Prospective characterisation of SARS-CoV-2 infections among children presenting to tertiary paediatric hospitals across Australia in 2020: a national cohort study

Why has the epidemiology of RSV changed during the COVID-19 pandemic?

The coronavirus disease 2019 (COVID-19) pandemic has drastically perturbed the epidemiology of Respiratory Syncytial Virus (RSV) respiratory tract infections in children. The reasons for this are not clear. In this article, we review the current literature and critically discuss the different theories to explain why the epidemiology of RSV has changed during the COVID-19 pandemic. Proposed mechanisms include decreased viral immunity in vulnerable age groups caused by the prolonged lack of RSV circulation early in the pandemic, potential Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2)-induced immune dysregulation, viral interactions between SARS-CoV-2 and RSV, and modifications in health-seeking behaviors as well as heath systems factors. Research in viral genomics and phylogeny, and more robust immunology research is needed to guide RSV prevention and health care resource planning.

COVID-19 related ICU admissions in paediatric and young adult patients in Australia: a national case series 2020-2022

Background

COVID-19 pandemic research efforts have focused on disease phenotypes in adults. A distinct spectrum of illness has been documented in paediatric populations. We aimed to review paediatric intensive care unit (ICU) admissions in Australia, across differing variant predominant phases of the pandemic.

Methods

Data reported to the Short PeRiod IncideNce sTudy of Severe Acute Respiratory Infection (SPRINT-SARI) Australia, across 49 ICUs from February 2020 to June 2022 were extracted. We defined 'child' as patients aged <12 years, 'adolescent' as patients aged 12-17 years, and 'young adult' as patients aged 18-25 years.

Findings

We identified 226 paediatric ICU admissions with COVID-19, representing 3.9% of ICU admissions across the study period. Comorbidity was present in 34.6% of children, 51.4% of adolescents, and 48.7% of young adults. The need for respiratory support was highest in young adults. While 28.3% of patients <18 years required invasive ventilation, in-hospital mortality in paediatric patients was 3.6%. During the Omicron period, there was an increase in the annualised incidence of age-specific COVID-19 ICU admissions per 100,000 population, albeit a decrease in the incidence per 1000 SARS-CoV-2 notifications.

Interpretation

This study demonstrated an appreciable burden of COVID-19 in paediatric patients. Adolescent patients presented phenotypically similar to young adults, however, illness severity was lower in younger cohorts. The Omicron phase of the pandemic demonstrated an increased age-specific population incidence of COVID-19 ICU admissions, albeit a reduced incidence when based on SARS-CoV-2 notifications.

Funding

SPRINT-SARI Australia is supported by the Department of Health, Commonwealth of Australia [Standing Deed SON60002733].

COVID-19 coronavirus infection in children: Clinical presentation, diagnosis, vaccination, and treatment

In late 2019, a new subtype of coronavirus named Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19 SARS-CoV-2) rapidly spread around the world, causing a global pandemic. Initially, the proportion of confirmed cases among children was relatively small, and it was believed that children were rarely infected. Subsequent observations have shown that in children and adolescents, the infection is either asymptomatic or paucisymptomatic, and therefore the true incidence is underestimated due to the lack of testing. The article systematizes the results of studies on the prevalence, diagnosis, clinical features, vaccination, and treatment of children with a new coronavirus infection COVID-19 SARS-CoV-2. The SARS-CoV-2 positivity rate throughout the peak of the pandemic in children was low compared to adults. Children are not only less likely to become infected with the virus, but they also endure the infection more easily than adults. The mortality rate in children with COVID-19 was <0.5%. In most children, infection is either asymptomatic or paucisymptomatic. Vaccination of children and adolescents is recommended mainly to achieve herd immunity in all age groups. However, there are no convincing data on the duration of the immune response, the level of the required protective antibody titer, as well as on the long-term side effects of vaccination due to the insufficient follow-up period and the uncertainty of the immune response criteria. As information is accumulated on the viral load of children and adolescents, their role in the transmission of the virus, diagnostic approaches in this age group are optimized. The effectiveness of the treatment was tested on patients admitted to the hospital, and recommendations for treatment were developed. Currently, global research efforts are focused on the protection of particularly vulnerable children, the prospects for total childhood vaccination, its effectiveness and safety.

Quantitative Antibody Levels Against SARS-CoV-2 Spike Protein in COVID-19 and Multisystem Inflammatory Syndrome in Children

The majority of children with coronavirus diseases 2019 (COVID-19) are asymptomatic or develop mild symptoms, and a small number of patients require hospitalization. Multisystem inflammatory syndrome in children (MIS-C) is one of the most severe clinical courses of COVID-19 and is suggested to be a hyperinflammatory condition. This study aimed to compare quantitative antibody levels against SARS-CoV-2 spike protein in children with COVID-19 and MIS-C. Blood samples from 75 patients [n = 36 (48%) with mild/asymptomatic (group 1), n = 22 (29.3%) with moderate-to-severe SARS-CoV-2 infection (group 2) and n = 17 (22.6%) patients with MIS-C (group 3)] were analyzed 3 months after COVID-19. The majority of the children with asymptomatic/mild COVID-19 symptoms (80.6%), moderate/severe disease (90.9%), and MIS-C (82.4%) had detectable IgG antibodies to SARS-CoV-2 spike protein (p = 0.567). The mean antibody value against SARS-CoV-2 spike protein was 321.9 ± 411.6 in group 1, 274 ± 261 in group 2, and 220 ± 299 in group 3, respectively (p > 0.05). Patients diagnosed with COVID-19 (asymptomatic/mild+moderate/severe) and those with MIS-C were also compared; the antibody positivity rates [COVID-19 group: 85.5%, MIS-C group: 82.4%, (p = 0.833)] and mean antibody values [COVID-19 group: 303.9 ± 360.3, MIS-C group: 220 ± 299, (p > 0.05)] were similar in both groups. In conclusion, the majority of children with COVID-19 and MIS-C developed a detectable antibody level against SARS-CoV-2 spike protein 3 months after COVID-19. Quantitative antibody levels were similar in both asymptomatic/mild disease, moderate/severe disease, and MIS-C group. Long-term studies evaluating antibody responses in children with COVID-19 and MIS-C are needed for more accurate vaccine schedules.

COVID ‐19 in New South Wales children during 2021: severity and clinical spectrum

Objectives: To describe the severity and clinical spectrum of coronavirus disease 2019 (COVID‐19) in children during the 2021 New South Wales outbreak of the Delta variant of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2).

Design, setting: Prospective cohort study in three metropolitan Sydney local health districts, 1 June – 31 October 2021.

Participants: Children under 16 years of age with positive SARS‐CoV‐2 nucleic acid test results admitted to hospital or managed by the Sydney Children’s Hospital Network (SCHN) virtual care team.

Main outcome measures: Age‐specific SARS‐CoV‐2 infection frequency, overall and separately for SCHN virtual and hospital patients; rates of medical and social reason admissions, intensive care admissions, and paediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2 per 100 SARS‐CoV‐2 infections; demographic and clinical factors that influenced likelihood of hospital admission.

Results: A total of 17 474 SARS‐CoV‐2 infections in children under 16 were recorded in NSW, of whom 11 985 (68.6%) received SCHN‐coordinated care, including 459 admitted to SCHN hospitals: 165 for medical reasons (1.38 [95% CI, 1.17–1.59] per 100 infections), including 15 admitted to intensive care, and 294 (under 18 years of age) for social reasons (2.45 [95% CI, 2.18–2.73] per 100 infections). In an analysis that included all children admitted to hospital and a random sample of those managed by the virtual team, having another medical condition (adjusted odds ratio [aOR], 7.42; 95% CI, 3.08–19.3) was associated with increased likelihood of medical admission; in univariate analyses, non‐asthmatic chronic respiratory disease was associated with greater (OR, 9.21; 95% CI, 1.61–174) and asthma/viral induced wheeze with lower likelihood of admission (OR, 0.38; 95% CI, 0.18–0.78). The likelihood of admission for medical reasons declined from infancy to 5–11 years, but rose again for those aged 12–15 years. Sex and Indigenous status did not influence the likelihood of admission.

Conclusion: Most SARS‐CoV‐2 infections (Delta variant) in children were asymptomatic or associated with mild disease. Hospitalisation was relatively infrequent, and most common for infants, adolescents, and children with other medical conditions. More children were hospitalised for social than for medical reasons.

The known: Information regarding disease severity and reasons for hospital admissions of children with COVID‐19 in Australia is very limited.

The new: In 2021, more NSW children with SARS‐CoV‐2 infections were hospitalised for social or welfare reasons (294, 64%; 2.45 per 100 infections) than for medical treatment (165, 36%; 1.38 per 100 infections). Children under six months of age, aged 12–15 years, or with another medical condition were more likely to be hospitalised than other children.

The implications: As acute COVID‐19 is typically mild in children, measures that protect them from SARS‐CoV‐2 but harm their overall wellbeing may be disproportionate. Community support for children with special care needs could reduce the number of hospitalisations.

Clinical Characteristics of Children With SARS-CoV-2 Infection in a Hospital in Latin America

OBJECTIVE

COVID-19 infections have shown a different behavior in children than in adults. The objective of this study was to describe the clinical characteristics and severity of SARS-CoV-2 infection in pediatric patients seen at a reference hospital in Colombia.

METHOD

A descriptive, observational study in patients under the age of 18 years with a positive test for SARS-CoV-2 infection (RT-PCR or antigen) between April 2020 and March 2021. Multiple variables were studied, including demographic data, clinical characteristics, lab measurements, treatments administered, intensive care unit admission, and mortality.

RESULTS

A total of 361 patients were included of whom 196 (54%) were males. The median age was 3 years. Of all the patients, 65 (18%) were asymptomatic. The majority of patients had no comorbidities (n = 225, 76%). In those who were symptomatic (n = 296, 82%), the most frequent complaints were fever (n = 178, 60%), nasal congestion (n = 164, 55%) and cough (n = 149, 50%). Chest x-rays were normal in 73 patients (50%). When abnormalities were found, interstitial (29%) and alveolar (12%) patterns were the most prevalent. One hundred and fifty-seven children (53%) required general ward hospitalization, and 24 patients (8%) required pediatric intensive care admission. The global mortality was 0.8% (3 patients).

CONCLUSIONS

The majority of cases were asymptomatic or mild. However, a significant percentage of patients required general ward admission, and some even required intensive care. The main symptom of COVID-19 infections in newborns was apnea. A second COVID-19 RT-PCR may be necessary to detect infections in critically ill patients with a high clinical suspicion of the disease if an initial test was negative.

Prevalence of paediatric hyperinflammatory conditions in paediatric and adolescent hospitalized COVID-19 patients: a systematic review and meta-analysis

In the milieu of coronavirus disease 2019 (COVID-19), there are increasing reports of paediatric hyperinflammatory conditions (PHICs), including multisystem inflammatory syndrome in children (MIS-C), paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and Kawasaki disease (KD). Few analyses of PHIC prevalence in paediatric and adolescent hospitalized COVID-19 patients exist. The purpose of this study was to perform a meta-analysis to determine a pooled prevalence estimate of PHICs in paediatric and adolescent hospitalized patients admitted for treatment due to COVID-19. Individual studies were retrieved from PubMed/Medline, EMBASE and Cochrane databases. Relevant prevalence, baseline, treatment and outcome data were extracted using a standardized datasheet. The systematic review and meta-analysis were conducted as per the PRISMA and MOOSE guidelines. Overall, 14 studies with 2202 patients admitted for treatment due to COVID-19, among whom 780 were diagnosed with PHICs, were included. The crude estimate of prevalence was 35.42%, and the pooled estimate of prevalence was 29% (random pooled ES = 0.29; 95% CIs = 0.18-0.42; p < 0.0001; z = 7.45). A sizeable proportion of paediatric and adolescent hospitalized patients admitted for treatment due to COVID-19 are diagnosed with a PHIC warranting a high index of clinical suspicion for PHICs. Further studies are required to validate these findings.