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International Pediatric COVID-19 Severity Over the Course of the Pandemic
Yanshan Zhu1,2, Flávia Jacqueline Almeida3,4, J Kenneth Baillie5,6,7,8
1School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia.
Insights
COVID-19 severity in hospitalized children varied by variant and age. While intensive care unit admissions decreased, younger children still required significant ventilatory and oxygen support across SARS-CoV-2 waves.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Global Health
Background:
- Multiple SARS-CoV-2 variants (variants of concern) have emerged globally.
- The impact of these variants on COVID-19 severity in pediatric populations remains unclear.
Purpose of the Study:
- To investigate the association between dominant SARS-CoV-2 variants of concern and COVID-19 severity in hospitalized children.
- To analyze differences in disease severity across distinct pediatric age groups and global regions.
Main Methods:
- Retrospective analysis of clinical data from 31,785 hospitalized children (<18 years) across 9 countries.
- Data categorized into three time frames representing ancestral virus, pre-Omicron VOCs, and Omicron dominance.
- Disease severity assessed by intensive care unit (ICU) admission, need for ventilatory support, or oxygen therapy.
Main Results:
- ICU admissions decreased across SARS-CoV-2 waves in all pediatric age groups.
- Ventilatory support and oxygen therapy needs did not significantly decrease over time in children younger than 5 years.
- Findings remained consistent in unvaccinated children.
Conclusions:
- While overall ICU admissions for COVID-19 in children have declined, specific support needs persist in younger age groups.
- Disease severity varies by pediatric age group and circulating SARS-CoV-2 variant.
- These insights are crucial for understanding and managing pediatric COVID-19, emphasizing age-specific considerations.
Importance:
Multiple SARS-CoV-2 variants have emerged over the COVID-19 pandemic. The implications for COVID-19 severity in children worldwide are unclear.
Objective:
To determine whether the dominant circulating SARS-CoV-2 variants of concern (VOCs) were associated with differences in COVID-19 severity among hospitalized children.
Design, Setting, And Participants:
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.
Exposures:
SARS-CoV-2 hospitalization during the stipulated time frame.
Main Outcomes And Measures:
The severity of disease was assessed by admission to intensive care unit (ICU), the need for ventilatory support, or oxygen therapy.
Results:
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.
Conclusions And Relevance:
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.
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