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Coronavirus Disease 2019 Disease Severity in Children Infected With the Omicron Variant
Adeel A Butt1,2,3, Soha R Dargham4, Srusvin Loka1
1Hamad Medical Corporation, Doha, Qatar.
Insights
The Omicron variant causes less severe COVID-19 in children and adolescents compared to the Delta variant. Older children (6-17 years) experienced milder illness than younger children (<6 years).
Area of Science:
- Pediatric infectious diseases
- Virology
- Public health
Background:
- Limited data exists on Omicron variant (severe acute respiratory syndrome coronavirus 2) disease severity in pediatric populations.
- Understanding variant-specific severity is crucial for public health strategies and clinical management.
Purpose of the Study:
- To compare the severity of coronavirus 2019 (COVID-19) disease between Omicron and Delta variant infections in children and adolescents.
- To assess age-related differences in disease severity within the pediatric population.
Main Methods:
- Retrospective cohort study using the National COVID-19 Database in Qatar.
- Propensity score matching was used to compare unvaccinated children and adolescents (<18 years) infected with Delta versus Omicron variants.
- Disease severity was defined by hospitalization, ICU admission, mechanical ventilation, or death.
Main Results:
- Omicron variant infection was associated with significantly lower odds of moderate to severe/critical disease compared to the Delta variant (adjusted odds ratio [AOR], 0.12).
- Children aged 6-17 years had lower odds of moderate to severe/critical disease than those younger than 6 years (AORs 0.47 and 0.45, respectively).
- No severe/critical cases were observed in the Omicron-infected group, compared to 0.1% in the Delta group.
Conclusions:
- Omicron variant infections in children and adolescents result in less severe disease than Delta variant infections.
- Older children (6-17 years) exhibit milder disease outcomes compared to younger children (<6 years) regardless of the variant.
Short Summary:
Severe acute respiratory syndrome coronavirus 2 infection from the Omicron variant in children/adolescents is less severe than infection from the Delta variant. Those 6 to <18 years also have less severe disease than those <6 years old.
Background:
There are limited data assessing coronavirus 2019 (COVID-19) disease severity in children/adolescents infected with the Omicron variant.
Methods:
We identified children and adolescents <18 years of age with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with Delta and propensity score-matched controls with Omicron variant infection from the National COVID-19 Database in Qatar. Primary outcome was disease severity, determined by hospital admission, admission to the intensive care unit (ICU), or mechanical ventilation within 14 days of diagnosis, or death within 28 days.
Results:
Among 1735 cases with Delta variant infection between 1 June and 6 November 2021, and 32 635 cases with Omicron variant infection between 1 January and 15 January 2022, who did not have prior infection and were not vaccinated, we identified 985 propensity score-matched pairs. Among those who were Delta infected, 84.2% had mild, 15.7% had moderate, and 0.1% had severe/critical disease. Among those who were Omicron infected, 97.8% had mild, 2.2% had moderate, and none had severe/critical disease (P < .001). Omicron variant infection (vs Delta) was associated with significantly lower odds of moderate or severe/critical disease (adjusted odds ratio [AOR], 0.12; 95% confidence interval [CI], .07-.18). Those aged 6-11 and 12 to <18 years had lower odds of developing moderate or severe/critical disease compared with those younger than age 6 years (aOR, 0.47; 95% CI, .33-.66 for 6-11 year olds; aOR, 0.45; 95% CI, .21-.94 for 12 to <18 year olds).
Conclusions:
Omicron variant infection in children/adolescents is associated with less severe disease than Delta variant infection as measured by hospitalization rates and need for ICU care or mechanical ventilation. Those 6 to <18 years of age also have less severe disease than those <6 years old.
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