factors and COVID-19 in children and adolescents. Acta Paediatr 2024; 113:384-393. [PMID: 38193593 DOI: 10.1111/apa.17091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
AIM To systematically review the evidence on Covid-19 infection risk, severity and vaccination uptake among children and adolescents by socioeconomic status. METHODS We conducted a systematic literature review, using the PubMed database. We searched for articles published from January 2020 to January 2022 using "MeSH" words and titles. The key terms were "COVID", "social status", "socioeconomic factor" and "children". We also searched secondary sources such as published reports and other databases. RESULTS The search identified 15 relevant articles and reports. This review shows that children of lower socioeconomic status have a higher risk of COVID-19 infection and a higher risk of being hospitalised. Mortality in a global setting was also higher in children with low socioeconomic status, though not observed in high-resourced countries. These children are also less likely to be vaccinated against the SARS-CoV-2 virus. CONCLUSIONS The higher risk of COVID-19 infection and hospitalisation and lower vaccination coverage in children and adolescents from lower socioeconomic backgrounds demonstrate health disparities also in young age. These disparities should inform health authorities in planning for future pandemics.
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Affiliation(s)
- Sarah Sahli
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ketil Størdal
- Department of Paediatric Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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11
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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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12
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Costa SDSB, Branco MDRFC, Pereira AR, Costa EM, Araújo MSM, Oliveira DCD, Oliveira BLCAD, Rangel MES, Tonello AS, Lopes DAM, Pinheiro VV, Câmara APB, Santos AMD, Vasconcelos VV. Spatial analysis of hospital-related mortality due to COVID-19 among children and adolescents in Brazil. CIENCIA & SAUDE COLETIVA 2024; 29:e19892022. [PMID: 38198339 DOI: 10.1590/1413-81232024291.19892022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/30/2023] [Indexed: 01/12/2024] Open
Abstract
The objective was to perform a spatial analysis of the hospital mortality rate (HMR) due to severe acute respiratory syndrome (SARS) attributed to COVID-19 among children and adolescents in Brazil from 2020 to 2021. A cluster method was used to group federal units (FUs) based on HMR. In 2020, clusters with high HMRs were formed by north/northeast FUs. In 2021, there was a reduction in HMR. Clusters with higher rates remained in the N/NE region. Regional differences were observed in the HMR. The findings may reflect social inequalities and access to hospital care, especially in the under 1-year-old age group due to the severity of the disease in this group.
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Affiliation(s)
- Silmery da Silva Brito Costa
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão (UFMA). R. Barão de Itapary 155, Centro. 65020-070 São Luís MA Brasil.
| | | | | | - Elisa Miranda Costa
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão (UFMA). R. Barão de Itapary 155, Centro. 65020-070 São Luís MA Brasil.
| | - Mayra Sharlenne Moraes Araújo
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão (UFMA). R. Barão de Itapary 155, Centro. 65020-070 São Luís MA Brasil.
| | | | | | | | | | | | | | - Ana Patricia Barros Câmara
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão (UFMA). R. Barão de Itapary 155, Centro. 65020-070 São Luís MA Brasil.
| | - Alcione Miranda Dos Santos
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão (UFMA). R. Barão de Itapary 155, Centro. 65020-070 São Luís MA Brasil.
| | - Vitor Vieira Vasconcelos
- Programa de Pós-Graduação em Ciência e Tecnologia Ambiental, Universidade Federal do ABC. São Paulo SP Brasil
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13
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Dias CS, Diniz LM, Oliveira MCL, Simões E Silva AC, Colosimo EA, Mak RH, Pinhati CC, Galante SC, Veloso IY, Martelli-Júnior H, Oliveira EA. Outcomes of SARS-CoV-2 and Seasonal Viruses Among Children Hospitalized in Brazil. Pediatrics 2024; 153:e2023064326. [PMID: 38213278 DOI: 10.1542/peds.2023-064326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Understanding how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) interacts with other respiratory viruses is crucial for developing effective public health strategies in the postpandemic era. This study aimed to compare the outcomes of SARS-CoV-2 and seasonal viruses in children and adolescents hospitalized with severe acute respiratory infection (SARI). METHODS This population-based, retrospective cohort study included children and adolescents hospitalized with SARI from February 2020 to February 2023 in Brazil. The main exposure of interest was viral etiology. The primary outcome was in-hospital mortality. Competing risk analysis was used to account for time dependency and competing events. RESULTS A total of 235 829 patients had available results of the viral tests, with SARS-CoV-2 predominance. According to the competing-risk survival analysis, the estimated probability of a fatal outcome at 30 days of hospitalization according to the viral strain was 6.5%, 3.4%, 2.9%, 2.3%, 2.1%, and 1.8%, for SARS-CoV-2, coinfection, adenovirus, influenza, other viruses, and respiratory syncytial virus, respectively. Individuals with a positive test for SARS-CoV-2 had hazard of death 3 times higher than subjects with a negative test (hazard ratio, 3.3; 95% confidence interval, 3.1-3.5). After adjustment by the competing-risk multivariable analysis, admission in Northeast and North regions, oxygen saturation <95%, and the presence of comorbidities were risk factors for death in all viral strains. CONCLUSIONS SARS-CoV-2 infection had the highest hazard of in-hospital mortality in this pediatric cohort hospitalized with SARI. Regardless of viral etiology, the presence of underlying medical conditions was a risk factor for death.
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Affiliation(s)
- Cristiane S Dias
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | - Lilian M Diniz
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | | | | | - Enrico A Colosimo
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Robert H Mak
- Department of Pediatrics, Rady Children's Hospital, University of California, San Diego
| | - Clara C Pinhati
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | - Stella C Galante
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | - Isadora Y Veloso
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | - Hercílio Martelli-Júnior
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros, Minas Gerais, Brazil
| | - Eduardo A Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
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14
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Korzeniewska-Eksterowicz A, Brzezinska O, Dryja U, Matczak D, Sopilnyak A, Szuszkiewicz E, Przysło Ł, Szmyd K, Jabłońska K, Krych P, Wojtków-Zielińska A, Wąsińska E, Niedźwiecki M. COVID-19 in pediatric palliative care patients: Multicenter, retrospective cohort study. Palliat Med 2024; 38:150-155. [PMID: 37937380 DOI: 10.1177/02692163231206928] [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] [Indexed: 11/09/2023]
Abstract
BACKGROUND Studies have shown the risk factors for COVID-19 severity in children, including comorbidities, but information on the infection course in children with life-limiting conditions is sparse. AIM To describe the effect of COVID-19 on pediatric patients receiving palliative care due to life-limiting conditions. DESIGN We conducted retrospective cohort study. The WHO Clinical Progression Scale was used to measure COVID-19 severity. SETTING/PARTICIPANTS Seven of the 24 invited pediatric palliative care centers participated in this study. We analyzed the medical records of children under palliative care with confirmed COVID-19 (January 2020-April 2022). RESULTS Records of 60 patients with COVID-19 aged 0.24 to 21.6 years (mean (SD); 9.8 (6.6)) were collected. The largest group of patients with COVID-19 was children with congenital malformations and chromosomal abnormalities (42%); the most common manifestation was fever (85%). Bacterial coinfection was confirmed in 17 (28%) children. Fifteen (25%) children required hospitalization, including four admitted to the Intensive Care Unit. Mild COVID-19 was identified in 44 (73%) children, moderate in 11 (18%), severe in 3 (5%), and death in 2 (3%). Six of the 20 eligible children were vaccinated against SARS-CoV-2, followed by 16 mothers and fathers. CONCLUSION In the study population initial presentation of COVID-19 was predominantly a mild; however, the small sample size precluded definitive conclusions. For children under palliative care, we should identify if they have an advance care plan for COVID-19, such as desires for intensive care support. Further studies are needed to define the short and long-term effects of COVID-19 in children with life-limiting conditions.
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Affiliation(s)
- Aleksandra Korzeniewska-Eksterowicz
- Pediatric Palliative Care Unit, Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
- Gajusz Foundation-Pediatric Palliative Care Center, Lodz, Poland
| | - Olga Brzezinska
- Department of Rheumatology With Subdepartment of Internal Medicine, Medical University of Lodz, Lodz, Poland
| | - Urszula Dryja
- Gajusz Foundation-Pediatric Palliative Care Center, Lodz, Poland
| | - Dominka Matczak
- Gajusz Foundation-Pediatric Palliative Care Center, Lodz, Poland
| | - Andriy Sopilnyak
- Pediatric Palliative Care Unit, Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
- Gajusz Foundation-Pediatric Palliative Care Center, Lodz, Poland
| | | | - Łukasz Przysło
- Department of Developmental Neurology and Epileptology, Research Institute of Polish Mother's Memorial Hospital, Lodz, Poland
| | - Krzystof Szmyd
- Hospice for Children of Lower Silesia "Formula Dobra," Wrocław, Poland
| | | | - Piotr Krych
- Home Children's Hospice Promyczek, Otwock, Poland
| | | | | | - Maciej Niedźwiecki
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
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Bain V, Abramczyk ML, Costa RLS, Paixão MR, Souza Junior JLD. Pediatric COVID-19: clinical and epidemiological data of 1303 cases in a general hospital in Brazil. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 42:e2023031. [PMID: 38126598 PMCID: PMC10742344 DOI: 10.1590/1984-0462/2024/42/2023031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/03/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This study aimed to describe the clinical characteristics of the pediatric population with COVID-19 in an Emergency Department (ED) of a Brazilian general hospital. METHODS Epidemiological and clinical data of patients younger than 20 years old were collected from patients' medical records from February 2020 to July 2021. Most of the epidemiological data described pertains to hospitalized patients. We also reviewed coinfections, treatment, and outcomes and compared the first and second waves of COVID-19. RESULTS We identified a total of 1303 episodes of SARS-CoV-2 infection. The median time from symptom onset to diagnosis was three days. Symptoms were present in 92.3% of the patients. The most common symptoms were fever (45.2%), nasal congestion/discharge (44.2%), and cough (39.4%). Chest radiography and tomography were performed in 7.7 and 3.3% of cases, with abnormal findings in 29.7 and 53.4%, respectively. Hospital admissions occurred in 3.5% of patients, mainly in the presence of comorbidities, in children under five years old and in those who presented to the ED during the first wave of COVID-19. Coinfection with a viral agent was identified in 20% of the 71 cases tested in this study, and a positive rapid test for Streptococcus pyogenes was found in 8% of the 174 cases tested, with no impact of these coinfections on hospitalization. CONCLUSIONS We found that COVID-19 was a mild disease in most children in our study population, with most hospitalizations and readmissions occurring during the first wave of COVID-19.
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Affiliation(s)
- Vera Bain
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Shafaei B, Nafei Z, Karimi M, Behniafard N, Shamsi F, Faisal M, Amel Shahbaz AP, Akbarian E. Which Groups of Children Are at More Risk of Fatality during COVID-19 Pandemic? A Case-Control Study in Yazd, Iran. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:8838056. [PMID: 38130842 PMCID: PMC10735732 DOI: 10.1155/2023/8838056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/02/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
Introduction The study aims to investigate the characteristics, comorbidities, laboratory findings, and clinical manifestations of under 18-year-old patients who died with the diagnosis of COVID-19 and determination of the most prevalent risk factors. Method This case-control study was performed at a referral hospital in Yazd from March 2020 to August 2021. All patients under 18 years who were diagnosed through real-time RT-PCR, chest computed tomography, and the World Health Organization definition were divided into deceased and survived groups. The characteristics (age and sex), disease severity, comorbidities, laboratory findings, and clinical manifestations of the two groups were compared and analyzed using SPSS, version 18 (SPSS Inc., Chicago, III., USA). Results A total of 24 patients in the deceased group and 167 patients in the survived group were compared. The highest mortality rate was observed in the age group of 1 month to 5 years, although no statistically significant relationship was found between age groups and the risk of mortality. Disease severity, dyspnea, low oxygen saturation on admission, length of hospital stays, and hospitalization history before the last admission were significantly correlated with mortality (P < 0.05). Lymphopenia increased the probability of mortality by more than two times (OR: 2.568; 95% CI (0.962-6.852)), but this was not the case for D-dimer and C-reactive protein. Furthermore, 27.5% of survived patients had normal chest CT scans, which was a statistically significant difference compared to the deceased patients (P: 0.031). Conclusion Based on the findings of this study, dyspnea, low oxygen saturation, and lymphopenia are critical indicators for identifying high-risk children with COVID-19 and triaging them for better care and treatment.
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Affiliation(s)
- Behnam Shafaei
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zahra Nafei
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mehran Karimi
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasrin Behniafard
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farimah Shamsi
- Center of Healthcare Data Modeling, Department of Biostatics and Epidemiology, School of Public Health, Shahid Sadoughi University of Sciences, Yazd, Iran
| | - Masoud Faisal
- Department of Radiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Amir Pasha Amel Shahbaz
- Department of Radiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Elahe Akbarian
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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17
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Schmidt CJ, Casassola GM, Affeldt GH, Morais DS, Alvarenga LKB, Miller C, Ziegler B. One-year follow-up of children hospitalized with COVID-19: a prospective cohort study. J Bras Pneumol 2023; 49:e20230151. [PMID: 37991071 PMCID: PMC10760420 DOI: 10.36416/1806-3756/e20230151] [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: 04/26/2023] [Accepted: 09/12/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE Currently, little is known about the long-term outcomes of COVID-19 in the pediatric population. The aim of this study was to investigate the long-term clinical outcomes of pediatric patients hospitalized with COVID-19. METHODS This was a prospective cohort study involving unvaccinated children and adolescents admitted to a tertiary hospital in southern Brazil with a COVID-19 diagnosis. Data were collected from electronic medical records for one year after the diagnosis. RESULTS A total of 66 children were included: the median age was 2.9 years; 63.6% were male; and 48.5% were under 2 years of age. Over 70% had at least one comorbidity prior to the COVID-19 diagnosis. During the one-year follow-up period, 59.1% of the children revisited the emergency department, 50% required readmission, and 15.2% died. Younger children with longer hospital stays were found to be at greater risk of readmission. Having cancer and impaired functionality were found to increase the risk of death within one year. CONCLUSIONS Our findings indicate that most children hospitalized with COVID-19 have comorbidities. Younger age at admission and a longer hospital stay seem to be risk factors for readmission. In addition, the presence of cancer and impaired functionality are apparently associated with the poor outcome of death within the first year after the diagnosis of COVID-19.
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Affiliation(s)
- Caroline Jacoby Schmidt
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Giovana Morin Casassola
- . Residente Multiprofissional em Saúde da Criança, Hospital de Clínicas de Porto Alegre - HCPA - Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Guilherme Hoff Affeldt
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Debora Sana Morais
- . Programa de Pós-Graduação em Pesquisa Clínica, Departamento de Fisioterapia, Hospital de Clínicas de Porto Alegre - HCPA - Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Letícia Krás Borges Alvarenga
- . Departamento de Fisioterapia, Hospital de Clínicas de Porto Alegre - HCPA - Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Cristina Miller
- . Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Departamento de Fisioterapia, Hospital de Clínicas de Porto Alegre - HCPA - Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Bruna Ziegler
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
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18
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da Silva ACCAC, Luiz RR, de Moraes JR, Rocha PHV, Zeitoune RCG, Barbosa AP, Moreira JPDL. Hospital mortality from covid-19 in children and adolescents in Brazil in 2020-2021. Rev Saude Publica 2023; 57:56. [PMID: 37878842 PMCID: PMC10519682 DOI: 10.11606/s1518-8787.2023057005172] [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: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE To describe cases, deaths, and hospital mortality from covid-19 in children and adolescents in Brazil, according to age group, during the evolving phases of the pandemic in 2020 and 2021. METHODS Census of patients aged up to 19 committed with severe acute respiratory syndrome, due to covid-19 or unspecified, notified to the Brazilian Influenza Epidemiological Surveillance Information System, from January 1, 2020, to December 31, 2021. The two years were divided into six phases, covering the spread of the disease-first, second and third wave-as well as the impact of vaccination. The pediatric population was categorized into infants, preschoolers, schoolchildren, and adolescents. Hospital mortality was assessed by pandemic phase and age group. RESULTS A total of 144,041 patients were recorded in the two years, 18.2% of whom had confirmed cases of covid-19. Children under 5 years old (infants and preschoolers) accounted for 62.8% of those hospitalized. A total of 4,471 patients died, representing about 6.1 deaths per day. Infants were the ones who most progressed to the intensive care unit (24.7%) and had the highest gross number of deaths (n = 2,012), but mortality was higher among adolescents (5.7%), reaching 9.8% in phase 1. The first peak of deaths occurred in phase 1 (May/2020), and two other peaks occurred in phase 4 (March/2021 and May/2021). There was an increase in cases and deaths for younger ages since phase 4. Hospital mortality in the pediatric population was higher in phases 1, 4, and 6, following the phenomena of dissemination/interiorization of the virus in the country, beginning of the second wave and beginning of the third wave, respectively. CONCLUSION The absolute number of cases of covid-19 in children and adolescents is significant. Although complete vaccination in descending order of age provided a natural deviation in age range, there was a greater gap between the curve of new hospitalized cases and the curve of deaths, indicating the positive impact of immunization.
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Affiliation(s)
- Amanda Cilene Cruz Aguiar Castilho da Silva
- Universidade Federal do Rio de JaneiroEscola de Enfermagem Anna NeryRio de JaneiroRJBrazilUniversidade Federal do Rio de Janeiro. Escola de Enfermagem Anna Nery. Rio de Janeiro, RJ, Brazil.
| | - Ronir Raggio Luiz
- Universidade Federal do Rio de JaneiroInstituto de Saúde ColetivaRio de JaneiroRJBrazilUniversidade Federal do Rio de Janeiro. Instituto de Saúde Coletiva. Rio de Janeiro, RJ, Brazil.
| | - José Rodrigo de Moraes
- Universidade Federal FluminenseInstituto de Matemática e EstatísticaDepartamento de EstatísticaNiteróiRJBrazilUniversidade Federal Fluminense. Instituto de Matemática e Estatística. Departamento de Estatística. Niterói, RJ, Brazil.
| | - Pedro Henrique Vieira Rocha
- Universidade Federal FluminenseFaculdade de FarmáciaNiteróiRJBrazilUniversidade Federal Fluminense. Faculdade de Farmácia. Niterói, RJ, Brazil.
| | - Regina Célia Gollner Zeitoune
- Universidade Federal do Rio de JaneiroEscola de Enfermagem Anna NeryRio de JaneiroRJBrazilUniversidade Federal do Rio de Janeiro. Escola de Enfermagem Anna Nery. Rio de Janeiro, RJ, Brazil.
| | - Arnaldo Prata Barbosa
- Instituto D’Or de Pesquisa e EnsinoDepartamento de PediatriaRio de JaneiroRJBrazilInstituto D’Or de Pesquisa e Ensino. Departamento de Pediatria. Rio de Janeiro, RJ, Brazil.
| | - Jessica Pronestino de Lima Moreira
- Universidade Federal FluminenseFaculdade de FarmáciaDepartamento de BromatologiaNiteróiRJBrazilUniversidade Federal Fluminense. Faculdade de Farmácia. Departamento de Bromatologia. Niterói, RJ, Brazil.
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19
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Oliveira EA, Oliveira MCL, Silva ACSE, Colosimo EA, Mak RH, Vasconcelos MA, Silva LR, Martelli DB, Pinhati CC, Martelli-Júnior H. Effectiveness of BNT162b2 and CoronaVac vaccines against omicron in children aged 5 to 11 years. World J Pediatr 2023; 19:949-960. [PMID: 36914907 PMCID: PMC10010648 DOI: 10.1007/s12519-023-00699-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/31/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND This study aimed to estimate vaccine effectiveness (VE) against omicron variant infection and severe corona virus disease 2019 (COVID-19) in children aged 5-11 years hospitalized with acute respiratory syndrome. METHODS A test-negative, case-control analysis was conducted from February 2022 to June 2022. We enrolled 6950 eligible children, including 1102 cases and 5848 controls. VE was calculated after immunization with one and two doses of BNT162b2 or CoronaVac. The outcomes were hospitalization with acute respiratory symptoms and detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe COVID-19. The adjusted odds ratio for the association of prior vaccination and outcomes was used to estimate VE. RESULTS For fully vaccinated children, the overall estimated VE against hospitalization with SARS-CoV-2 infection was 42% [95% confidence interval (CI) 26 to 54]. VE peaked at 29-42 days (67%, 95% CI 40% to 82%) and then declined to 19% (95% CI, - 20% to 45%) at 57-120 days after the second dose. The BNT162b2 vaccine had a similar VE against hospitalization with SARS-CoV-2 infection (45%, 95% CI, 20 to 61) compared to the CoronaVac vaccine (40%, 95% CI, 17% to 56%). Among cases, 56 (5%) children died; 53 (94.6%) were not fully vaccinated. For cases, the two-dose schedule effectiveness against ICU admission, need for invasive ventilation, severe illness, and death were 10% (95% CI, - 54%-45%), 22% (95% CI - 70%-68%), 12% (95% CI, - 62%-52%), and 16% (95% CI, - 77%-75%), respectively. CONCLUSIONS For hospitalized children aged 5-11 years during the omicron-predominant period in Brazil, two doses of both vaccines had moderate effectiveness against hospitalization with acute respiratory symptoms and SARS-CoV-2 infection and offered limited protection against endpoints of COVID-19 severity.
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Affiliation(s)
- Eduardo A Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30130-100, Brazil.
| | - Maria Christina L Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30130-100, Brazil
| | - Ana Cristina Simões E Silva
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30130-100, Brazil
| | - Enrico A Colosimo
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Robert H Mak
- Department of Pediatrics, Rady Children's Hospital, University of California, La Jolla, San Diego, CA, USA
| | - Mariana A Vasconcelos
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30130-100, Brazil
| | - Ludmila R Silva
- Health Science/Postgraduate Program in Nursing. School of Nursing, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, 30130-100, Brazil
| | - Daniella B Martelli
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros, MG, 39401-089, Brazil
| | - Clara C Pinhati
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30130-100, Brazil
| | - Hercílio Martelli-Júnior
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros, MG, 39401-089, Brazil
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Peixoto PH, Silva ML, Portela FV, da Silva B, Milanez E, de Oliveira D, Ribeiro A, de Almeida H, Lima-Neto R, Guedes GM, Castelo-Branco D, Cordeiro R. Clinical, Epidemiological and Laboratory Features of Invasive Candida parapsilosis Complex Infections in a Brazilian Pediatric Reference Hospital during the COVID-19 Pandemic. J Fungi (Basel) 2023; 9:844. [PMID: 37623615 PMCID: PMC10456047 DOI: 10.3390/jof9080844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
The present study aimed to describe the clinical, epidemiological and laboratory characteristics of invasive candidiasis by C. parapsilosis complex (CPC) in a Brazilian tertiary pediatric hospital during the COVID-19 pandemic. Clinical samples were processed in the BACT/ALERT® 3D system or on agar plates. Definitive identification was achieved by MALDI-TOF MS. Antifungal susceptibility was initially analyzed by the VITEK 2 system (AST-YS08 card) and confirmed by the CLSI protocol. Patient data were collected from the medical records using a structured questionnaire. CPC was recovered from 124 patients over an 18-month period, as follows: C. parapsilosis (83.87%), C. orthopsilosis (13.71%) and C. metapsilosis (2.42%). Antifungal resistance was not detected. The age of the patients with invasive CPC infections ranged from <1 to 18 years, and most of them came from oncology-related sectors, as these patients were more affected by C. parapsilosis. C. orthopsilosis infections were significantly more prevalent in patients from critical care units. Invasive infections caused by different pathogens occurred in 75 patients up to 30 days after the recovery of CPC isolates. Overall, 23 (18.55%) patients died within 30 days of CPC diagnosis. Catheter removal and antifungal therapy were important measures to prevent mortality. COVID-19 coinfection was only detected in one patient.
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Affiliation(s)
- Paulo Henrique Peixoto
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Maria Laína Silva
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Fernando Victor Portela
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Bruno da Silva
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Edlâny Milanez
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Denis de Oliveira
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Aldaíza Ribeiro
- Albert Sabin Children Hospital, Fortaleza 60410-794, Brazil;
| | - Henrique de Almeida
- Department of Tropical Medicine, Federal University of Pernambuco, Recife 50670-901, Brazil; (H.d.A.); (R.L.-N.)
| | - Reginaldo Lima-Neto
- Department of Tropical Medicine, Federal University of Pernambuco, Recife 50670-901, Brazil; (H.d.A.); (R.L.-N.)
| | - Glaucia Morgana Guedes
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Débora Castelo-Branco
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Rossana Cordeiro
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
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Hurst JH, Mohan AA, Dalapati T, George IA, Aquino JN, Lugo DJ, Pfeiffer TS, Rodriguez J, Rotta AT, Turner NA, Burke TW, McClain MT, Henao R, DeMarco CT, Louzao R, Denny TN, Walsh KM, Xu Z, Mejias A, Ramilo O, Woods CW, Kelly MS. Differential host responses within the upper respiratory tract and peripheral blood of children and adults with SARS-CoV-2 infection. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.31.23293337. [PMID: 37577568 PMCID: PMC10418569 DOI: 10.1101/2023.07.31.23293337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Age is among the strongest risk factors for severe outcomes from SARS-CoV-2 infection. We sought to evaluate associations between age and both mucosal and systemic host responses to SARS-CoV-2 infection. We profiled the upper respiratory tract (URT) and peripheral blood transcriptomes of 201 participants (age range of 1 week to 83 years), including 137 non-hospitalized individuals with mild SARS-CoV-2 infection and 64 uninfected individuals. Among uninfected children and adolescents, young age was associated with upregulation of innate and adaptive immune pathways within the URT, suggesting that young children are primed to mount robust mucosal immune responses to exogeneous respiratory pathogens. SARS-CoV-2 infection was associated with broad induction of innate and adaptive immune responses within the URT of children and adolescents. Peripheral blood responses among SARS-CoV-2-infected children and adolescents were dominated by interferon pathways, while upregulation of myeloid activation, inflammatory, and coagulation pathways was observed only in adults. Systemic symptoms among SARS-CoV-2-infected subjects were associated with blunted innate and adaptive immune responses in the URT and upregulation of many of these same pathways within peripheral blood. Finally, within individuals, robust URT immune responses were correlated with decreased peripheral immune activation, suggesting that effective immune responses in the URT may promote local viral control and limit systemic immune activation and symptoms. These findings demonstrate that there are differences in immune responses to SARS-CoV-2 across the lifespan, including between young children and adolescents, and suggest that these varied host responses contribute to observed differences in the clinical presentation of SARS-CoV-2 infection by age. One Sentence Summary Age is associated with distinct upper respiratory and peripheral blood transcriptional responses among children and adults with SARS-CoV-2 infection.
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Shamsi F, Karimi M, Nafei Z, Akbarian E. Survival and Mortality in Hospitalized Children with COVID-19: A Referral Center Experience in Yazd, Iran. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:5205188. [PMID: 37492855 PMCID: PMC10365916 DOI: 10.1155/2023/5205188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/05/2023] [Accepted: 07/04/2023] [Indexed: 07/27/2023]
Abstract
Introduction COVID-19 prognostic risk factors, therapeutic protocols, and clinical outcomes in pediatric cases are still under investigation. Materials and Methods This historical cohort study evaluated the survival time of hospitalized children (1 month-18 years old) with COVID-19 admitted from March 2020 to August 2021 to an educational hospital in Yazd, Iran. The follow-up of patients was performed at least one month after discharge. Results From 183 hospitalized cases, 24 children were deceased. The median age of patients was 5.41, and 54.2% were male. The survival rate after one-month follow-up was 0.88, and the most significant predictors associated with survival time were the male sex, positive history of hospitalization, lymphopenia, hypoxia, and length of stay more than two weeks using Bayesian Cox regression analysis. Conclusion Accurate estimation of the impact of predictors on poor outcomes may help healthcare providers use therapeutic protocols based on risk factors and healthcare requirements of each patient to improve their survival.
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Affiliation(s)
- Farimah Shamsi
- Center for Healthcare Data Modeling, Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mehran Karimi
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zahra Nafei
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Elahe Akbarian
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Tsegaye AT, Sherry C, Oduol C, Otieno J, Rwigi D, Masheti M, Machura I, Liru M, Akuka J, Omedo D, Symekher S, Khamadi SA, Isaaka L, Ogero M, Mumelo L, Berkley JA, Agweyu A, Walson JL, Singa BO, Tickell KD. Clinical epidemiology of COVID-19 among hospitalized children in rural western Kenya. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002011. [PMID: 37315023 PMCID: PMC10266603 DOI: 10.1371/journal.pgph.0002011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/12/2023] [Indexed: 06/16/2023]
Abstract
The epidemiology of pediatric COVID-19 in sub-Saharan Africa and the role of fecal-oral transmission in SARS-CoV-2 are poorly understood. Among children and adolescents in Kenya, we identify correlates of COVID-19 infection, document the clinical outcomes of infection, and evaluate the prevalence and viability of SARS-CoV-2 in stool. We recruited a prospective cohort of hospitalized children aged two months to 15 years in western Kenya between March 1 and June 30 2021. Children with SARS-CoV-2 were followed monthly for 180-days after hospital discharge. Bivariable logistic regression analysis was used to identify the clinical and sociodemographics correlates of SARS-CoV-2 infection. We also calculated the prevalence of SARS-CoV-2 detection in stool of confirmed cases. Of 355 systematically tested children, 55 (15.5%) were positive and were included in the cohort. The commonest clinical features among COVID-19 cases were fever (42/55, 76%), cough (19/55, 35%), nausea and vomiting (19/55, 35%), and lethargy (19/55, 35%). There were no statistically significant difference in baseline sociodemographic and clinical characteristics between SARS-CoV-2 positive and negative participants. Among positive participants, 8/55 (14.5%, 95%CI: 5.3%-23.9%) died; seven during the inpatient period. Forty-nine children with COVID-19 had stool samples or rectal swabs available at baseline, 9 (17%) had PCR-positive stool or rectal swabs, but none had SARS-CoV-2 detected by culture. Syndromic identification of COVID-19 is particularly challenging among children as the presenting symptoms and signs mirror other common pediatric diseases. Mortality among children hospitalized with COVID-19 was high in this cohort but was comparable to mortality seen with other common illnesses in this setting. Among this small set of children with COVID-19 we detected SARS-CoV-2 DNA, but were not able to culture viable SARs-CoV-2 virus, in stool. This suggests that fecal transmission may not be a substantial risk in children recently diagnosed and hospitalized with COVID-19 infection.
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Affiliation(s)
- Adino Tesfahun Tsegaye
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Christina Sherry
- Departments of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Chrisantus Oduol
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Joyce Otieno
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Doreen Rwigi
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mary Masheti
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Meshack Liru
- Homa Bay County Referral Hospital, Homa Bay, Kenya
| | - Joyce Akuka
- Migori County Referral Hospital, Migori, Kenya
| | | | - Samwel Symekher
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Samoel A. Khamadi
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lynda Isaaka
- KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Morris Ogero
- KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - James A. Berkley
- KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya
- Centre for Tropical Medicine & Global Health Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ambrose Agweyu
- KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Judd L. Walson
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya
- Departments of Global Health, Medicine (Infectious Disease), Pediatrics and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Benson O. Singa
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kirkby D. Tickell
- Departments of Global Health, University of Washington, Seattle, Washington, United States of America
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya
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Ng DCE, Liew CH, Tan KK, Chin L, Ting GSS, Fadzilah NF, Lim HY, Zailanalhuddin NE, Tan SF, Affan MA, Nasir FFWA, Subramaniam T, Ali MM, Rashid MFA, Ong SQ, Ch'ng CC. Risk factors for disease severity among children with Covid-19: a clinical prediction model. BMC Infect Dis 2023; 23:398. [PMID: 37308825 DOI: 10.1186/s12879-023-08357-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/30/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Children account for a significant proportion of COVID-19 hospitalizations, but data on the predictors of disease severity in children are limited. We aimed to identify risk factors associated with moderate/severe COVID-19 and develop a nomogram for predicting children with moderate/severe COVID-19. METHODS We identified children ≤ 12 years old hospitalized for COVID-19 across five hospitals in Negeri Sembilan, Malaysia, from 1 January 2021 to 31 December 2021 from the state's pediatric COVID-19 case registration system. The primary outcome was the development of moderate/severe COVID-19 during hospitalization. Multivariate logistic regression was performed to identify independent risk factors for moderate/severe COVID-19. A nomogram was constructed to predict moderate/severe disease. The model performance was evaluated using the area under the curve (AUC), sensitivity, specificity, and accuracy. RESULTS A total of 1,717 patients were included. After excluding the asymptomatic cases, 1,234 patients (1,023 mild cases and 211 moderate/severe cases) were used to develop the prediction model. Nine independent risk factors were identified, including the presence of at least one comorbidity, shortness of breath, vomiting, diarrhea, rash, seizures, temperature on arrival, chest recessions, and abnormal breath sounds. The nomogram's sensitivity, specificity, accuracy, and AUC for predicting moderate/severe COVID-19 were 58·1%, 80·5%, 76·8%, and 0·86 (95% CI, 0·79 - 0·92) respectively. CONCLUSION Our nomogram, which incorporated readily available clinical parameters, would be useful to facilitate individualized clinical decisions.
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Affiliation(s)
- David Chun-Ern Ng
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia.
| | - Chuin-Hen Liew
- Hospital Tuanku Ampuan Najihah, Negeri Sembilan, Ministry of Health, Jalan Melang, 72000, Kuala Pilah, Malaysia
| | - Kah Kee Tan
- Perdana University Seremban Clinical Academic Center, Negeri Sembilan, Jalan Rasah, 70300, Seremban, Malaysia
| | - Ling Chin
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Grace Sieng Sing Ting
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Nur Fadzreena Fadzilah
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Hui Yi Lim
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Nur Emylia Zailanalhuddin
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Shir Fong Tan
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Muhamad Akmal Affan
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | | | - Thayasheri Subramaniam
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Marlindawati Mohd Ali
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Mohammad Faid Abd Rashid
- Negeri Sembilan State Health Department, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Song-Quan Ong
- Institute for Tropical Biology and Conservation, University Malaysia Sabah, Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Chin Chin Ch'ng
- Clinical Research Centre Hospital Pulau Pinang, Ministry of Health, Jalan Residensi, 10450, Pulau Pinang, Malaysia
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25
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Jarovsky D, de Freitas Fongaro G, Zampol RM, de Oliveira TA, Farias CGA, da Silva DGBP, Cavalcante DTG, Nery SB, de Moraes JC, de Oliveira FI, Almeida FJ, Sáfadi MAP. Characteristics and clinical outcomes of COVID-19 in children: a hospital-based surveillance study in Latin America's hardest-hit city. IJID REGIONS 2023; 7:52-62. [PMID: 36536932 PMCID: PMC9753484 DOI: 10.1016/j.ijregi.2022.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND In 2020, Brazil became the epicentre of the coronavirus disease (COVID-19) pandemic in Latin America, resulting in an unparalleled health catastrophe. Nevertheless, comprehensive clinical reports in Brazilian children are not available. METHODS This retrospective, hospital-based, active surveillance study was performed to identify paediatric patients with COVID-19 who presented at a private academic medical centre in a large urban area between March 2020 and March 2021. Clinical and demographic information was analysed for those requiring hospitalization, those with severe illness and those with clinical syndromes. RESULTS In total, 964 symptomatic cases were evaluated; of these, 17.7% required hospitalization, and 27.5% of hospitalized cases were classified as severe/critical. Acute bronchiolitis and pneumonia were the most common causes of hospitalization among the severe cases. Twenty-seven hospitalized children fulfilled the diagnostic criteria for multi-system inflammatory syndrome (median age 29 months; 85.2% cases were non-severe). A significant co-existing condition was present in 29% of hospitalized children. The risk of hospitalization was higher in children with at least one comorbidity, children aged <2 years and obese children. Increased risk of severe disease was described among those with leukopenia, leukocytosis or any significant comorbidity. No deaths occurred among the study population. CONCLUSION Although most children with COVID-19 experienced mild disease, and no deaths occurred among the study population, a significant proportion of cases required hospitalization and developed severe illness. Obesity, young age, underlying comorbidity, leukopenia and leukocytosis were risk factors for hospitalization or severe disease.
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Affiliation(s)
- Daniel Jarovsky
- Hospital Infantil Sabará, São Paulo, Brazil
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | - Flávia Jacqueline Almeida
- Hospital Infantil Sabará, São Paulo, Brazil
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Marco Aurélio Palazzi Sáfadi
- Hospital Infantil Sabará, São Paulo, Brazil
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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26
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Gupta V, Singh A, Ganju S, Singh R, Thiruvengadam R, Natchu UCM, Gupta N, Kaushik D, Chanana S, Sharma D, Gosain M, Rao SP, Pandey N, Gupta A, Singh S, Jhamb U, Annayappa Venkatesh L, Dinakar C, Pandey AK, Gera R, Chellani H, Wadhwa N, Bhatnagar S. Severity and mortality associated with COVID-19 among children hospitalised in tertiary care centres in India: a cohort study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 13:100203. [PMID: 37159588 PMCID: PMC10110927 DOI: 10.1016/j.lansea.2023.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/02/2022] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
Background It is critical to identify high-risk groups among children with COVID-19 from low-income and middle-income countries (LMICs) to facilitate the optimum use of health system resources. The study aims to describe the severity and mortality of different clinical phenotypes of COVID-19 in a large cohort of children admitted to tertiary care hospitals in India. Methods Children aged 0-19 years with evidence of SARS-CoV-2 infection (real time polymerase chain reaction or rapid antigen test positive) or exposure (anti-SARS-CoV-2 antibody, or history of contact with SARS-CoV-2) were enrolled in the study, between January 2021 and March 2022 across five tertiary hospitals in India. All study participants enrolled prospectively and retrospectively were followed up for three months after discharge. COVID-19 was classified into severe (Multisystem Inflammatory Syndrome in Children (MIS-C), severe acute COVID-19, 'unclassified') or non-severe disease. The mortality rates were estimated in different phenotypes. Findings Among 2468 eligible children enrolled, 2148 were hospitalised. Signs of illness were present in 1688 (79%) children with 1090 (65%) having severe disease. High mortality was reported in MIS-C (18.6%), severe acute COVID-19 (13.3%) and the unclassified severe COVID-19 disease (12.3%). Mortality remained high (17.5%) when modified MIS-C criteria was used. Non-severe COVID-19 disease had 14.1% mortality when associated with comorbidity. Interpretation Our findings have important public health implications for low resource settings. The high mortality underscores the need for better preparedness for timely diagnosis and management of COVID-19. Children with associated comorbidity or coinfections are a vulnerable group and need special attention. MIS-C requires context specific diagnostic criteria for low resource settings. It is important to evaluate the clinical, epidemiological and health system-related risk factors associated with severe COVID-19 and mortality in children from LMICs. Funding Department of Biotechnology, Govt of India and Department of Maternal, Child and Adolescent Health and Aging, WHO, Geneva, Switzerland.
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Affiliation(s)
- Vidushi Gupta
- Translational Health Science and Technology Institute (THSTI), Faridabad, India
| | - Amitabh Singh
- Vardhman Mahavir Medical College and Safdarjung Hospital (VMMC & SJH), New Delhi, India
| | - Sheetal Ganju
- Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, India
- All India Institute of Medical Sciences (AIIMS)-Jammu, Vijaypur, Jammu, India
| | - Raghvendra Singh
- Maulana Azad Medical College, and Lok Nayak Hospital (MAMC & LNH), New Delhi, India
| | - Ramachandran Thiruvengadam
- Translational Health Science and Technology Institute (THSTI), Faridabad, India
- Pondicherry Institute of Medical Sciences (PIMS), Puducherry, India
| | | | - Nitesh Gupta
- Vardhman Mahavir Medical College and Safdarjung Hospital (VMMC & SJH), New Delhi, India
| | - Deepali Kaushik
- Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, India
| | - Surbhi Chanana
- Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, India
| | - Dharmendra Sharma
- Translational Health Science and Technology Institute (THSTI), Faridabad, India
| | - Mudita Gosain
- Translational Health Science and Technology Institute (THSTI), Faridabad, India
| | - Suman Pn Rao
- St. John's Medical College and Research Institute (SJRI), Bengaluru, India
| | - Narendra Pandey
- Asian Institute of Medical Sciences (ASIAN), Faridabad, India
| | - Arvind Gupta
- Asian Institute of Medical Sciences (ASIAN), Faridabad, India
| | - Sandeep Singh
- Asian Institute of Medical Sciences (ASIAN), Faridabad, India
| | - Urmila Jhamb
- Maulana Azad Medical College, and Lok Nayak Hospital (MAMC & LNH), New Delhi, India
| | | | - Chitra Dinakar
- St. John's Medical College and Research Institute (SJRI), Bengaluru, India
| | - Anil Kumar Pandey
- Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, India
| | - Rani Gera
- Vardhman Mahavir Medical College and Safdarjung Hospital (VMMC & SJH), New Delhi, India
| | - Harish Chellani
- Vardhman Mahavir Medical College and Safdarjung Hospital (VMMC & SJH), New Delhi, India
| | - Nitya Wadhwa
- Translational Health Science and Technology Institute (THSTI), Faridabad, India
| | - Shinjini Bhatnagar
- Translational Health Science and Technology Institute (THSTI), Faridabad, India
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27
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Oliveira MCL, Simões E Silva AC, Colosimo EA, Campos MK, Martelli-Júnior H, Silva LR, Pinhati CC, Mak RH, Oliveira EA. Clinical Impact and Risk Factors of Mortality in Hospitalized Children and Adolescents With Hematologic Diseases and COVID-19: An Observational Retrospective Cohort Study. J Pediatr Hematol Oncol 2023; 45:e315-e322. [PMID: 36044328 DOI: 10.1097/mph.0000000000002532] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
Abstract
This study aimed to evaluate the risk factors for COVID-19-related death in a large cohort of hospitalized children with hematological disorders. We performed an analysis of all pediatric patients with COVID-19 registered in a Brazilian nationwide surveillance database between February 2020 and May 2021. The primary outcome was time to death, which was evaluated considering discharge as a competitive risk by using the cumulative incidence function. Among 21,591 hospitalized pediatric patients with COVID-19, 596 cases (2.8%) had hematological diseases. Sixty-one children (27.4%) with malignant hematological diseases had a fatal outcome as compared with 4.2% and 7.4% of nonmalignant hematological and nonhematological cohorts, respectively ( P <0.0001). Children with hematological diseases had a significant increased hazard of death compared with those without these conditions (hazard ratio [HR],=2.40, 95% confidence interval, 1.98 - 2.91). In multivariable analysis, the factors associated with death were the presence of malignant hematological disease (HR, 2.22, 95% CI 1.47 - 3.36), age >10 years (HR 2.19, 95% CI 1.46 - 3.19), male (HR 1.52, 95% CI 1.02 - 2.27), oxygen saturation <95% (HR 2.02, 95% CI 1.38 - 2.96), and abdominal pain at admission (HR 2.75, 95% CI 1.76 - 4.27). Children with malignant hematological diseases had a higher risk of death compared with those without these disorders.
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Affiliation(s)
| | | | | | | | - Hercílio Martelli-Júnior
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros
| | - Ludmila R Silva
- Health Science/Postgraduate Program in Nursing. School of Nursing, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Clara C Pinhati
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California, San Diego, La Jolla, CA
| | - Eduardo A Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
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28
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Lamarca AP, Souza UJBD, Moreira FRR, Almeida LGPD, Menezes MTD, Souza ABD, Ferreira ACDS, Gerber AL, Lima ABD, Guimarães APDC, Cavalcanti AC, Silva ABPE, Lima BI, Lobato C, Silva CGD, Mendonça CPTB, Queiroz DC, Zauli DAG, Menezes D, Possebon FS, Cardoso FDP, Malta FSV, Braga-Paz I, Silva JDP, Ferreira JGG, Galvão JD, Souza LMD, Ferreira L, Possuelo LG, Cavalcante LTDF, Alvim LB, Souza LFAD, Santos LCGDAE, Dias RC, Souza RB, Castro TRY, Valim ARDM, Campos FS, Araujo JP, Trindade PDA, Aguiar RS, Michael Delai R, Vasconcelos ATRD. The Omicron Lineages BA.1 and BA.2 ( Betacoronavirus SARS-CoV-2) Have Repeatedly Entered Brazil through a Single Dispersal Hub. Viruses 2023; 15:888. [PMID: 37112869 PMCID: PMC10146814 DOI: 10.3390/v15040888] [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: 02/13/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Brazil currently ranks second in absolute deaths by COVID-19, even though most of its population has completed the vaccination protocol. With the introduction of Omicron in late 2021, the number of COVID-19 cases soared once again in the country. We investigated in this work how lineages BA.1 and BA.2 entered and spread in the country by sequencing 2173 new SARS-CoV-2 genomes collected between October 2021 and April 2022 and analyzing them in addition to more than 18,000 publicly available sequences with phylodynamic methods. We registered that Omicron was present in Brazil as early as 16 November 2021 and by January 2022 was already more than 99% of samples. More importantly, we detected that Omicron has been mostly imported through the state of São Paulo, which in turn dispersed the lineages to other states and regions of Brazil. This knowledge can be used to implement more efficient non-pharmaceutical interventions against the introduction of new SARS-CoV variants focused on surveillance of airports and ground transportation.
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Affiliation(s)
- Alessandra P Lamarca
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica, Petrópolis 25651-075, Brazil
| | - Ueric José Borges de Souza
- Laboratório de Bioinformática e Biotecnologia, Universidade Federal do Tocantins, Campus de Gurupi, Palmas 77410-570, Brazil
| | - Filipe Romero Rebello Moreira
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Luiz G P de Almeida
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica, Petrópolis 25651-075, Brazil
| | - Mariane Talon de Menezes
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | | | | | - Alexandra L Gerber
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica, Petrópolis 25651-075, Brazil
| | - Aline B de Lima
- Departamento de Pesquisa & Desenvolvimento, Instituto Hermes Pardini, Belo Horizonte 30140-070, Brazil
| | - Ana Paula de C Guimarães
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica, Petrópolis 25651-075, Brazil
| | | | - Aryel B Paz E Silva
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Bruna Israel Lima
- Laboratório de Biologia Molecular, Parque Científico e Tecnológico Regional, Universidade de Santa Cruz do Sul, Santa Cruz do Sul 96815-900, Brazil
| | - Cirley Lobato
- Centro de Ciências de Saúde e do Desporto, Universidade Federal do Acre, Rio Branco 69920-900, Brazil
| | | | - Cristiane P T B Mendonça
- Departamento de Pesquisa & Desenvolvimento, Instituto Hermes Pardini, Belo Horizonte 30140-070, Brazil
| | - Daniel Costa Queiroz
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | | | - Diego Menezes
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Fábio Sossai Possebon
- Instituto de Biotecnologia, Universidade Estadual Paulista, Botucatu 18618-689, Brazil
| | | | | | - Isabela Braga-Paz
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Joice do Prado Silva
- Departamento de Pesquisa & Desenvolvimento, Instituto Hermes Pardini, Belo Horizonte 30140-070, Brazil
| | - Jorge Gomes Goulart Ferreira
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | | | | | - Leonardo Ferreira
- Centro de Medicina Tropical da Tríplice Fronteira, Foz do Iguaçu 85866-010, Brazil
| | - Lia Gonçalves Possuelo
- Departmento de Ciências da Vida, Universidade de Santa Cruz do Sul, Santa Cruz do Sul 96815-900, Brazil
| | | | - Luige B Alvim
- Departamento de Pesquisa & Desenvolvimento, Instituto Hermes Pardini, Belo Horizonte 30140-070, Brazil
| | - Luiz Fellype Alves de Souza
- Centro de Infectologia Charles Mérieux and Laboratório Rodolphe Mérieux, Hospital das Clínicas do Acre, Rio Branco 69920-223, Brazil
| | - Luiza C G de Araújo E Santos
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Rillery Calixto Dias
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Rutilene Barbosa Souza
- Centro de Infectologia Charles Mérieux and Laboratório Rodolphe Mérieux, Hospital das Clínicas do Acre, Rio Branco 69920-223, Brazil
| | - Thaís Regina Y Castro
- Laboratório de Biologia Molecular e Bioinformática Aplicadas a Microbiologia Clínica, Universidade Federal de Santa Maria, Santa Maria 97105-900, Brazil
| | | | - Fabrício Souza Campos
- Laboratório de Virologia, Departamento de Microbiologia, Imunologia e Parasitologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre 90010-150, Brazil
| | - João Pessoa Araujo
- Instituto de Biotecnologia, Universidade Estadual Paulista, Botucatu 18618-689, Brazil
| | - Priscila de Arruda Trindade
- Laboratório de Biologia Molecular e Bioinformática Aplicadas a Microbiologia Clínica, Universidade Federal de Santa Maria, Santa Maria 97105-900, Brazil
| | - Renato S Aguiar
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Robson Michael Delai
- Centro de Medicina Tropical da Tríplice Fronteira, Foz do Iguaçu 85866-010, Brazil
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Surendra H, Praptiningsih CY, Ersanti AM, Rahmat M, Noviyanti W, Harmani JAD, Mansur ENA, Suleman YY, Sudrani S, Rosalina R, Mukhtar I, Rosadi D, Fauzi L, Elyazar IRF, Hawley WA, Wibisono H. Clinical characteristics and factors associated with COVID-19-related mortality and hospital admission during the first two epidemic waves in 5 rural provinces in Indonesia: A retrospective cohort study. PLoS One 2023; 18:e0283805. [PMID: 36996045 PMCID: PMC10062642 DOI: 10.1371/journal.pone.0283805] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Data on coronavirus disease 2019 (COVID-19) clinical characteristics and severity from resource-limited settings are limited. This study examined clinical characteristics and factors associated with COVID-19 mortality and hospitalisation in rural settings of Indonesia, from 1 January to 31 July, 2021. METHODS This retrospective cohort included individuals diagnosed with COVID-19 based on polymerase chain reaction or rapid antigen diagnostic test, from five rural provinces in Indonesia. We extracted demographic and clinical data, including hospitalisation and mortality from a new piloted COVID-19 information system named Sistem Informasi Surveilans Epidemiologi (SISUGI). We used mixed-effect logistic regression to examine factors associated with COVID-19-related mortality and hospitalisation. RESULTS Of 6,583 confirmed cases, 205 (3.1%) died and 1,727 (26.2%) were hospitalised. The median age was 37 years (Interquartile range 26-51), with 825 (12.6%) under 20 years, and 3,371 (51.2%) females. Most cases were symptomatic (4,533; 68.9%); 319 (4.9%) had a clinical diagnosis of pneumonia and 945 (14.3%) presented with at least one pre-existing comorbidity. Age-specific mortality rates were 0.9% (2/215) for 0-4 years; 0% (0/112) for 5-9 years; 0% (1/498) for 10-19 years; 0.8% (11/1,385) for 20-29 years; 0.9% (12/1,382) for 30-39 years; 2.1% (23/1,095) for 40-49 years; 5.4% (57/1,064) for 50-59 years; 10.8% (62/576) for 60-69 years; 15.9% (37/232) for ≥70 years. Older age, pre-existing diabetes, chronic kidney disease, liver diseases, malignancy, and pneumonia were associated with higher risk of mortality and hospitalisation. Pre-existing hypertension, cardiac diseases, COPD, and immunocompromised condition were associated with risk of hospitalisation but not with mortality. There was no association between province-level density of healthcare workers with mortality and hospitalisation. CONCLUSION The risk of COVID-19-related mortality and hospitalisation was associated with higher age, pre-existing chronic comorbidities, and clinical pneumonia. The findings highlight the need for prioritising enhanced context-specific public health action to reduce mortality and hospitalisation risk among older and comorbid rural populations.
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Affiliation(s)
- Henry Surendra
- Monash University Indonesia, Tangerang Selatan, Indonesia
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - C. Yekti Praptiningsih
- Perhimpunan Ahli Epidemiologi Indonesia, Jakarta, Indonesia
- US Centers for Disease Control and Prevention, Jakarta, Indonesia
| | | | - Mariati Rahmat
- Perhimpunan Ahli Epidemiologi Indonesia, Jakarta, Indonesia
- Dinas Kesehatan Kabupaten Sinjai, Sinjai, Indonesia
| | | | | | | | | | - Sitti Sudrani
- Dinas Kesehatan Provinsi Sulawesi Tengah, Manado, Indonesia
| | | | - Ismen Mukhtar
- Dinas Kesehatan Provinsi Lampung, Bandar Lampung, Indonesia
| | - Dian Rosadi
- Faculty of Medicine, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
| | - Lukman Fauzi
- Public Health Science Department, Universitas Negeri Semarang, Semarang, Indonesia
| | - Iqbal R. F. Elyazar
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Mendoza Cardozo OI, Pérez Bedoya JP, Ruiz Galvis LM, Pérez Aguirre CA, Rodríguez Rey BA, Barengo NC, Cardona Jiménez J, Díaz Valencia PA. Socioeconomic disparities associated with mortality in patients hospitalized for COVID-19 in Colombia. Front Public Health 2023; 11:1139379. [PMID: 37151581 PMCID: PMC10157783 DOI: 10.3389/fpubh.2023.1139379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/22/2023] [Indexed: 03/31/2023] Open
Abstract
Socioeconomic disparities play an important role in the development of severe clinical outcomes including deaths from COVID-19. However, the current scientific evidence in regard the association between measures of poverty and COVID-19 mortality in hospitalized patients is scant. The objective of this study was to investigate whether there is an association between the Colombian Multidimensional Poverty Index (CMPI) and mortality from COVID-19 in hospitalized patients in Colombia from May 1, 2020 to August 15, 2021. This was an ecological study using individual data on hospitalized patients from the National Institute of Health of Colombia (INS), and municipal level data from the High-Cost Account and the National Administrative Department of Statistics. The main outcome variable was mortality due to COVID-19. The main exposure variable was the CMPI that ranges from 0 to 100% and was categorized into five levels: (i) level I (0%−20%), (ii) level II (20%−40%), (iii) level III (40%−60%), (iv) level IV (60%−80%); and (v) level V (80%−100%). The higher the level, the higher the level of multidimensional poverty. A Bayesian multilevel logistic regression model was applied to estimate Odds Ratio (OR) and their corresponding 95% credible intervals (CI). In addition, a subgroup analysis was performed according to the epidemiological COVID-19 waves using the same model. The odds for dying from COVID-19 was 1.46 (95% CI 1.4–1.53) for level II, 1.41 (95% CI 1.33–1.49) for level III and 1.70 (95% CI 1.54–1.89) for level IV hospitalized COVID-19 patients compared with the least poor patients (CMPI level I). In addition, age and male sex also increased mortality in COVID-19 hospitalized patients. Patients between 26 and 50 years-of-age had 4.17-fold increased odds (95% CI 4.07–4.3) of death compared with younger than 26-years-old patients. The corresponding for 51–75 years-old patients and those above the age of 75 years were 9.17 (95% CI 8.93–9.41) and 17.1 (95% CI 16.63–17.56), respectively. Finally, the odds of death from COVID-19 in hospitalized patients gradually decreased as the pandemic evolved. In conclusion, socioeconomic disparities were a major risk factor for mortality in patients hospitalized for COVID-19 in Colombia.
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Bentes AA, Dos Santos Junior WR, Pessoa NL, Costa TA, Oliveira GFG, Diniz LMO, Torres BR, Teixeira DC, Mendes RB, Avelar ABA, Campos MA, Kroon EG, Drumond BP. Neuro-COVID-19 With or Without the Multisystem Inflammatory Syndrome (MIS-C): A Single-Center Study : COVID-19: Neurologic Manifestations in Children. J Mol Neurosci 2023; 73:250-258. [PMID: 36976476 PMCID: PMC10044054 DOI: 10.1007/s12031-023-02109-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/22/2023] [Indexed: 03/29/2023]
Abstract
This study evaluates the range of neurological manifestation in children with COVID-19 (neuro-COVID-19) both with and without the multisystem inflammatory syndrome (MIS-C) and the persistence of symptoms after hospital discharge. The study was conducted as a prospective study of children and adolescents under 18 years of age who were admitted to a children's hospital for infectious diseases from January 2021 to January 2022. The children had no previous neurological or psychiatric disorders. Out of the 3021 patients evaluated, 232 were confirmed to have COVID-19 and 21 of these patients (9%) showed neurological manifestations associated with the virus. Of these 21 patients, 14 developed MIS-C, and 7 had neurological manifestations unrelated to MIS-C. There was no statistical difference regarding the neurological manifestations during hospitalization and outcomes between patients with neuro-COVID-19 who had or did not have MIS-C, except for seizures that occurred more frequently in patients with neuro-COVID-19 without MIS-C (p-value = 0.0263). One patient died, and 5 patients still had neurological or psychiatric manifestations at discharge, which persisted for up to 7 months. The study highlights that SARS-CoV-2 infection can affect the central and peripheral nervous system, particularly in children and adolescents with MIS-C, and that it is crucial to be vigilant for long-term adverse outcomes, as the neurological and psychiatric effects of COVID-19 in children are emerging during an important stage of brain development.
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Affiliation(s)
- Aline Almeida Bentes
- Departamento de Pediatria, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil.
- Hospital Infantil João Paulo II, FHEMIG, Minas Gerais, Brazil.
| | | | - Natalia Lima Pessoa
- Laboratório de Vírus, Departamento de Microbiologia, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
- Imunologia de Doenças Virais, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil
| | - Thais Alkifeles Costa
- Laboratório de Vírus, Departamento de Microbiologia, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | | | - Lilian Martins Oliveira Diniz
- Departamento de Pediatria, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil
- Hospital Infantil João Paulo II, FHEMIG, Minas Gerais, Brazil
| | | | | | | | | | - Marco Antônio Campos
- Imunologia de Doenças Virais, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil
| | - Erna Geessien Kroon
- Laboratório de Vírus, Departamento de Microbiologia, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Betania Paiva Drumond
- Laboratório de Vírus, Departamento de Microbiologia, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
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Oliveira MCL, Colosimo EA, Vasconcelos MA, Martelli-Júnior H, Mak RH, Silva LR, Pinhati CC, Simões E Silva AC, Oliveira EA. The association between pre-existing asthma and reduced risk of death among children and adolescents hospitalized with COVID-19 in Brazil. Pediatr Pulmonol 2023; 58:727-737. [PMID: 36382503 DOI: 10.1002/ppul.26245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/28/2022] [Accepted: 11/13/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There have been conflicting reports on the relationship between asthma and COVID-19 severity. This study aimed to compare the risk of death among children with asthma and healthy peers hospitalized due to COVID-19. METHODS We carried out an analysis of all pediatric patients 2-19 years of age with asthma and COVID-19 registered in Influenza Epidemiological Surveillance Information System-Gripe, a Brazilian nationwide surveillance database, between February 2020 and March 2022. The primary outcome was time to death, which was evaluated considering discharge as a competitive risk using the cumulative incidence function. RESULTS Among 30,405 hospitalized children with COVID-19, 21,340 (70.2%) had no comorbidities, 6444 (21.2%) had comorbidities other than asthma, 2165 (7.1%) had asthma, and 465 (1.5%) had asthma with other comorbidities. The estimated probability of a fatal outcome for each group was 4.1%, 14.9%, 2.1%, and 10.7%, respectively. After adjustment, children with asthma had a 60% reduction in the hazard of death than healthy peers (hazard ratio [HR] = 0.39, 95% confidence interval [CI], 0.29-0.53, p < 0.0001). Among children with asthma and no other comorbidities, two covariates were independently associated with in-hospital mortality, age ≥12 years, HR = 4.0, 95% CI, 2.5-6.4), and low oxygen saturation at admission (HR = 2.3, 95% CI, 1.4-3.2). CONCLUSION Children with asthma and no comorbidities had a lower risk of death compared with healthy peers after controlling for clinical and demographic confounding factors.
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Affiliation(s)
- Maria C L Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Enrico A Colosimo
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mariana A Vasconcelos
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Hercílio Martelli-Júnior
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros, Minas Gerais, Brazil
| | - Robert H Mak
- Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, La Jolla, California, USA
| | - Ludmila R Silva
- Health Science/Postgraduate Program in Nursing, School of Nursing, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Clara C Pinhati
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ana C Simões E Silva
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Eduardo A Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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Oliveira EA, Oliveira MCL, Silva ACSE, Colosimo EA, Mak RH, Vasconcelos MA, Silva LR, Martelli DB, Pinhati CC, Martelli-Júnior H. Clinical Outcomes of Omicron Variant (B.1.1.529) Infection in Children and Adolescents Hospitalized With COVID-19 in Brazil With Observational Data on the Efficacy of the Vaccines in Adolescents. Pediatr Infect Dis J 2023; 42:218-225. [PMID: 36730085 PMCID: PMC9935234 DOI: 10.1097/inf.0000000000003783] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Eduardo A. Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Maria Christina L. Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ana Cristina Simões e Silva
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Enrico A. Colosimo
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Robert H. Mak
- Department of Pediatrics, Rady Children’s Hospital, University of California, San Diego, La Jolla, CA
| | - Mariana A. Vasconcelos
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ludmila R. Silva
- Health Science/Postgraduate Program in Nursing. School of Nursing, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Daniella B. Martelli
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros, Brazil
| | - Clara C. Pinhati
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Hercílio Martelli-Júnior
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros, Brazil
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Fabrin C, Boing AC, Garcia LP, Boing AF. Socioeconomic inequality in hospital case fatality rate and care among children and adolescents hospitalized for COVID-19 in Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230015. [PMID: 36820752 PMCID: PMC9949490 DOI: 10.1590/1980-549720230015] [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: 09/08/2022] [Accepted: 11/23/2022] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE To analyze the association of hospital case fatality rate and care received by children and adolescents hospitalized for COVID-19 with the gross domestic product (GDP) per capita of Brazilian municipalities and regions of residence. METHODS Data were collected from the Influenza Epidemiological Surveillance Information System and the Brazilian Institute of Geography and Statistics. The dichotomous outcomes analyzed were hospital case fatality rate of COVID-19, biological samples collected for COVID-19 diagnosis, X-rays, computed tomography (CT) scans, use of ventilatory support, and intensive care unit hospitalization. The covariates were municipal GDP per capita and the Brazilian region of residence. Poisson regression was used for the outcomes recorded in 2020 and 2021 in Brazil, covering the two COVID-19 waves in the country, adjusted for age and gender. RESULTS The hospital case fatality rate was 7.6%. In municipalities with lower GDP per capita deciles, the case fatality rate was almost four times higher among children and twice as high in adolescents compared to cities with higher deciles. Additionally, residents of municipalities with lower GDP per capita had fewer biological samples collected for diagnosis, X-ray examinations, and CT scans. We found regional disparities associated with case fatality rate, with worse indicators in the North and Northeast regions. The findings remained consistent over the two COVID-19 waves. CONCLUSION Municipalities with lower GDP per capita, as well as the North and Northeast regions, had worse indicators of hospital case fatality rate and care.
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Affiliation(s)
- Caroline Fabrin
- Universidade Federal de Santa Catarina, Graduate Program in Collective Health – Florianópolis (SC), Brazil
| | - Alexandra Crispim Boing
- Universidade Federal de Santa Catarina, Graduate Program in Collective Health – Florianópolis (SC), Brazil
| | | | - Antonio Fernando Boing
- Universidade Federal de Santa Catarina, Graduate Program in Collective Health – Florianópolis (SC), Brazil
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Pereira AR, Branco MDRFC, Costa SDSB, Lopes DAM, Pinheiro VV, de Oliveira DC, Pasklan ANP, Gomes JA, dos Santos AM, Gama MEA. COVID-19 severe acute respiratory syndrome in Brazilian newborns in 2020-2021. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230012. [PMID: 36820749 PMCID: PMC9949484 DOI: 10.1590/1980-549720230012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/23/2022] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE To describe the clinical characteristics of cases of COVID-19 severe acute respiratory syndrome (SARS) in Brazilian newborns (NBs) in 2020 and 2021, recorded in the Influenza Epidemiological Surveillance Information System (Sistema de Informação da Vigilância Epidemiológica da Gripe - SIVEP-Gripe). METHODS The variables analyzed were gender, race/skin color, hospitalization, intensive care unit (ICU) admission, use of ventilatory support, signs and symptoms (fever, cough, O2 saturation<95%, dyspnea, respiratory distress, diarrhea, and vomiting), progress (death or cure), risk factors/comorbidities. Categorical variables were expressed as absolute and relative frequencies. RESULTS We found 1,649 records of COVID-19 SARS in NBs, with a predominance of multiracial babies in both years. The most frequent symptoms in 2020 and 2021 were, respectively: respiratory distress (67.0 and 69.7%), fever (46.3 and 46.2%), and cough (37.0 and 46.3%). In 2020, 30.5% of patients received invasive ventilatory support; in 2021, this number was 41.6%. In addition, more than 55% of cases required ICU admission, and over 16% died. CONCLUSION We emphasize the high proportion of cases that required intensive care and progressed to death.
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Lota-Salvado R, Padua JR, Agrupis KA, Malijan GM, Sayo AR, Suzuki S, Go GD, Smith C. Epidemiological and clinical characteristics of children with confirmed COVID-19 infection in a tertiary referral hospital in Manila, Philippines. Trop Med Health 2023; 51:9. [PMID: 36814333 PMCID: PMC9944764 DOI: 10.1186/s41182-023-00507-x] [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: 01/25/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND COVID-19 has challenged the under-resourced health systems of low- and middle-income countries, significantly affecting child health. Available published data on Filipino children with COVID-19 infection are limited. This study aims to describe the epidemiological and clinical characteristics of pediatric patients with confirmed COVID-19 in an infectious disease hospital in Manila, Philippines. MAIN TEXT This cross-sectional study reviewed data on patients ages 0 to 18 years with confirmed COVID-19 infection, admitted to San Lazaro Hospital from January 25, 2020 to January 25, 2022. Demographic data and clinical characteristics obtained from COVID-19 case investigation forms were summarized and compared between severe and non-severe cases. Risk factors for disease severity and mortality were analyzed. Of 115 patients, 64% were males. There were 87 patients (75.7%) with asymptomatic, mild, or moderate disease, and 28 cases (24.3%) with severe or critical illness. The median age of all patients was 10 years (interquartile range: 4-15 years). The majority of patients (40.9%) were adolescents ages 13 to 18 years. Predominant symptoms were fever (73.9%) and cough (55.7%). Patients with severe or critical illness were more likely to experience difficulty of breathing (55.2% vs 44.8%, p < 0.001), and have a longer hospital stay (11 days vs 8 days, p = 0.043). Among all patients, 48.7% had at least one underlying disease; and common infectious co-morbidities were tuberculosis (17.4%), dengue (12.2%), and HIV (4.3%). Having tuberculosis (p = 0.008) or at least one co-morbidity (p < 0.001) was associated with disease severity. Ten patients (8.7%) died; and mortality was higher among those with severe or critical illness (80% vs 20%, p < 0.001). Sepsis (p = 0.020) or having at least one co-morbidity (p = 0.007) was associated with death. CONCLUSION Children of all ages remain susceptible to COVID-19 infection, and usually present with mild or moderate symptoms. In this study, many adolescents are affected, highlighting the value of COVID-19 vaccination in this age group. Understanding the clinical features of COVID-19 in Filipino children is essential to identifying and optimally managing those at highest risk of severe disease.
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Affiliation(s)
- Rhanee Lota-Salvado
- grid.174567.60000 0000 8902 2273School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Jay Ron Padua
- grid.517911.aSan Lazaro Hospital, Manila, Philippines
| | - Kristal An Agrupis
- grid.517911.aSan Lazaro Hospital–Nagasaki University Collaborative Research Office, Manila, Philippines
| | - Greco Mark Malijan
- grid.517911.aSan Lazaro Hospital–Nagasaki University Collaborative Research Office, Manila, Philippines
| | - Ana Ria Sayo
- grid.517911.aSan Lazaro Hospital, Manila, Philippines
| | - Shuichi Suzuki
- grid.174567.60000 0000 8902 2273School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan ,grid.517911.aSan Lazaro Hospital–Nagasaki University Collaborative Research Office, Manila, Philippines
| | | | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan. .,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
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Soares MCB, de Freitas BAC, Toledo LV, Mendes IR, Quintão APDC, de Souza SM. Hospitalizations and deaths of children and adolescents with Severe Acute Respiratory Infection due to COVID-19 during the epidemiological year of 2020. Rev Inst Med Trop Sao Paulo 2023; 65:e11. [PMID: 36722673 PMCID: PMC9886224 DOI: 10.1590/s1678-9946202365011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/13/2022] [Indexed: 02/02/2023] Open
Abstract
This study aimed to analyze the profile of hospitalizations and factors associated with the deaths of children and adolescents with severe acute respiratory infection (SARI) caused by SARS-CoV-2 nationwide. The study comprised 6,843 children and adolescents hospitalized in 2020 who tested positive for COVID-19, based on data from the Influenza Epidemiological Surveillance Information System. Sociodemographic and clinical profiles, hospitalization frequency, lethality and recovery rates were analyzed. The outcome was recovery or death. The 6,843 children and adolescents comprised 1.9% of SARI hospitalized cases (n = 563,051). Of these, 57.7% developed critical SARI and 90% survived. Comorbidities were present in 40.8%, especially asthma, immunodepression, and neurological and cardiovascular diseases. The main symptoms were fever, cough, dyspnea, respiratory distress, and low oxygen saturation. Among those with critical SARI, 91.4% died. There was a higher frequency of children, especially those under five years of age and of mixed ethnicity. The highest hospitalization frequency occurred in the Southeastern and Northeastern regions, the highest recovery rates in the Southeastern and Southern regions, and the highest lethality rates in the Northern and Northeastern regions. Deaths were associated with ages ranging from 12 to 19 and being under one year of age, living in the Northern and Northeastern regions, progression to critical SARI, and having immunosuppression and cardiovascular disease. In contrast, asthma was associated with lower death rates. The frequency of complications and mortality rates caused by SARS-Cov-2 in the pediatric population are relevant, as well as the severity of the epidemic in the social inequality context and the health services' frailty.
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Affiliation(s)
- Maria Cristina Bento Soares
- Universidade Federal de Viçosa, Programa de Pós-Graduação em Ciências da Saúde, Viçosa, Minas Gerais, Brazil
| | | | - Luana Vieira Toledo
- Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem, Viçosa, Minas Gerais, Brazil
| | - Igor Rodrigues Mendes
- Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem, Viçosa, Minas Gerais, Brazil
| | | | - Silvania Medina de Souza
- Universidade Federal de Viçosa, Programa de Pós-Graduação em Ciências da Saúde, Viçosa, Minas Gerais, Brazil
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Singhal T. Looking Back at the COVID-19 Pandemic in Children. Indian J Pediatr 2023; 90:114-115. [PMID: 36542266 PMCID: PMC9768393 DOI: 10.1007/s12098-022-04426-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Tanu Singhal
- Department of Pediatrics and Infectious Disease, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India.
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Chiew CJ, Premikha M, Chong CY, Wei WE, Ong B, Lye DC, Heng D, Lee VJ, Tan KB. Effectiveness of primary series and booster vaccination against SARS-CoV-2 infection and hospitalisation among adolescents aged 12-17 years in Singapore: a national cohort study. THE LANCET. INFECTIOUS DISEASES 2023; 23:177-182. [PMID: 36182678 PMCID: PMC9519171 DOI: 10.1016/s1473-3099(22)00573-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/07/2022] [Accepted: 08/11/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Singapore offered the BNT162b2 vaccine (tozinameran; Pfizer-BioNTech) to adolescents aged 12-17 years in May 18, 2021, and extended booster vaccines to this group in Jan 21, 2022. Literature on the effectiveness of primary series and booster vaccination among adolescents is scarce outside of Europe and North America. We aimed to determine primary series and booster vaccine effectiveness against SARS-CoV-2 infection and hospitalisation among adolescents in Singapore. METHODS For this national cohort study, we assessed the incidence of confirmed SARS-CoV-2 infection and hospitalisation among adolescents aged 12-17 years vaccinated with BNT162b2 in Singapore from Sept 1 to Dec 15, 2021, during the delta (B.1.617.2) variant wave, and from Jan 21 to April 28, 2022, during the omicron (B.1.1.529) variant wave. Data were collected from official databases maintained by the Ministry of Health of Singapore. Individuals were classified as partly vaccinated (those who had received one dose and those who had received the second dose no more than 7 days previously), fully vaccinated (8 days after receiving a second dose), or boosted (8 days after receiving a third dose) and compared with unvaccinated individuals. FINDINGS 249 763 individuals aged 12-17 years were included in the study, contributing over 56·2 million person-days of observation. Compared with unvaccinated individuals, two vaccine doses achieved vaccine effectiveness of 66% (95% CI 63-69) against infection with the delta variant and 25% (21-29) against infection with the omicron variant, and 83% (74-89) against delta variant-associated hospitalisation and 75% (56-86) against omicron variant-associated hospitalisation. Booster vaccination with a third dose achieved vaccine effectiveness of 56% (53-58) against infection with the omicron variant and 94% (86-97) against omicron-associated hospitalisation, compared with unvaccinated adolescents. Vaccine effectiveness against infection for both variants after two doses waned over time, whereas vaccine effectiveness against hospitalisation for both variants remained stable; both were increased after three doses. INTERPRETATION Among adolescents aged 12-17 years, vaccine effectiveness against confirmed SARS-CoV-2 infection after two doses of BNT162b2 decreased over time and increased after a third dose. Boosted adolescents were also the most protected from hospitalisation compared with fully vaccinated, partly vaccinated, and unvaccinated adolescents. Therefore, the booster dose of BNT162b2 can help to reduce the burden on the health-care system and individual morbidity during an omicron wave. FUNDING None.
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Affiliation(s)
| | - M Premikha
- Crisis Strategy and Operations Group, Ministry of Health, Singapore
| | - Chia Yin Chong
- Department of Infectious Diseases, KK Women's and Children's Hospital, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore,Duke-NUS Medical School, Singapore
| | | | - Benjamin Ong
- DMS Office, Ministry of Health, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Chien Lye
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore,National Centre for Infectious Diseases, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Derrick Heng
- Public Health Group, Ministry of Health, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Vernon J Lee
- Public Health Group, Ministry of Health, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Kelvin Bryan Tan
- Crisis Strategy and Operations Group, Ministry of Health, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Oliveira EA, Oliveira MCL, Colosimo EA, Simões E Silva AC, Mak RH, Vasconcelos MA, Silva LR, Martelli DB, Pinhati CC, Martelli-Júnior H. Vaccine Effectiveness against SARS-CoV-2 Variants in Adolescents from 15 to 90 Days after Second Dose: A Population-Based Test-Negative Case-Control Study. J Pediatr 2023; 253:189-196.e2. [PMID: 36181868 PMCID: PMC9519371 DOI: 10.1016/j.jpeds.2022.09.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study was to estimate the vaccine effectiveness (VE) against hospitalization and severe illness in adolescents due to infection with SARS-CoV-2 variants (gamma, delta, and omicron). STUDY DESIGN A test-negative, case-control analysis was conducted in Brazil from July 2021 to March 2022. We enrolled 8458 eligible individuals (12-19 years of age) hospitalized with an acute respiratory syndrome, including 3075 cases with laboratory-proven COVID-19 and 4753 controls with negative tests for COVID-19. The primary exposure of interest was vaccination status. The primary outcome was SARS-CoV-2 infection during gamma/delta vs omicron-predominant periods. The aOR for the association of prior vaccination and outcomes was used to estimate VE. RESULTS In the pre-omicron period, VE against COVID-19 hospitalization was 88% (95% CI, 83%-92%) and has dropped to 59% (95% CI, 49%-66%) during the omicron period. For hospitalized cases of COVID-19, considering the entire period of the analysis, 2-dose schedule was moderately effective against intensive care unit admission (46%, [95% CI, 27-60]), need of mechanical ventilation (49%, [95% CI, 32-70]), severe COVID-19 (42%, [95% CI, 17-60]), and death (46%, [95% CI, 8-67]). There was a substantial reduction of about 40% in the VE against all end points, except for death, during the omicron-predominant period. Among cases, 240 (6.6%) adolescents died; of fatal cases, 224 (93.3%) were not fully vaccinated. CONCLUSION Among adolescents, the VE against all end points was substantially reduced during the omicron-predominant period. Our findings suggest that the 2-dose regimen may be insufficient for SARS-CoV-2 variants and support the need for updated vaccines to provide better protection against severe COVID-19.
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Affiliation(s)
- Eduardo A Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
| | - Maria Christina L Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Enrico A Colosimo
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Cristina Simões E Silva
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Robert H Mak
- Department of Pediatrics, Rady Children's Hospital, University of California San Diego, La Jolla, CA
| | - Mariana A Vasconcelos
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Ludmila R Silva
- Health Science/Postgraduate Program in Nursing, School of Nursing, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Daniella B Martelli
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros, Minas Gerais, Brazil
| | - Clara C Pinhati
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Hercílio Martelli-Júnior
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros, Minas Gerais, Brazil
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Surendra H, Paramita D, Arista NN, Putri AI, Siregar AA, Puspaningrum E, Rosylin L, Gardera D, Girianna M, Elyazar IRF. Geographical variations and district-level factors associated with COVID-19 mortality in Indonesia: a nationwide ecological study. BMC Public Health 2023; 23:103. [PMID: 36641453 PMCID: PMC9840537 DOI: 10.1186/s12889-023-15015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Ensuring health equity, especially for vulnerable populations in less developed settings with poor health system is essential for the current and future global health threats. This study examined geographical variations of COVID-19 mortality and its association with population health characteristics, health care capacity in responding pandemic, and socio-economic characteristics across 514 districts in Indonesia. METHODS This nationwide ecological study included aggregated data of COVID-19 cases and deaths from all 514 districts in Indonesia, recorded in the National COVID-19 Task Force database, during the first two years of the epidemic, from 1 March 2020 to 27 February 2022. The dependent variable was district-level COVID-19 mortality rate per 100,000 populations. The independent variables include district-level COVID-19 incidence rate, population health, health care capacity, and socio-demographics data from government official sources. We used multivariable ordinal logistic regression to examine factors associated with higher mortality rate. RESULTS Of total 5,539,333 reported COVID-19 cases, 148,034 (2.7%) died, and 5,391,299 (97.4%) were recovered. The district-level mortality rate ranged from 0 to 284 deaths per 100,000 populations. The top five districts with the highest mortality rate were Balikpapan (284 deaths per 100,000 populations), Semarang (263), Madiun (254), Magelang (250), and Yogyakarta (247). A higher COVID-19 incidence (coefficient 1.64, 95% CI 1.22 to 1.75), a higher proportion of ≥ 60 years old population (coefficient 0.26, 95% CI 0.06 to 0.46), a higher prevalence of diabetes mellitus (coefficient 0.60, 95% CI 0.37 to 0.84), a lower prevalence of obesity (coefficient -0.32, 95% CI -0.56 to -0.08), a lower number of nurses per population (coefficient -0.27, 95% CI -0.50 to -0.04), a higher number of midwives per population (coefficient 0.32, 95% CI 0.13 to 0.50), and a higher expenditure (coefficient 0.34, 95% CI 0.10 to 0.57) was associated with a higher COVID-19 mortality rate. CONCLUSION COVID-19 mortality rate in Indonesia was highly heterogeneous and associated with higher COVID-19 incidence, different prevalence of pre-existing comorbidity, healthcare capacity in responding the pandemic, and socio-economic characteristics. This study revealed the need of controlling both COVID-19 and those known comorbidities, health capacity strengthening, and better resource allocation to ensure optimal health outcomes for vulnerable population.
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Affiliation(s)
- Henry Surendra
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
- Monash University Indonesia, Tangerang Selatan, Indonesia.
| | - Danarastri Paramita
- Komite Pengendalian COVID-19 Dan Pemulihan Ekonomi Nasional, Jakarta, Indonesia
- United Nations Development Program, Jakarta, Indonesia
| | - Nora N Arista
- United Nations Development Program, Jakarta, Indonesia
| | - Annisa I Putri
- Komite Pengendalian COVID-19 Dan Pemulihan Ekonomi Nasional, Jakarta, Indonesia
- United States Agency of International Development, Jakarta, Indonesia
| | - Akbar A Siregar
- Komite Pengendalian COVID-19 Dan Pemulihan Ekonomi Nasional, Jakarta, Indonesia
- United States Agency of International Development, Jakarta, Indonesia
| | - Evelyn Puspaningrum
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Leni Rosylin
- Komite Pengendalian COVID-19 Dan Pemulihan Ekonomi Nasional, Jakarta, Indonesia
| | - Dida Gardera
- Komite Pengendalian COVID-19 Dan Pemulihan Ekonomi Nasional, Jakarta, Indonesia
| | - Montty Girianna
- Komite Pengendalian COVID-19 Dan Pemulihan Ekonomi Nasional, Jakarta, Indonesia
| | - Iqbal R F Elyazar
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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ICU Admission, Invasive Mechanical Ventilation, and Mortality among Children and Adolescents Hospitalized for COVID-19 in a Private Healthcare System. Int J Pediatr 2023; 2023:1698407. [PMID: 36873820 PMCID: PMC9981283 DOI: 10.1155/2023/1698407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/12/2023] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
Aim The COVID-19 pandemic devastated healthcare around the world. Data about the COVID-19 outcomes among young people are still scarce. We aim to identify factors associated with the composite outcome among children and adolescents hospitalized due to COVID-19. Methods We performed a search in the database of a large Brazilian private healthcare system. Insured people aged 21 years or younger who were hospitalized due to COVID-19 from Feb/28th/2020 to Nov/1st/2021 were included. The primary endpoint was the composite outcome consisting of ICU admission, need for invasive mechanical ventilation, or death. Results We evaluated 199 patients who had an index hospitalization due to COVID-19. The median monthly rate of index hospitalization was 2.7 (interquartile range [IQR], 1.6-3.9) per 100,000 clients aged 21 years or less. The median age of the patients was 4.5 years (IQR, 1.4-14.1). At the index hospitalization, the composite outcome rate was 26.6%. The composite outcome was associated with all the previous coexisting morbidities evaluated. The median follow-up was 249.0 days (IQR, 152.0-438.5). There were 27 readmissions (16 patients) within 30 days after the discharge. Conclusions In conclusion, hospitalized children and adolescents had a composite outcome rate of 26.6% at the index hospitalization. Having previous chronic morbidity was associated with the composite.
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Leung C, Su L, Simões-E-Silva AC, Arocha LS, de Paiva KM, Haas P. Risk for Severe Illness and Death among Pediatric Patients with Down Syndrome Hospitalized for COVID-19, Brazil. Emerg Infect Dis 2023; 29:26-35. [PMID: 36573520 PMCID: PMC9796221 DOI: 10.3201/eid2901.220530] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Down syndrome is the most common human chromosomal disorder. Whether Down syndrome is a risk factor for severe COVID-19 outcomes in pediatric patients remains unclear, especially in low-to-middle income countries. We gathered data on patients <18 years of age with SARS-CoV-2 infection from a national registry in Brazil to assess the risk for severe outcomes among patients with Down syndrome. We included data from 14,684 hospitalized patients, 261 of whom had Down syndrome. After adjustments for sociodemographic and medical factors, patients with Down syndrome had 1.8 times higher odds of dying from COVID-19 (odds ratio 1.82, 95% CI 1.22-2.68) and 27% longer recovery times (hazard ratio 0.73, 95% CI 0.61-0.86) than patients without Down syndrome. We found Down syndrome was associated with increased risk for severe illness and death among COVID-19 patients. Guidelines for managing COVID-19 among pediatric patients with Down syndrome could improve outcomes for this population.
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Fabrin C, Boing AC, Garcia LP, Boing AF. Desigualdade socioeconômica na letalidade e no cuidado hospitalar de crianças e adolescentes internados por COVID-19 no Brasil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023. [DOI: 10.1590/1980-549720230015.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
RESUMO Objetivo: Analisar a associação entre a letalidade e o cuidado hospitalar recebido por crianças e adolescentes internados por COVID-19 e o produto interno bruto (PIB) per capita dos municípios brasileiros e a região de residência. Métodos: Os dados foram extraídos do Sistema de Informação de Vigilância Epidemiológica da Gripe e do Instituto Brasileiro de Geografia e Estatística. Analisaram-se como desfechos dicotômicos a letalidade hospitalar por COVID-19, a coleta de amostra biológica para diagnóstico de COVID-19, a realização de exames raio X e tomografia, o uso de suporte ventilatório e a internação em unidade de terapia intensiva. As covariáveis foram o PIB municipal per capita e a região brasileira de residência. Foi realizada regressão de Poisson para os desfechos registrados em 2020 e 2021 no Brasil e segundo o período compreendido em duas ondas de COVID-19 no país, ajustando-a por idade e sexo. Resultados: A letalidade hospitalar foi de 7,6%. Nos municípios dos menores decis de PIB per capita a letalidade foi quase quatro vezes maior entre crianças e duas vezes mais elevada entre adolescentes quando comparada àquela dos maiores decis. Adicionalmente, os residentes de municípios com menor PIB per capita realizaram menos coleta de amostra biológica para diagnóstico, exames de raio X e tomografias. Foram encontradas disparidades regionais associadas à letalidade, com piores indicadores nas regiões Norte e Nordeste. Os achados mantiveram-se consistentes durante as duas ondas de COVID-19. Conclusão: Em municípios com menor PIB per capita e das regiões Norte e Nordeste houve piores indicadores de letalidade e cuidado hospitalar.
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Leung C, Khong KW, Chan KH, Lacerda MVG, Frank CHM. Difference in clinical features of SARS-CoV-2 in pediatric patients before and after emergence of P.1. Pediatr Res 2023; 93:176-182. [PMID: 35418598 PMCID: PMC9006205 DOI: 10.1038/s41390-022-02046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND The P.1 variant is a Variant of Concern announced by the WHO. The present work aimed to characterize the clinical features of pediatric patients with SARS-CoV-2 before and after the emergence of P.1. METHODS This is a cohort study. Data of symptomatic patients younger than 18 years diagnosed with COVID-19 by PCR tests registered in Painel COVID-19 Amazonas were analyzed. RESULTS A total of 4080 symptomatic pediatric patients were identified in the database between March 2020 and July 2021, of which 1654 were categorized as pre-P.1 and 978 as P.1-dominant cases, based on the prevalence of P.1 of >90% in the North Region, Brazil. Lower case-fatality rate was observed in non-infants infected during the P.1-dominant period (0.9% vs. 2.2%). In general, patients infected during the P.1-dominant period had less fever (70.8% vs. 74.2%) and less lower respiratory tract symptoms (respiratory distress: 11.8% vs. 18.9%, dyspnea: 27.9% vs. 34.5%) yet higher prevalence of neurological symptoms, headache for example (42.8% vs. 5.9%). CONCLUSIONS The prevalence of symptoms of COVID-19 can differ across different periods of variant dominance. Lower prevalence of fever during the P.1-dominant period may reduce the effectiveness of symptom-based screening in public premises where laboratory diagnostic tests are not available. IMPACT The prevalence rate of symptoms of SARS-CoV-2 infection can differ among different variants. The present work documents the difference in the clinical features of SARS-CoV-2 in patients aged below 18 years before and after the emergence of P.1, the first study of its kind. Unlike previous studies that focus solely on hospitalized cases, the present work considers both mild and severe cases. While non-infants had a lower fatality rate, lower prevalence of fever associated with the emergence of P.1 may reduce the effectiveness of symptom-based screening in public premises where laboratory diagnostic tests are not available.
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Affiliation(s)
- Char Leung
- School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK. .,Deakin University, Burwood, VIC, Australia.
| | - Ka-Wah Khong
- grid.194645.b0000000121742757Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Kwok-Hung Chan
- grid.194645.b0000000121742757State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Marcus Vinicius Guimarães Lacerda
- grid.418153.a0000 0004 0486 0972Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas Brazil ,grid.418068.30000 0001 0723 0931Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas Brazil
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Pereira AR, Branco MDRFC, Costa SDSB, Lopes DAM, Pinheiro VV, Oliveira DCD, Pasklan ANP, Gomes JA, Santos AMD, Gama MEA. Síndrome Respiratória Aguda Grave por COVID-19 em recém-nascidos no Brasil em 2020–2021. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023. [DOI: 10.1590/1980-549720230012.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
RESUMO Objetivo: Descrever as características clínicas dos casos de Síndrome Respiratória Aguda Grave (SRAG) por COVID-19 em recém-nascidos (RNs) em 2020 e 2021, no Brasil, registrados no Sistema de Informação da Vigilância Epidemiológica da Gripe (SIVEP-Gripe). Métodos: As variáveis analisadas foram: sexo, raça/cor, hospitalização, internação em unidade de terapia intensiva (UTI), uso de suporte ventilatório, sinais e sintomas (febre, tosse, saturação de O2<95%, dispneia, desconforto respiratório, diarreia e vômitos), evolução (óbito ou cura), fatores de risco/comorbidades. As variáveis categóricas foram apresentadas em frequências absolutas e relativas. Resultados: Houve 1.649 registros de SRAG por COVID-19 em RNs, com predomínio de pardos nos dois anos. Os sintomas mais frequentes foram, respectivamente, em 2020 e 2021: desconforto respiratório (67,0 e 69,7%), febre (46,3 e 46,2%) e tosse (37,0 e 46,3%). Em 2020, 30,5% dos pacientes receberam suporte ventilatório invasivo, e 41,6% em 2021. Além disso, mais de 55% dos casos precisaram de internação em UTI, e acima de 16% morreram. Conclusão: Destaca-se a elevada proporção de casos que precisou de cuidados intensivos e que evoluíram para óbito.
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Ortiz-Prado E, Izquierdo-Condoy JS, Fernandez-Naranjo R, Vasconez J, Dávila Rosero MG, Revelo-Bastidas D, Herrería-Quiñonez D, Rubio-Neira M. The deadly impact of COVID-19 among children from Latin America: The case of Ecuador. Front Pediatr 2023; 11:1060311. [PMID: 37152328 PMCID: PMC10160383 DOI: 10.3389/fped.2023.1060311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/17/2023] [Indexed: 05/09/2023] Open
Abstract
Background The SARS-CoV-2 pandemic remains a critical global health concern, with older adults being the most vulnerable group. Nonetheless, it is crucial to recognize that COVID-19 has caused numerous deaths in children worldwide. Emerging evidence indicates that infants and breastfeeding children, particularly those aged below one year, face a greater risk of hospitalization and mortality than older children with COVID-19. Objective This study aimed to describe the epidemiology of COVID-19 among children during the early phase of the pandemic in Ecuador. Methods We conducted a country-wide population-based analysis of the epidemiology of COVID-19, using incidence and mortality data reported from Ecuador between February 15, 2020 and May 14 2021. Measurements of frequency, central tendency, dispersion, and absolute differences were calculated for all categorical and continuous variables. Results At least 34,001 cases (23,587 confirmed cases, 5,315 probable and 5,099 suspected) and 258 COVID-19 related deaths have been reported among children in Ecuador during the first 16 months of the pandemic. The overall incidence rate was 612 cases per 100,000 children, the mortality rate was 3 per 100,000, while the case fatality rate was 0.76%. The highest risk group for infection was children and adolescents between 15 and 19 years of age; however, the highest mortality rate occurred in children under one year of age. The largest provinces, such as Pichincha, Guavas and Manabí, were the ones that reported the highest number of cases, 27%, 12.1% and 10.8%, respectively. Conclusions This study is the first to report on COVID-19 epidemics among children in Ecuador. Our findings reveal that younger children have a lower risk of SARS-CoV-2 infection, but a higher risk of mortality compared to older children and adolescents. Additionally, we observed significant disparities in infection rates and outcomes among children living in rural areas, those with comorbidities, and those from indigenous ethnic groups.
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Affiliation(s)
- Esteban Ortiz-Prado
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
- Facultad de Ciencias de la Salud, Universidad Latina de Costa Rica,San José, Costa Rica
- Correspondence: Esteban Ortiz-Prado
| | - Juan S. Izquierdo-Condoy
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - Raul Fernandez-Naranjo
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - Jorge Vasconez
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - María Gabriela Dávila Rosero
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - Doménica Revelo-Bastidas
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - Diva Herrería-Quiñonez
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - Mario Rubio-Neira
- Department of Cardiology, Baca Ortiz Pediatric Hospital, Quito, Ecuador
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Pessoa IL, Paolilo RB, da Paz JA. COVID-19 in children and adolescents with neuroimmunological disorders. Clinics (Sao Paulo) 2023; 78:100142. [PMID: 36512952 PMCID: PMC9672691 DOI: 10.1016/j.clinsp.2022.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/06/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ingrid Lacerda Pessoa
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Renata Barbosa Paolilo
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
| | - José Albino da Paz
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Vasconcelos MA, Mendonça ACQ, Colosimo EA, Nourbakhsh N, Martelli-Júnior H, Silva LR, Oliveira MCL, Pinhati CC, Mak RH, Simões E Silva AC, Oliveira EA. Outcomes and risk factors for death among hospitalized children and adolescents with kidney diseases and COVID-19: an analysis of a nationwide database. Pediatr Nephrol 2023; 38:181-191. [PMID: 35488136 PMCID: PMC9054113 DOI: 10.1007/s00467-022-05588-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/16/2022] [Accepted: 04/13/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with kidney diseases (KD) appear to be at particularly high risk for severe COVID-19. This study aimed to characterize the clinical outcomes and risk factors for COVID-19-related death in a large cohort of hospitalized pediatric patients with KD. METHODS We performed an analysis of all pediatric patients with KD and COVID-19 registered in SIVEP-Gripe, a Brazilian nationwide surveillance database, between February 16, 2020, and May 29, 2021. The primary outcome was time to death, which was evaluated considering discharge as a competitive risk by using cumulative incidence function. RESULTS Among 21,591 hospitalized patients with COVID-19, 290 cases (1.3%) had KD. Of these, 59 (20.8%) had a fatal outcome compared with 7.5% of the non-KD cohort (P < 0.001). Pediatric patients with KD had an increased hazard of death compared with the non-KD cohort (Hazard ratio [HR] = 2.85, 95% CI 2.21-3.68, P < 0.0001). After adjustment, the factors associated with the death among KD patients were living in Northeast (HR 2.16, 95% CI 1.13-4.31) or North regions (HR 3.50, 95% CI 1.57-7.80), oxygen saturation < 95% at presentation (HR 2.31, 95% CI 1.30-4.10), and presence of two or more associated comorbidities (HR 2.10, 95% CI 1.08-4.04). CONCLUSIONS Children and adolescents with KD had a higher risk of death compared with the non-KD cohort. The higher risk was associated with low oxygen saturation at admission, living in socioeconomically disadvantaged regions, and presence of other pre-existing comorbidities. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Mariana A Vasconcelos
- Division of Pediatric Nephrology, Hospital das Clínicas, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ana Carmen Q Mendonça
- Division of Pediatric Nephrology, Hospital das Clínicas, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Enrico A Colosimo
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Noureddin Nourbakhsh
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California, La Jolla, San Diego, CA, USA
| | - Hercílio Martelli-Júnior
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros, MG, 39401-089, Brazil
| | - Ludmila R Silva
- Health Science/Postgraduate Program in Nursing, School of Nursing, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, 30130-100, Brazil
| | - Maria Christina L Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Clara C Pinhati
- Division of Pediatric Nephrology, Hospital das Clínicas, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California, La Jolla, San Diego, CA, USA
| | - Ana Cristina Simões E Silva
- Division of Pediatric Nephrology, Hospital das Clínicas, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Eduardo A Oliveira
- Division of Pediatric Nephrology, Hospital das Clínicas, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil.
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Solórzano-Santos F, Miranda-Lora AL, Márquez-González H, Klünder-Klünder M. Survival analysis and mortality predictors of COVID-19 in a pediatric cohort in Mexico. Front Public Health 2022; 10:969251. [PMID: 36589967 PMCID: PMC9801985 DOI: 10.3389/fpubh.2022.969251] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
Background The new coronavirus SARS-CoV-2 pandemic has been relatively less lethal in children; however, poor prognosis and mortality has been associated with factors such as access to health services. Mexico remained on the list of the ten countries with the highest case fatality rate (CFR) in adults. It is of interest to know the behavior of COVID-19 in the pediatric population. The aim of this study was to identify clinical and sociodemographic variables associated with mortality due to COVID-19 in pediatric patients. Objective Using National open data and information from the Ministry of Health, Mexico, this cohort study aimed to identify clinical and sociodemographic variables associated with COVID-19 mortality in pediatric patients. Method A cohort study was designed based on National open data from the Ministry of Health, Mexico, for the period April 2020 to January 2022, and included patients under 18 years of age with confirmed SARS-CoV-2 infection. Variables analyzed were age, health services used, and comorbidities (obesity, diabetes, asthma, cardiovascular disease, immunosuppression, high blood pressure, and chronic kidney disease). Follow-up duration was 60 days, and primary outcomes were death, hospitalization, and requirement of intensive care. Statistical analysis included survival analysis, prediction models created using the Cox proportional hazards model, and Kaplan-Meier estimation curves. Results The cohort included 261,099 cases with a mean age of 11.2 ± 4 years, and of these, 11,569 (4.43%) were hospitalized and 1,028 (0.39%) died. Variables associated with risk of mortality were age under 12 months, the presence of comorbidities, health sector where they were treated, and first wave of infection. Conclusion Based on data in the National database, we show that the pediatric fatality rate due to SARS-CoV-2 is similar to that seen in other countries. Access to health services and distribution of mortality were heterogeneous. Vulnerable groups were patients younger than 12 months and those with comorbidities.
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Affiliation(s)
- Fortino Solórzano-Santos
- Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Ciudad de México, Mexico
| | - América Liliana Miranda-Lora
- Unidad de Investigación Epidemiológica en Endocrinología y Nutrición, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Ciudad de México, Mexico
| | - Horacio Márquez-González
- Departamento de Investigación Clínica, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Ciudad de México, Mexico,*Correspondence: Horacio Márquez-González
| | - Miguel Klünder-Klünder
- Subdirección de Investigación, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Ciudad de México, Mexico,Miguel Klünder-Klünder
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