International Pediatric COVID-19 Severity Over the Course of the Pandemic

Zhu, Yanshan, Almeida, Flavia Jacqueline, Baillie, J Kenneth, Bowen, Asha C, Britton, Philip N, Brizuela, Martin Eduardo, Buonsenso, Danilo, Burgner, David, Chew, Keng Yih, Chokephaibulkit, Kulkanya
et al (show 39 more authors) (2023) International Pediatric COVID-19 Severity Over the Course of the Pandemic. JAMA PEDIATRICS, 177 (10). pp. 1073-1084.

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<h4>Importance</h4>Multiple SARS-CoV-2 variants have emerged over the COVID-19 pandemic. The implications for COVID-19 severity in children worldwide are unclear.<h4>Objective</h4>To determine whether the dominant circulating SARS-CoV-2 variants of concern (VOCs) were associated with differences in COVID-19 severity among hospitalized children.<h4>Design, setting, and participants</h4>Clinical data from hospitalized children and adolescents (younger than 18 years) who were SARS-CoV-2 positive were obtained from 9 countries (Australia, Brazil, Italy, Portugal, South Africa, Switzerland, Thailand, UK, and the US) during 3 different time frames. Time frames 1 (T1), 2 (T2), and 3 (T3) were defined to represent periods of dominance by the ancestral virus, pre-Omicron VOCs, and Omicron, respectively. Age groups for analysis were younger than 6 months, 6 months to younger than 5 years, and 5 to younger than 18 years. Children with an incidental positive test result for SARS-CoV-2 were excluded.<h4>Exposures</h4>SARS-CoV-2 hospitalization during the stipulated time frame.<h4>Main outcomes and measures</h4>The severity of disease was assessed by admission to intensive care unit (ICU), the need for ventilatory support, or oxygen therapy.<h4>Results</h4>Among 31 785 hospitalized children and adolescents, the median age was 4 (IQR 1-12) years and 16 639 were male (52.3%). In children younger than 5 years, across successive SARS-CoV-2 waves, there was a reduction in ICU admission (T3 vs T1: risk ratio [RR], 0.56; 95% CI, 0.42-0.75 [younger than 6 months]; RR, 0.61, 95% CI; 0.47-0.79 [6 months to younger than 5 years]), but not ventilatory support or oxygen therapy. In contrast, ICU admission (T3 vs T1: RR, 0.39, 95% CI, 0.32-0.48), ventilatory support (T3 vs T1: RR, 0.37; 95% CI, 0.27-0.51), and oxygen therapy (T3 vs T1: RR, 0.47; 95% CI, 0.32-0.70) decreased across SARS-CoV-2 waves in children 5 years to younger than 18 years old. The results were consistent when data were restricted to unvaccinated children.<h4>Conclusions and relevance</h4>This study provides valuable insights into the impact of SARS-CoV-2 VOCs on the severity of COVID-19 in hospitalized children across different age groups and countries, suggesting that while ICU admissions decreased across the pandemic in all age groups, ventilatory and oxygen support generally did not decrease over time in children aged younger than 5 years. These findings highlight the importance of considering different pediatric age groups when assessing disease severity in COVID-19.

Item Type: Article
Uncontrolled Keywords: International Severe Acute Respiratory and Emerging Infection Consortium Comprehensive Clinical Characterisation Collaboration (ISARIC4C) investigatorsPediatric Active Enhanced Disease Surveillance (PAEDS) Network group, Humans, Oxygen, Adolescent, Child, Child, Preschool, Infant, Female, Male, Pandemics, COVID-19, SARS-CoV-2
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 17 Nov 2023 08:27
Last Modified: 14 Mar 2024 20:31
DOI: 10.1001/jamapediatrics.2023.3117
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