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Wiedenmann M, Ipekci AM, Araujo-Chaveron L, Prajapati N, Lam YT, Alam MI, L'Huillier AG, Zhelyazkov I, Heron L, Low N, Goutaki M. SARS-CoV-2 variants of concern in children and adolescents with COVID-19: a systematic review. BMJ Open 2023; 13:e072280. [PMID: 37813543 PMCID: PMC10565293 DOI: 10.1136/bmjopen-2023-072280] [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: 02/13/2023] [Accepted: 09/04/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES Infections by SARS-CoV-2 variants of concern (VOCs) might affect children and adolescents differently than earlier viral lineages. We aimed to address five questions about SARS-CoV-2 VOC infections in children and adolescents: (1) symptoms and severity, (2) risk factors for severe disease, (3) the risk of infection, (4) the risk of transmission and (5) long-term consequences following a VOC infection. DESIGN Systematic review. DATA SOURCES The COVID-19 Open Access Project database was searched up to 1 March 2022 and PubMed was searched up to 9 May 2022. ELIGIBILITY CRITERIA We included observational studies about Alpha, Beta, Gamma, Delta and Omicron VOCs among ≤18-year-olds. We included studies in English, German, French, Greek, Italian, Spanish and Turkish. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted and verified the data and assessed the risk of bias. We descriptively synthesised the data and assessed the risks of bias at the outcome level. RESULTS We included 53 articles. Most children with any VOC infection presented with mild disease, with more severe disease being described with the Delta or the Gamma VOC. Diabetes and obesity were reported as risk factors for severe disease during the whole pandemic period. The risk of becoming infected with a SARS-CoV-2 VOC seemed to increase with age, while in daycare settings the risk of onward transmission of VOCs was higher for younger than older children or partially vaccinated adults. Long-term symptoms following an infection with a VOC were described in <5% of children and adolescents. CONCLUSION Overall patterns of SARS-CoV-2 VOC infections in children and adolescents are similar to those of earlier lineages. Comparisons between different pandemic periods, countries and age groups should be improved with complete reporting of relevant contextual factors, including VOCs, vaccination status of study participants and the risk of exposure of the population to SARS-CoV-2. PROSPERO REGISTRATION NUMBER CRD42022295207.
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Affiliation(s)
- Margarethe Wiedenmann
- Medical Service Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Aziz Mert Ipekci
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Lucia Araujo-Chaveron
- EHESP French School of Public Health, Rennes, France
- Emerging Disease Epidemiology Unit, Insitut Pasteur, Paris, France
| | - Nirmala Prajapati
- Université Paris-Saclay, Gif-sur-Yvette, France
- Exposome and Heredity Team, Institut national de la santé et de la recherche médicale, Paris, France
| | - Yin Ting Lam
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Arnaud G L'Huillier
- Département de pédiatrie, gynécologie et obstétrique, HUG, Geneve, Switzerland
| | | | - Leonie Heron
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Ho RM, Bowen AC, Blyth CC, Imrie A, Kollmann TR, Stick SM, Kicic A. Defining the pediatric response to SARS-CoV-2 variants. Front Immunol 2023; 14:1200456. [PMID: 37304275 PMCID: PMC10248061 DOI: 10.3389/fimmu.2023.1200456] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/05/2023] [Indexed: 06/13/2023] Open
Abstract
The global population has been severely affected by the coronavirus disease 2019 (COVID-19) pandemic, however, with older age identified as a risk factor, children have been underprioritized. This article discusses the factors contributing to the less severe response observed in children following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including, differing viral entry receptor expression and immune responses. It also discusses how emerging and future variants could present a higher risk to children, including those with underlying comorbidities, in developing severe disease. Furthermore, this perspective discusses the differential inflammatory markers between critical and non-critical cases, as well as discussing the types of variants that may be more pathogenic to children. Importantly, this article highlights where more research is urgently required, in order to protect the most vulnerable of our children.
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Affiliation(s)
- Reanne M. Ho
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
- Medical School, University of Western Australia, Nedlands, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
| | - Asha C. Bowen
- Medical School, University of Western Australia, Nedlands, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Christopher C. Blyth
- Medical School, University of Western Australia, Nedlands, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA, Australia
| | - Allison Imrie
- Medical School, University of Western Australia, Nedlands, WA, Australia
- School of Biomedical Sciences, University of Western Australia, Nedlands, WA, Australia
| | - Tobias R. Kollmann
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA, Australia
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Stephen M. Stick
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, WA, Australia
- Centre for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, University of Western Australia and Harry Perkins Institute of Medical Research, Nedlands, WA, Australia
| | - Anthony Kicic
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, WA, Australia
- Centre for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, University of Western Australia and Harry Perkins Institute of Medical Research, Nedlands, WA, Australia
- School of Population Health, Curtin University, Perth, WA, Australia
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Li H, Zhu X, Yu R, Qian X, Huang Y, Chen X, Lin H, Zheng H, Zhang Y, Lin J, Deng Y, Zhong W, Ji Y, Li Q, Fang J, Yang X, Lin R, Chen F, Su Z, Xie B, Li H. The effects of vaccination on the disease severity and factors for viral clearance and hospitalization in Omicron-infected patients: A retrospective observational cohort study from recent regional outbreaks in China. Front Cell Infect Microbiol 2022; 12:988694. [PMID: 36420118 PMCID: PMC9677104 DOI: 10.3389/fcimb.2022.988694] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/14/2022] [Indexed: 08/04/2023] Open
Abstract
OBJECT This study attempted to explore the effects of vaccination on disease severity and the factors for viral clearance and hospitalization in omicron-infected patients. METHODS The clinical manifestations of 3,265 Omicron-infected patients (BA.2 lineage variant; the Omicron group) were compared with those of 226 Delta-infected patients (the Delta group). A Multi-class logistic regression model was employed to analyze the impacts of vaccination doses and intervals on disease severity; a logistic regression model to evaluate the risk factors for hospitalization; R 4.1.2 data analysis to investigate the factors for time for nucleic acid negativization (NAN). RESULTS Compared with the Delta group, the Omicron group reported a fast transmission, mild symptoms, and lower severity incidence, and a significant inverse correlation of vaccination dose with clinical severity (OR: 0.803, 95%CI: 0.742-0.868, p<0.001). Of the 7 or 5 categories of vaccination status, the risk of severity significantly decreased only at ≥21 days after three doses (OR: 0.618, 95% CI: 0.475-0.803, p<0.001; OR: 0.627, 95% CI: 0.482-0.815, p<0.001, respectively). The Omicron group also reported underlying illness as an independent factor for hospitalization, sore throat as a protective factor, and much shorter time for NAN [15 (12,19) vs. 16 (12,22), p<0.05]. NAN was associated positively with age, female gender, fever, cough, and disease severity, but negatively with vaccination doses. CONCLUSION Booster vaccination should be advocated for COVID-19 pandemic-related control and prevention policies and adequate precautions should be taken for patients with underlying conditions.
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Affiliation(s)
- Hongru Li
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Fujian Provincial Key Laboratory of Medical Big Data Engineering, Fujian Provincial Hospital, Fuzhou, China
| | - Xiongpeng Zhu
- Department of Hematology, Quanzhou First Hospital, Quanzhou, China
| | - Rongguo Yu
- Department of Surgical Critical Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Xin Qian
- Fujian Provincial Hospital, Emergency Center of Fujian Provincial Hospital, National Emergency Rescue Team (Fujian), Fuzhou, China
| | - Yu Huang
- Fujian Provincial Health Commission, Fujian, Fuzhou, China
| | - Xiaoping Chen
- College of Mathematics and Statistics & Fujian Key Laboratory of Mathematical Analysisand Applications (FJKLMAA), Fujian Normal University, Fuzhou, China
| | - Haibin Lin
- Department of Orthopedics, Affiliated Hospital of Putian University, Putian, Fujian, China
| | - Huiming Zheng
- Department of Pediatric Surgery, Quanzhou First Hospital, Quanzhou, China
| | - Yi Zhang
- Department of Endocrinology, Quanzhou First Hospital, Quanzhou, China
| | - Jiarong Lin
- Medical Affairs Office, Quanzhou First Hospital, Quanzhou, China
| | - Yanqin Deng
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Wen Zhong
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Yuejiao Ji
- College of Mathematics and Statistics & Fujian Key Laboratory of Mathematical Analysisand Applications (FJKLMAA), Fujian Normal University, Fuzhou, China
| | - Qing Li
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Jiabin Fang
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaojie Yang
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Rong Lin
- Department of Infectious Diseases, Quanzhou First Hospital, Fuzhou, China
| | - Fangsu Chen
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Zhijun Su
- Department of Infectious Diseases, Quanzhou First Hospital, Fuzhou, China
| | - Baosong Xie
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Hong Li
- Fujian Provincial Key Laboratory of Medical Big Data Engineering, Fujian Provincial Hospital, Fuzhou, China
- Department of Nursing, Fujian Provincial Hospital, Fuzhou, China
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Leone V, Meisinger C, Temizel S, Kling E, Gerstlauer M, Frühwald MC, Burkhardt K. Longitudinal change in SARS-CoV-2 seroprevalence in 3-to 16-year-old children: The Augsburg Plus study. PLoS One 2022; 17:e0272874. [PMID: 35951611 PMCID: PMC9371315 DOI: 10.1371/journal.pone.0272874] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Currently, more than 30,200,000 COVID-19 cases have been diagnosed in Germany alone. However, data regarding prevalence of COVID-19 in children, both in Germany and internationally, are sparse. We sought to evaluate the number of infected children by measuring IgG antibodies.
Methods
Oropharyngeal swabs were collected between December 2020 and August 2021 to measure SARS-CoV-2, and capillary blood for the detection of SARS-CoV-2 antibodies (by rapid test NADAL® and filter paper test Euroimmun® ELISA); venous blood was taken for validation (Roche® ECLIA and recomLine Blot) in 365 German children aged 3–16 years from 30 schools and preschools. We used multiple serological tests because the filter paper test Euroimmun® ELISA performs better in terms of sensitivity and specificity than the rapid test NADAL®. The Roche® ECLIA test is used to detect SARS-CoV-2 spike protein, and the recomLine Blot test is used to rule out the possibility of infection by seasonal SARS-viruses and to test for specific SARS-CoV-2 proteins (NP, RBD and S1). In addition, one parent each (n = 336), and 4–5 teachers/caregivers (n = 90) per institution were tested for IgG antibodies from capillary blood samples. The total study duration was 4 months per child, including the first follow-up after 2 months and the second after 4 months.
Results
Of 364 children tested at baseline, 3.6% (n = 13) were positive for SARS-CoV-2 IgG antibodies using Euroimmun® ELISA. Seven children reported previously testing positive for SARS-CoV-2; each of these was confirmed by the Roche® Anti-SARS-CoV-2-ECLIA (antibody to spike protein 1) test. SARS-CoV-2 IgG antibodies persisted over a 4-month period, but levels decreased significantly (p = 0.004) within this timeframe. The median IgG values were 192.0 BAU/ml [127.2; 288.2], 123.6 BAU/ml [76.6; 187.7] and 89.9 BAU/ml [57.4; 144.2] at baseline, 2 months and 4 months after baseline, respectively. During the study period, no child tested positive for SARS-CoV-2 by oropharyngeal swab. A total of 4.3% of all parents and 3.7% of teachers/caregivers tested positive for IgG antibodies by Euroimmun® ELISA at baseline.
Conclusion
We noted a rather low seroprevalence in children despite an under-reporting of SARS-CoV-2 infections. Measurement of IgG antibodies derived from capillary blood appears to be a valid tool to detect asymptomatic infections in children. However, no asymptomatic active infection was detected during the study period of 4 months in the whole cohort. Further data on SARS-CoV-2 infections in children are needed, especially in the group of <5-year-olds, as there is currently no licensed vaccine for this age group in Germany. The Robert Koch Institute’s Standing Commission on Vaccination (STIKO) recommended COVID-19 vaccination for 12–17 and 5–11 year olds in August 2021 and May 2022 respectively.
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Affiliation(s)
- Vincenza Leone
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Augsburg, Germany
- * E-mail:
| | - Christa Meisinger
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Augsburg, Germany
| | - Selin Temizel
- Department of Hygiene and Environmental Medicine, University Hospital Augsburg, Augsburg, Germany
| | - Elisabeth Kling
- Institute of Laboratory Medicine and Microbiology University Hospital Augsburg, Augsburg, Germany
| | - Michael Gerstlauer
- Paediatric and Adolescent Medicine University Hospital Augsburg, Augsburg, Germany
| | - Michael C. Frühwald
- Paediatric and Adolescent Medicine University Hospital Augsburg, Augsburg, Germany
| | - Katrin Burkhardt
- Institute of Laboratory Medicine and Microbiology University Hospital Augsburg, Augsburg, Germany
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