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Burden of SARS-CoV-2 and protection from symptomatic second infection in children
John Kubale1, Angel Balmaseda2, Aaron M Frutos1
1Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
Insights
COVID-19 infection rates and severe disease were highest in children under 5 years old. Younger children showed better protection against reinfection, highlighting an urgent need for vaccines in this age group.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Vaccinology
Background:
- The impact of SARS-CoV-2 on children is not fully understood.
- Understanding COVID-19 burden and re-infection protection in children is critical for vaccination strategies.
Approach:
- Prospective, community-based pediatric cohort study in Managua, Nicaragua (March 2020 - October 2021).
- 1964 children aged 0-14 years enrolled.
- Assessed COVID-19 infection, hospitalization, and re-infection rates by age group.
Key Points:
- COVID-19 incidence and severity were highest in children under 2 years.
- Re-infections constituted 19.8% of symptomatic SARS-CoV-2 episodes.
- Children under 10 years demonstrated greater protection against symptomatic re-infection.
Conclusions:
- Youngest children (<5 years) face the highest burden of symptomatic and severe COVID-19.
- Reinfections are common, and younger children have better protection against symptomatic re-infection.
- Effective COVID-19 vaccines are urgently needed for children under 5 years old.
Importance:
The impact of the SARS-CoV-2 pandemic on children remains unclear. Better understanding of the burden of COVID-19 among children and their protection against re-infection is crucial as they will be among the last groups vaccinated.
Objective:
To characterize the burden of COVID-19 and assess how protection from symptomatic re-infection among children may vary by age.
Design:
A prospective, community-based pediatric cohort study conducted from March 1, 2020 through October 15, 2021.
Setting:
The Nicaraguan Pediatric Influenza Cohort is a community-based cohort in District 2 of Managua, Nicaragua.
Participants:
A total of 1964 children aged 0-14 years participated in the cohort. Non-immunocompromised children were enrolled by random selection from a previous pediatric influenza cohort. Additional newborn infants aged ≤4 weeks were randomly selected and enrolled monthly, via home visits.
Exposures:
Prior COVID-19 infection as confirmed by positive anti SARS-CoV-2 antibodies (receptor binding domain [RBD] and spike protein) or real time RT-PCR confirmed COVID-19 infection ≥60 days prior to current COVID-19.
Main Outcomes And Measures:
Symptomatic COVID-19 cases confirmed by real time RT-PCR and hospitalization within 28 days of symptom onset of confirmed COVID-19 case.
Results:
Overall, 49.8% of children tested were seropositive over the course of the study. There were also 207 PCR-confirmed COVID-19 cases, 12 (6.4%) of which were severe enough to require hospitalization. Incidence of COVID-19 was highest among children aged <2 years-16.1 per 100 person-years (95% Confidence Interval [CI]: 12.5, 20.5)-approximately three times that of children in any other age group assessed. Additionally, 41 (19.8%) symptomatic SARS-CoV-2 episodes were re-infections, with younger children slightly more protected against symptomatic reinfection. Among children aged 6-59 months, protection was 61% (Rate Ratio [RR]:0.39, 95% CI:0.2,0.8), while protection among children aged 5-9 and 10-14 years was 64% (RR:0.36,0.2,0.7), and 49% (RR:0.51,0.3-0.9), respectively.
Conclusions And Relevance:
In this prospective community-based pediatric cohort rates of symptomatic and severe COVID-19 were highest among the youngest participants, with rates stabilizing around age 5. Reinfections represent a large proportion of PCR-positive cases, with children <10 years displaying greater protection from symptomatic reinfection. A vaccine for children <5 years is urgently needed.
Key Points:
Question: What is the burden of COVID-19 among young children and how does protection from re-infection vary with age?Findings: In this study of 1964 children aged 0-14 years children <5 years had the highest rates of symptomatic and severe COVID-19 while also displaying greater protection against re-infection compared to children ≥10 years.Meaning: Given their greater risk of infection and severe disease compared to older children, effective vaccines against COVID-19 are urgently needed for children under 5.
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