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Clinical manifestations and disease severity of SARS-CoV-2 infection among infants in Canada
Pierre-Philippe Piché-Renaud1, Luc Panetta2,3, Daniel S Farrar4
1Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada.
Insights
Severe COVID-19 is uncommon in infants. Infants with comorbid conditions or those younger than one month face higher hospitalization risks for SARS-CoV-2 infection.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Limited data exist on SARS-CoV-2 (COVID-19) outcomes in infants under one year.
- Understanding hospitalization and severe disease risk factors is crucial for clinical management and public health strategies, especially with no approved infant vaccines.
- This study addresses the need for data on clinical manifestations and hospitalization predictors in infants with SARS-CoV-2.
Purpose of the Study:
- To describe clinical features, disease severity, and factors associated with hospitalization in infants infected with SARS-CoV-2.
- To identify characteristics that increase the likelihood of hospitalization among infants with COVID-19.
- To contribute to the understanding of SARS-CoV-2 impact on the pediatric population.
Main Methods:
- A national, prospective surveillance study of infants (<1 year) with confirmed SARS-CoV-2 infection from April 2020 to May 2021.
- Inclusion of both hospitalized and non-hospitalized infants, with cases categorized by hospitalization reason (COVID-19-related vs. non-COVID-19-related).
- Severity was defined (asymptomatic to severe), and multivariable logistic regression identified hospitalization predictors.
Main Results:
- 531 infant cases reported: 332 non-hospitalized (62.5%) and 199 hospitalized (37.5%).
- Of hospitalized infants, 70.9% were admitted for COVID-19-related illness. Common symptoms included fever (66.5%), coryza (47.1%), and cough (37.3%).
- Infants with comorbidities (aOR=4.53) and those under one month (aOR=3.78) had significantly higher odds of hospitalization. Severe disease occurred in 3.8% of cases.
Conclusions:
- Severe COVID-19 is infrequent in infants.
- Comorbid conditions and very young age (under one month) are significant risk factors for COVID-19-related hospitalization in infants.
- Findings support targeted public health interventions and clinical vigilance for vulnerable infants.
Background:
There are limited data on outcomes of SARS-CoV-2 infection among infants (<1 year of age). In the absence of approved vaccines for infants, understanding characteristics associated with hospitalization and severe disease from COVID-19 in this age group will help inform clinical management and public health interventions. The objective of this study was to describe the clinical manifestations, disease severity, and characteristics associated with hospitalization among infants infected with the initial strains of SARS-CoV-2.
Methods:
This is a national, prospective study of infants with SARS-CoV-2 from April 8th 2020 to May 31st 2021 using the infrastructure of the Canadian Paediatric Surveillance Program. Infants <1 year of age with microbiologically confirmed SARS-CoV-2 infection from both inpatients and outpatients seen in clinics and emergency departments were included. Cases were classified as either: 1) Non-hospitalized patient with SARS-CoV-2 infection; 2) COVID-19-related hospitalization; or 3) non-COVID-19-related hospitalization (e.g., incidentally detected SARS-CoV-2). Case severity was defined as asymptomatic, outpatient care, mild (inpatient care), moderate or severe disease. Multivariable logistic regression was performed to identify characteristics associated with hospitalization.
Results:
A total of 531 cases were reported, including 332 (62.5%) non-hospitalized and 199 (37.5%) hospitalized infants. Among hospitalized infants, 141 of 199 infants (70.9%) were admitted because of COVID-19-related illness, and 58 (29.1%) were admitted for reasons other than acute COVID-19. Amongst all cases with SARS-CoV-2 infection, the most common presenting symptoms included fever (66.5%), coryza (47.1%), cough (37.3%) and decreased oral intake (25.0%). In our main analysis, infants with a comorbid condition had higher odds of hospitalization compared to infants with no comorbid conditions (aOR = 4.53, 2.06-9.97), and infants <1 month had higher odds of hospitalization then infants aged 1-3 months (aOR = 3.78, 1.97-7.26). In total, 20 infants (3.8%) met criteria for severe disease.
Conclusions:
We describe one of the largest cohorts of infants with SARS-CoV-2 infection. Overall, severe COVID-19 in this age group was found to be uncommon. Comorbid conditions and younger age were associated with COVID-19-related hospitalization amongst infants.
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