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Risk for severe outcomes of COVID-19 and PIMS-TS in children with SARS-CoV-2 infection in Germany
Anna-Lisa Sorg1,2, Markus Hufnagel3, Maren Doenhardt4
1Institute of Social Paediatrics and Adolescent Medicine, Division of Paediatric Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany. annalisa.sorg@med.uni-muenchen.de.
Insights
The overall burden of severe COVID-19 in children is low, especially for those aged 5-11 without comorbidities. Pediatric Inflammatory Multisystem Syndrome (PIMS-TS) contributes significantly to severe outcomes in all pediatric age groups.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Public health
Background:
- Accurate risk estimates for severe SARS-CoV-2 outcomes in children are limited due to frequent asymptomatic infections.
- The burden of SARS-CoV-2-associated disease in children is generally considered low.
Purpose of the Study:
- To estimate the risk of hospitalization, ICU admission, and death from COVID-19 and PIMS-TS in children infected with SARS-CoV-2.
- To assess these risks across different age groups and in children with and without comorbidities.
Main Methods:
- Combined data from a national seroprevalence study (SARS-CoV-2 KIDS study), a national PCR-confirmed infection registry, and a national hospitalization registry.
- Analyzed hospitalization rates for COVID-19 treatment, ICU admissions, and case fatality due to COVID-19 and PIMS-TS.
Main Results:
- Hospitalization rate for COVID-19 treatment was 7.13/10,000, ICU admission 2.21/10,000, and case fatality 0.09/10,000 among seropositive children.
- Children aged 5-11 without comorbidities had the lowest risk for severe COVID-19 outcomes.
- The overall PIMS-TS rate was 2.47/10,000 SARS-CoV-2 infections, predominantly affecting children without comorbidities.
Conclusions:
- The SARS-CoV-2-associated burden of severe disease or death in children and adolescents is low, particularly for those aged 5-11 without comorbidities.
- PIMS-TS represents a significant component of the overall disease burden in pediatric SARS-CoV-2 infections across all age groups.
Abstract:
Although children and adolescents have a lower burden of SARS-CoV-2-associated disease compared to adults, assessing the risk for severe outcomes among SARS-CoV-2-infected children remains difficult due to a high rate of undetected cases. We combine data from three data sources - a national seroprevalence study (the SARS-CoV-2 KIDS study), the nationwide, state-based reporting system for PCR-confirmed SARS-CoV-2 infections in Germany, and a nationwide registry on children and adolescents hospitalized with either SARS-CoV-2 or pediatric inflammatory multisystem syndrome (PIMS-TS, also known as MIS-C) - in order to provide estimates on the risk of hospitalization for COVID-19-related treatment, intensive care admission, and death due to COVID-19 and PIMS-TS in children. The rate of hospitalization for COVID-19-related treatment among all SARS-CoV-2 seropositive children was 7.13 per 10,000, ICU admission 2.21 per 10,000, and case fatality was 0.09 per 10,000. In children without comorbidities, the corresponding rates for severe or fatal disease courses were substantially lower. The lowest risk for the need of COVID-19-specific treatment was observed in children aged 5-11 without comorbidities. In this group, the ICU admission rate was 0.37 per 10,000, and case fatality could not be calculated due to the absence of cases. The overall PIMS-TS rate was 2.47 per 10,000 SARS-CoV-2 infections, the majority being children without comorbidities.
Conclusion:
Overall, the SARS-CoV-2-associated burden of a severe disease course or death in children and adolescents is low. This seems particularly the case for 5-11-year-old children without comorbidities. By contrast, PIMS-TS plays a major role in the overall disease burden among all pediatric age groups.
What Is Known:
• SARS-CoV-2-associated burden of disease in children is considered to be low, but accurate risk estimates accounting for clinically undiagnosed infections are lacking. • Asymptomatic SARS-CoV-2 infections are common in children.
What Is New:
• We provide risk estimates for hospitalization for COVID-19-related treatment, ICU admission, death from COVID-19, and PIMS-TS for children with SARS-CoV-2 infections by pooling different data sources. • The risk for PIMS-TS exceeds the risk for severe COVID-19 in all age groups; the risk for severe COVID-19 is the lowest in 5-11 years old.
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