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Jin Q, Ma W, Zhang W, Wang H, Geng Y, Geng Y, Zhang Y, Gao D, Zhou J, Li L, Gou Y, Zhong B, Li J, Hou W, Lu S. Clinical and hematological characteristics of children infected with the omicron variant of SARS-CoV-2: role of the combination of the neutrophil: lymphocyte ratio and eosinophil count in distinguishing severe COVID-19. Front Pediatr 2024; 12:1305639. [PMID: 38978839 PMCID: PMC11228319 DOI: 10.3389/fped.2024.1305639] [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: 10/02/2023] [Accepted: 05/30/2024] [Indexed: 07/10/2024] Open
Abstract
Purpose Investigate the clinical/hematological characteristics of children infected with the Omicron variant of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and identify an effective indicator to distinguish coronavirus disease 2019 (COVID-19) severity in children. Methods A retrospective study was conducted through electronic medical records from pediatric patients. The demographic, clinical, and routine blood test (RBT) features of children diagnosed by real-time PCR for SARS-CoV-2 were collected. Results Data of 261 patients were analyzed. The most common abnormality shown by RBTs was increased monocyte count (68%). Children had "mild-moderate" or "severe" forms of COVID-19. Prevalence of abnormal neutrophil count (p = 0.048), eosinophil count (p = 0.006), mean corpuscular volume (p = 0.033), mean platelet volume (p = 0.006), platelet-large cell ratio (p = 0.043), and red blood cell distribution width-standard deviation (p = 0.031) were significantly different in the two types. A combination of the neutrophil: lymphocyte ratio (NLR) and eosinophil count for diagnosing severe COVID-19 presented the largest AUC (0.688, 95% CI = 0.599-0.777; p < 0.001), and the AUC increased with a decrease in age. Conclusions Combination of the NLR and eosinophil count might be a promising indicator for identifying severe COVID-19 in children at infection onset.
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Affiliation(s)
- Qiaoyan Jin
- Department of Pediatrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Biochemistry and Molecular Biology, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Wenxian Ma
- Department of Biochemistry and Molecular Biology, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Wei Zhang
- Xijing 986 Hospital Department, Air Force Medical University, Xi’an, China
| | - Huiyuan Wang
- Department of Pediatrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yiongxiang Geng
- Department of Pediatrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yan Geng
- Department of Pediatrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yang Zhang
- Department of Pediatrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Dan Gao
- Department of Pediatrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jing Zhou
- Department of Pediatrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Lin Li
- Xijing 986 Hospital Department, Air Force Medical University, Xi’an, China
| | - Yaping Gou
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xi’an, China
| | - Bo Zhong
- Department of Pediatrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jing Li
- Department of Pediatrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Wei Hou
- Department of Pediatrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Shemin Lu
- Department of Biochemistry and Molecular Biology, Xi’an Jiaotong University Health Science Center, Xi’an, China
- National Joint Engineering Research Center of Biodiagnostics and Biotherapy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China
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Li J, Li J, Cao L, Wang L, Chen X, Niu W, Dang L, Dai S, Wang Y, Ge M, Liu W, Song Q, Xu W, Ma L. Clinical manifestations and long-term symptoms associated with SARS-CoV-2 omicron infection in children aged 0-17 years in Beijing: a single-center study. Front Pediatr 2024; 12:1332020. [PMID: 38813546 PMCID: PMC11133534 DOI: 10.3389/fped.2024.1332020] [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: 11/03/2023] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
Objective The study aims to analyze the clinical characteristics of acute phase of SARS-CoV-2 infection in children aged 0-17 years with the Omicron variant, and summarize the persistent symptoms or new-onset clinical manifestations from 4 to 12 weeks after acute COVID. Explore the association between the vaccination status and SARS-CoV-2 neutralizing antibody levels post infection among preschool-aged children. The comprehensive study systematically describes the clinical characteristics of children infected with SARS-CoV-2, providing a foundation for diagnosis and evaluating long-term COVID in pediatric populations. Methods The study enrolled children who were referred to the Children's Hospital, Capital Institute of Pediatrics, (Beijing, China) from January 10, 2023 to March 31, 2023. Participants were classified as infant and toddlers, preschool, school-age, and adolescent groups. Children or their legal guardians completed survey questionnaires to provide information of previous SARS-CoV-2 infection history, as well as clinical presentation during the acute phase and long-term symptoms from 4 to 12 weeks following infection. Furthermore, serum samples were collected from children with confirmed history of SARS-CoV-2 infection for serological testing of neutralizing antibodies. Results The study recruited a total of 2,001 children aged 0-17 years who had previously tested positive for SARS-CoV-2 through nucleic acid or antigen testing. Fever emerged as the predominant clinical manifestation in 1,902 (95.1%) individuals with body temperature ranging from 37.3 to 40.0°C. Respiratory symptoms were identified as secondary clinical manifestations, with cough being the most common symptom in 777 (38.8%) children, followed by sore throat (22.1%), nasal congestion (17.8%), and runnning nose (17.2%). Fatigue (21.6%), headache (19.8%) and muscle-joint pain (13.5%) were frequently reported systemic symptoms in children. The proportion of children with symptoms of SARS-CoV-2 infection varied across age groups. 1,100 (55.0%) children experienced persistent symptoms from 4 to 12 weeks post the acute phase of infection. Trouble concentrating (22.1%), cough (22.1%), and fatigue (12.1%) were frequently reported across age groups in the extended period. A limited number of children exhibited cardiovascular symptoms with chest tightness, tachycardia, and chest pain reported by 3.5%, 2.5%, and 1.8% of children, respectively. Among 472 children aged 3-5 years, 208 children had received two doses of SARS-CoV-2 vaccine at least 6 months prior to infection, and no association was found between the incidence of long-term COVID and pre-infection vaccination statuses among the 3-5 years age groups (χ2 = 1.136, P = 0.286). Conclusions In children aged 0-17 years infected with SARS-CoV-2 Omicron variant, fever was the primary clinical manifestation in the acute phase, followed by respiratory symptoms, systemic non-specific and digestive presentations. In particular, respiratory and digestive system symptoms were more frequent in children aged above 6 years. Regarding the long-term symptoms from 4 to 12 weeks post-infection, the most common presentations were concentrating difficulty, cough, and fatigue. The incidence of persistent symptoms of SARS-CoV-2 did not exhibit a significant correlation with vaccination status, which was attributed to the waning efficacy of the vaccine-induced humoral immune response after 6 months.
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Affiliation(s)
- Jing Li
- Department of Clinical Laboratory, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Jingjing Li
- Department of Clinical Laboratory, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Ling Cao
- Department of Respiratory, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Lin Wang
- Department of Child Health Care, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Xiaobo Chen
- Department of Endocrinology, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Wenquan Niu
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing, China
| | - Li Dang
- Department of Outpatient Treatment Center, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Shuzhi Dai
- Department of Clinical Laboratory, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Ying Wang
- Department of Clinical Laboratory, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Menglei Ge
- Department of Clinical Laboratory, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Weijie Liu
- Department of Clinical Laboratory, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Qinwei Song
- Department of Clinical Laboratory, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Wenjian Xu
- Department of Clinical Laboratory, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Lijuan Ma
- Department of Clinical Laboratory, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
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Lin F, Jiang DJ, Zhang S, Yang Z, Zeng HS, Liu ZP, Yang LY. Critically ill children with SARS-COV-2 Omicron infection at a national children medical center, Guangdong, China. BMC Pediatr 2024; 24:254. [PMID: 38622552 PMCID: PMC11017605 DOI: 10.1186/s12887-024-04735-w] [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: 12/25/2023] [Accepted: 04/01/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND SARS-CoV-2 infection is described as asymptomatic, mild, or moderate disease in most children. SARS-CoV-2 infection related death in children and adolescents is rare according to the current reports. COVID-19 cases increased significantly in China during the omicron surge, clinical data regarding pediatric critical patients infected with the omicron variant is limited. In this study, we aim to provide an overview of the clinical characteristics and outcomes of critically ill children admitted to a national children's medical center in Guangdong Province, China, during the outbreak of the omicron variant infection. METHODS We conducted a retrospective study from November 25, 2022, to February 8, 2023, which included 63 critically ill children, under the age of 18, diagnosed with SARS-CoV-2 infection. The patients were referred from medical institutions of Guangdong province. The medical records of these patients were analyzed and summarized. RESULTS The median age of patients was 2 years (Interquartile Range, IQR: 1.0-8.0), sex-ratio (male/female) was 1.52. 12 (19%) patients (age ≥ 3 years) were vaccinated. The median length of hospital stay was 14 days (IQR: 6.5-23) in 63 cases, and duration of fever was 5 days (IQR: 3-8.5), pediatric intensive care unit (PICU) stay was 8 days (IQR 4.0-14.0) in 57 cases. 30 (48%) cases had clear contact history with family members who were infected with SARS-CoV-2. Three children who tested positive for SARS-CoV-2 infection did not show any abnormalities on chest imaging examination. Out of the total patients, 33 (52%) had a bacterial co-infection, with Staphylococcus aureus being the most commonly detected bacterial pathogen. Our cohort exhibited respiratory and nervous system involvement as the primary features. Furthermore, fifty (79%) patients required mechanical ventilation, with a median duration of 7 days (IQR 3.75-13.0). Among these patients, 35 (56%) developed respiratory failure, 16 (25%) patients experienced a deteriorating progression of symptoms and ultimately succumbed to the illness, septic shock was the most common condition among these patients (15 cases), followed by multiple organ failure in 12 cases, and encephalopathy identified in 7 cases. CONCLUSION We present a case series of critically ill children infected with the SARS-CoV-2 omicron variant. While there is evidence suggesting that Omicron may cause less severe symptoms, it is important to continue striving for measures that can minimize the pathogenic impact of SARS-CoV-2 infection in children.
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Affiliation(s)
- Fen Lin
- Precision Medical Lab Center, Chaozhou Central Hospital, Chaozhou, Guangdong Province, P. R. China
| | - Dao-Ju Jiang
- Department of Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangdong Province, P. R. China
| | - Song Zhang
- Department of Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangdong Province, P. R. China
| | - Zhe Yang
- Department of Pediatrics, Chaozhou Central Hospital, Chaozhou, Guangdong Province, P. R. China
| | - Hua-Song Zeng
- Department of Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangdong Province, P. R. China
| | - Zhi-Ping Liu
- Precision Medical Lab Center, Chaozhou Central Hospital, Chaozhou, Guangdong Province, P. R. China
| | - Li-Ye Yang
- Precision Medical Lab Center, People's Hospital of Yangjiang, No.42 Dongshan Road, Jiangcheng District, Yangjiang, 529500, Guangdong Province, P. R. China.
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Wu CH, Chang TH, Tan BF, Wu JL, Huang SM, Yen TY, Wu ET, Wang CC, Lin MT, Lu CY, Chang LY, Huang LM. Clinical manifestations and risk factors of shock in children with multisystem inflammatory syndrome. J Formos Med Assoc 2024; 123:496-500. [PMID: 37903693 DOI: 10.1016/j.jfma.2023.10.002] [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: 02/20/2023] [Revised: 09/14/2023] [Accepted: 10/01/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a novel disease associated with COVID-19. The COVID-19 epidemic peaked in May 2022 in Taiwan, and we encountered our first case of MIS-C in late May 2022. We aimed to present patients' clinical manifestations and identify risk factors for shock. METHODS We included patients diagnosed with MIS-C at two medical centers from May 2022 to August 2022. We separated those patients into two groups according to whether they experienced shock. We collected demographic, clinical manifestation, and laboratory data of the patients and performed statistical analysis between the two groups. RESULTS We enrolled 28 patients, including 13 (46 %) with shock and 15 (54 %) without shock. The median age was 6.4 years (IQR: 1.9-7.5). In single variable analysis, patients with shock tended to be older, had more neurological symptoms, more conjunctivitis and strawberry tongue, lower lymphocyte count, lower platelet counts, and higher C-reactive protein, higher procalcitonin, higher ferritin, and higher D-dimer levels than those without shock. The area under the ROC curve that used procalcitonin to be the risk factor of shock with MIS-C was 0.815 (95 % CI 0.644 to 0.987). The cutoff value obtained by ROC analysis of procalcitonin was 1.68 ng/mL. With this cutoff, the test characteristics of procalcitonin were as follows: sensitivity 77 %, specificity 93 %, positive predictive value 91 %, negative predictive value 82 %. Multivariable analysis revealed that procalcitonin was the only independent risk factor of shock with MIS-C on admission (OR, 26.00, 95 % CI, 1.01-668.89). CONCLUSIONS MIS-C patients with high initial procalcitonin levels have higher risks of experiencing shock and may need ICU admission.
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Affiliation(s)
- Chi-Hsien Wu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tu-Hsuan Chang
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Boon-Fatt Tan
- Department of Pediatrics, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Jong-Lin Wu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Song-Ming Huang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ting-Yu Yen
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - En-Ting Wu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Chia Wang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Yi Lu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Zhao D, Liu W, Zhang Z, Li Y, Luo J, Zheng W, Sun R. Timing of general anesthesia for pediatric patients recovering from COVID-19: a prospective cohort study. BMC Anesthesiol 2024; 24:11. [PMID: 38166732 PMCID: PMC10759690 DOI: 10.1186/s12871-023-02390-9] [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: 10/11/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To explore the timing of general anesthesia for pediatric patients who have recovered from novel coronavirus infection and summarize anesthesia-related complications. METHODS We summarized the perioperative management of children under 14 years of age who underwent general anesthesia in our hospital according to national epidemic prevention and control requirements. We compared the incidence of postoperative pulmonary complications within 2 weeks (Group A), 3-4 weeks (Group B), and 5-6 weeks (Group C) after COVID-19 recovery. RESULTS There were differences among the three groups in terms of decreased blood oxygen saturation (< 94%), secretions, and coughing during the PACU period. The risk of low blood oxygen saturation during PACU decreased as the time of COVID-19 recovery extended in the three groups. Compared to Group A, the risk of low blood oxygen saturation was lower in Group B. The presence of respiratory symptoms and a body temperature above 40℃ increased the risk of decreased blood oxygen saturation. The proportion of children aged 11-14 years and children with high fever experiencing decreased blood oxygen saturation during PACU was higher in Groups A and B. Among the three groups, children with respiratory symptoms and longer illness duration had a higher proportion of decreased blood oxygen saturation during PACU. CONCLUSION Pediatric patients who have recovered from COVID-19 for more than 2 weeks have a lower risk of postoperative complications after general anesthesia. For children with respiratory system symptoms or high fever, there is a higher risk of transient blood oxygen saturation decrease during PACU. For older children, those with high fever, respiratory system symptoms, or longer illness duration, it is recommended to appropriately extend the time from COVID-19 recovery to surgery.
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Affiliation(s)
- Dinghuan Zhao
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Wei Liu
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Zhao Zhang
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Yuting Li
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Jun Luo
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Weiqiang Zheng
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Ruiqiang Sun
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China.
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Arslan A, Sahbudak Bal Z, Erci E, Yıldırım Arslan S, Bilen NM, Avcu G, Çiçek C, Ozkinay F, Kurugol Z. SARS-CoV-2 reinfections in the pediatric cohort-a single-center experience. J Trop Pediatr 2023; 70:fmad049. [PMID: 38150674 DOI: 10.1093/tropej/fmad049] [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] [Indexed: 12/29/2023]
Abstract
BACKGROUND This study focused on timelines of infection episodes and dominant variants and aims to determine disease severity and outcome of pediatric patients with reinfection. MATERIALS AND METHODS This study retrospectively evaluated the medical records of the hospitalized patients and/or outpatients aged 0-18 with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction between March 2020 and September 2022 at Ege University Children's Hospital. RESULTS Ninety-one pediatric patients reinfected with SARS-CoV-2 were included in the study. There was an underlying disease in 26.4% of the patients. The median time between the two infection episodes was 184 (90-662) days. There were 24 patients (26.3%) with the first infection in pre-Delta period; 17 (18.6%) of them were reinfected in Omicron BA.1 period, while 7 (7.6%) in Omicron BA.4/BA.5 period. Forty-five patients (49.4%) were infected initially in the Delta period; 35 patients (38.4%) were reinfected in the Omicron BA.1 period, while 10 patients (10.9%) were reinfected in the Omicron BA.4/BA.5 period. Twenty-two patients (24.1%) had the first infection in the Omicron BA.1 period and then reinfected in the Omicron BA.4/BA.5 period. Patients with reinfection more frequently displayed a symptom (84.6% vs. 94.5%, p = 0.03). The hospitalization rate significantly declined in reinfection (15.3% vs. 7.6%, p = 0.03). Severe disease, treatment needs and steroid use were decreased in reinfections without a significant difference (p > 0.05). Intensive care unit admission was not altered. CONCLUSION This study revealed that reinfections frequently develop in previously healthy children but do not cause more severe outcomes. The risk of symptomatic reinfections is still high due to the effect of the Omicron variant.
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Affiliation(s)
- Asli Arslan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir 35040, Turkey
| | - Zumrut Sahbudak Bal
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir 35040, Turkey
| | - Ece Erci
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir 35040, Turkey
| | - Sema Yıldırım Arslan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir 35040, Turkey
| | - Nimet Melis Bilen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir 35040, Turkey
| | - Gülhadiye Avcu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir 35040, Turkey
| | - Candan Çiçek
- Department of Microbiology, Faculty of Medicine, Ege University, Izmir 35040, Turkey
| | - Ferda Ozkinay
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir 35040, Turkey
| | - Zafer Kurugol
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir 35040, Turkey
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Liu HF, Lu R, Yang J, Xiang M, Ban D, Yang JW, Guo ZH, Yuan TY, Fu HM. Evaluation of febrile seizures in children infected with SARS-CoV-2 Omicron variant in Yunnan, China: a multi-center, retrospective observational study. Front Pediatr 2023; 11:1223521. [PMID: 38027295 PMCID: PMC10679341 DOI: 10.3389/fped.2023.1223521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Background The SARS-CoV-2 Omicron variant was reported to be linked to febrile seizures (FSs), but studies on FSs in children with Omicron infection remain relatively scarce, especially in the Chinese population. This study aimed to investigate the characteristics of children diagnosed with Omicron infection with FSs in Yunnan, China, and evaluate the potential association between FSs and Omicron infection. Methods This study was conducted at four hospitals in Yunnan from December 8, 2022, to January 8, 2023, and consisted of 590 pediatric subjects. According to clinical characteristics, 85, 129 and 376 subjects were divided into the FS-only, Omicron-FS, and Omicron-only groups, respectively. Demographic, clinical and laboratory data were retrospectively collected for analysis. Results The incidence of FSs in children with Omicron infection was 25.5% (129/505). Older age, stronger male predominance, as well as lower proportions of prior history and family history of seizures were observed in Omicron-FS and Omicron-only groups than in FS-only group, but there were no differences in these four above-mentioned events between these two Omicron-related groups. Compared to FS-only group, Omicron-FS group also had a shorter fever-to-seizure onset duration and more frequent seizures during a single course of fever. Moreover, higher levels of IL-6, TNF-α and ferritin as well as decreased counts of leukocytes and lymphocytes were confirmed in Omicron-FS group than in FS-only and Omicron-only groups. Regarding COVID-19 vaccination status, Omicron-FS group revealed a higher proportion of unvaccinated children and a lower proportion of three-dose vaccination than Omicron-only group. As for clinical outcomes, proportions of mechanical ventilation and intensive care unit admission observed in the two Omicron-related groups were notably higher than those in FS-only group. Meanwhile, Omicron-FS group showed the longest length of hospital stay, followed by Omicron-only group and FS-only group, in order. Finally, all patients but one who died of fulminant myocarditis had been successfully discharged. Conclusions The incidence of FSs in children with Omicron infection was 25.5% in Yunnan. FSs might be a clinical sign deserving more attention in children with Omicron infection. Furthermore, COVID-19 vaccination is likely to provide effective protection against Omicron-related FSs in children.
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Affiliation(s)
- Hai-feng Liu
- Department of Respiratory and Critical Care Medicine, Yunnan Key Laboratory of Children’s Major Disease Research, Kunming Children’s Hospital, Kunming Medical University, Kunming, China
| | - Rui Lu
- Department of Pediatrics, The People’s Hospital of Wenshan Zhuang & Miao Autonomous Prefecture, Wenshan, China
| | - Jian Yang
- Department of Respiratory and Critical Care Medicine, Yunnan Key Laboratory of Children’s Major Disease Research, Kunming Children’s Hospital, Kunming Medical University, Kunming, China
| | - Mei Xiang
- Department of Pediatrics, The First People’s Hospital of Honghe Prefecture, Mengzi, China
| | - Deng Ban
- Department of Respiratory and Critical Care Medicine, Yunnan Key Laboratory of Children’s Major Disease Research, Kunming Children’s Hospital, Kunming Medical University, Kunming, China
| | - Jia-wu Yang
- Department of Respiratory and Critical Care Medicine, Yunnan Key Laboratory of Children’s Major Disease Research, Kunming Children’s Hospital, Kunming Medical University, Kunming, China
| | - Zheng-hong Guo
- Department of Pediatrics, The First People’s Hospital of Zhaotong, Zhaotong, China
| | - Ting-yun Yuan
- Department of Respiratory and Critical Care Medicine, Yunnan Key Laboratory of Children’s Major Disease Research, Kunming Children’s Hospital, Kunming Medical University, Kunming, China
| | - Hong-min Fu
- Department of Respiratory and Critical Care Medicine, Yunnan Key Laboratory of Children’s Major Disease Research, Kunming Children’s Hospital, Kunming Medical University, Kunming, China
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Yu L, Wang C, Li X, Wang X, Kang Y, Ma X, Sun R, Sun Y, Zhu R, Jia L, Yao Y, Li X, Zhang D, Pan Y, Lv B, Yuan J, Zhao L, Gu Q, Zhang J. Clinical characteristics of abruptly increased paediatric patients with Omicron BF.7 or BA.5.2 in Beijing. Virol J 2023; 20:209. [PMID: 37684638 PMCID: PMC10492331 DOI: 10.1186/s12985-023-02177-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/04/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 outbreak has hit Beijing since mid-Nov, 2022, with soaring growth of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among children. Therefore, it is vital to determine the clinical manifestations of epidemic SARS-CoV-2 strains in paediatric patients. METHODS In this study, nucleic acid tests (NATs) for SARS-CoV-2 were performed in paediatric outpatients with symptoms of acute respiratory tract infection during 18 Nov-6 Dec, 2022. Half of the outpatients positive for SARS-CoV-2 were randomly selected to screen for other respiratory pathogens, whereas those with low cycle threshold values in SARS-CoV-2 NATs were amplified and sequenced to determine the SARS-CoV-2 variants. Finally, children positive for SARS-CoV-2 with clinical information in detail were enrolled in a follow-up study to identify potential factors significantly associated with long recovery. RESULTS Among 9625 paediatric outpatients tested for nucleic acid of SARS-CoV-2, 733 (7.62%, 733/9625) were identified as SARS-CoV-2 NAT positive, with only three (0.82%, 3/366) co-infected with other pathogens among 366 randomly selected patients, and 71 (62.83%) determined as Omicron subvariant BF.7 and 42 (37.22%) as BA.5.2 among 113 successfully sequenced. Among the 681 patients with complete clinical information, fever was the most common symptom (96.8%). In a follow-up study of 592 patients, 46.96% became asymptomatic on the third day and 65.71% on the fifth day. Only 1.7% of infected children experienced febrile seizures. Combined with abnormal C-reactive protein, a higher percentage of antibiotics administration was observed. More co-living members and longer duration of first symptoms served as independent risk factors for long-term recovery, especially in children vaccinated for SARS-CoV-2. CONCLUSIONS BF.7 and BA.5.2 were the dominate Omicron subvariants and caused milder infections during the SARS-CoV-2 outbreak in Beijing. The number of co-living members and duration of first symptoms were independent risk factors for long-term recovery.
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Affiliation(s)
- Lei Yu
- Department of Infection Management, Children's Hospital Capital Institute of Pediatrics, Beijing, 100020, China
| | - Congying Wang
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 100020, China
| | - Xiaoyun Li
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Disease in Children, Capital Institute of Pediatrics, Beijing, 100020, China
| | - Xinning Wang
- Department of Rheumatology and Immunology, Children's Hospital Capital Institute of Pediatrics, Beijing, 100020, China
| | - Yingying Kang
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 100020, China
| | - Xiaomei Ma
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 100020, China
| | - Rui Sun
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 100020, China
| | - Yu Sun
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Disease in Children, Capital Institute of Pediatrics, Beijing, 100020, China
| | - Runan Zhu
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Disease in Children, Capital Institute of Pediatrics, Beijing, 100020, China
| | - Liping Jia
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Disease in Children, Capital Institute of Pediatrics, Beijing, 100020, China
| | - Yao Yao
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Disease in Children, Capital Institute of Pediatrics, Beijing, 100020, China
| | - Xiaohui Li
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, 100020, China
| | - Daitao Zhang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Control and Prevention, Beijing, 100013, China
| | - Yang Pan
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Control and Prevention, Beijing, 100013, China
| | - Bing Lv
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Control and Prevention, Beijing, 100013, China
| | - Jing Yuan
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, 100020, China
| | - Linqing Zhao
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Disease in Children, Capital Institute of Pediatrics, Beijing, 100020, China.
| | - Qinglong Gu
- Department of Otorhinolaryngology, Children's Hospital Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, China.
| | - Jian Zhang
- Department of Neurosurgery, Children's Hospital Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, China.
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Mohamed ZA, Tang C, Thokerunga E, Deng Y, Fan J. Pediatric infection with the Omicron variant increases the risks of febrile seizures among COVID-19 infected children. Front Pediatr 2023; 11:1226403. [PMID: 37664550 PMCID: PMC10469930 DOI: 10.3389/fped.2023.1226403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
Background The Omicron variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is less likely to cause severe disease in children than the other variants but has become an increasing cause of febrile seizures (FS) among children. In this case-control study, we aimed to examine the risk factors associated with FS in children infected with the COVID-19 Omicron variant and related treatment modalities. Methods This retrospective case-control study includes 113 subjects infected with the COVID-19 Omicron variant, grouped into 45 cases (those with FS) and 68 controls (those without FS). Data on clinical features, laboratory parameters, and treatment modalities were collected and analyzed. Results Approximately 5.74% of COVID-19 infected children developed COVID-19-associated FS. Children with COVID-19 and high body temperatures [RR 1.474; (95% CI: 1.196-1.818), p < 0.001], previous history of FS [RR 1.421; (95% CI: 1.088-1.855), p = 0.010], high procalcitonin levels [RR 1.140; (95% CI: 1.043-1.246), p = 0.048] and high neutrophil counts [RR 1.015; (95% CI: 1.000-1.029), p = 0.048] were more likely to experience FS than the controls. In contrast, children with COVID-19 and low eosinophil counts, low hemoglobin levels, and cough had a lower risk of developing FS [RR 0.494; (95% CI: 0.311-0.783), p = 0.003], [RR 0.979; (95% CI: 0.959-0.999), p = 0.044]; and [RR 0.473 (95% CI 0.252-0.890), p = 0.020]; respectively. Children with FS received more anti-flu medications than those without. Conclusion A significant increase in FS was observed in children with Omicron SARS-CoV-2 infection. A higher body temperature, a history of FS, a higher procalcitonin level, and a high neutrophil count were all associated with an increased risk of FS in children with COVID-19. The risk of developing FS was lower in children with COVID-19 and low eosinophil counts and hemoglobin levels than in those without.
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Affiliation(s)
| | - Chunjiao Tang
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Erick Thokerunga
- Department of Clinical Laboratory Medicine, Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Youping Deng
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jingyi Fan
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
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10
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Lin B, Xu X, Shen Z, Huang P, Gao Y, Liu J, Xie Z, Zhao T, Xia J, Lv J, Ren D, Zheng H, Wang X, Hu M, Ruan G, Zhang M. Clinical and radiological characteristics of pediatric COVID-19 before and after the Omicron outbreak: a multi-center study. Front Pediatr 2023; 11:1172111. [PMID: 37664548 PMCID: PMC10470622 DOI: 10.3389/fped.2023.1172111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction The emergence of the Omicron variant has seen changes in the clinical and radiological presentations of COVID-19 in pediatric patients. We sought to compare these features between patients infected in the early phase of the pandemic and those during the Omicron outbreak. Methods A retrospective study was conducted on 68 pediatric COVID-19 patients, of which 31 were infected with the original SARS-CoV-2 strain (original group) and 37 with the Omicron variant (Omicron group). Clinical symptoms and chest CT scans were examined to assess clinical characteristics, and the extent and severity of lung involvement. Results Pediatric COVID-19 patients predominantly had normal or mild chest CT findings. The Omicron group demonstrated a significantly reduced CT severity score than the original group. Ground-glass opacities were the prevalent radiological findings in both sets. The Omicron group presented with fewer symptoms, had milder clinical manifestations, and recovered faster than the original group. Discussion The clinical and radiological characteristics of pediatric COVID-19 patients have evolved with the advent of the Omicron variant. For children displaying severe symptoms warranting CT examinations, it is crucial to weigh the implications of ionizing radiation and employ customized scanning protocols and protective measures. This research offers insights into the shifting disease spectrum, aiding in the effective diagnosis and treatment of pediatric COVID-19 patients.
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Affiliation(s)
- Bin Lin
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaopei Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhujing Shen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuantong Gao
- Department of Radiology, The Third Affiliated Hospital of Wenzhou Medical University, Ruian, China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zongyu Xie
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Tongtong Zhao
- Department of Radiology, The Second People's Hospital, Fuyang, China
| | - Junli Xia
- Department of Radiology, Bozhou Bone Trauma Hospital, Bozhou, China
| | - Jian Lv
- Department of Radiology, Nanxishan Hospital, Gui Lin, China
| | - Dawei Ren
- Department of Radiology, Ningbo First Hospital, Ningbo, China
| | - Hanpeng Zheng
- Department of Radiology, Yueqing People's Hospital, Wenzhou, China
| | - Xiangming Wang
- Department of Radiology, Yiwu Central Hospital, Yiwu, China
| | - Minghua Hu
- Department of Radiology, Taizhou Central Hospital, Taizhou University Hospital, Taizhou, China
| | - Guixiang Ruan
- Department of Radiology, The First People's Hospital of Yuhang District, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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