Severity of COVID-19 in Hospitalized Immunocompromised Children Across Canada
Costanza Di Chiara1,2,3, Tilmann Schober4,5, Daniel S Farrar6
1From the Division of Infectious Diseases.
Insights
Hospitalized immunocompromised children (IC) had a lower risk of severe COVID-19 compared to non-IC peers. This finding may suggest earlier hospital admission for IC with respiratory infections.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Public Health
Background:
- The impact of immunocompromised states on pediatric COVID-19 severity is not well understood.
- This study investigates COVID-19 outcomes in hospitalized children with and without immunocompromising conditions.
Purpose of the Study:
- To assess and compare the severity of COVID-19 in hospitalized children with and without immunocompromising conditions.
- To identify risk factors associated with severe COVID-19 in pediatric patients.
Main Methods:
- Retrospective cohort study of children under 17 hospitalized for COVID-19 in Canada (April 2020-December 2022).
- Immunocompromised (IC) status defined by immune-compromising conditions and/or immunosuppressive treatment.
- Severe COVID-19 defined by ICU admission, mechanical ventilation, hemodynamic support, organ complications, or death.
- Adjusted risk ratios (aRR) calculated using Poisson regression, controlling for covariates.
Main Results:
- 11.0% of 3218 hospitalized children were immunocompromised (IC).
- IC children experienced less severe COVID-19 (14.1% vs. 29.0%) and lower rates of respiratory support and ICU admission compared to non-IC.
- Immunocompromised status, including immunodeficiency and immunosuppression, was independently associated with a reduced risk of severe COVID-19 (aRR=0.46).
Conclusions:
- Hospitalized immunocompromised children demonstrated a lower risk of severe COVID-19 compared to non-immunocompromised children.
- This reduced risk may be attributed to potentially lower hospital admission thresholds for immunocompromised children presenting with respiratory infections.
Background:
The association of immunocompromised states with pediatric COVID-19 outcomes remains unclear. This study assessed COVID-19 severity in hospitalized children with and without immunocompromising conditions.
Methods:
Children <17 years hospitalized in Canada for COVID-19 (April 2020-December 2022) were identified through the Canadian Paediatric Surveillance Program and Canadian Immunization Monitoring Program, ACTive. Immunocompromised children (IC) were those with immune-compromising conditions and/or on immunosuppressive treatment. Severe COVID-19 was defined as intensive care unit admission, ventilator/hemodynamic support, organ complications or death. Adjusted risk ratios (aRR) for severe COVID-19 among IC versus nonimmunocompromised children (non-IC) were calculated using Poisson regression, adjusting for age, sex, other underlying conditions, SARS-CoV-2 lineage and vaccination.
Results:
Among 3218 children hospitalized for COVID-19, 354 (11.0%) were IC. IC were older [median age 6.7 years (interquartile range = 3.6-11.8)] than non-IC [1.2 years (interquartile range = 0.2-4.8); P < 0.001]. IC experienced less respiratory distress than non-IC (20.9% vs. 48.1%). Severe COVID-19 (14.1% vs. 29.0%; P < 0.001), respiratory support (16.1% vs. 35.6%; P < 0.001) and intensive care unit admission (5.9% vs. 17.4%; P < 0.001) were less frequent in IC. IC were less likely to have severe COVID-19 than non-IC [aRR = 0.46 (95% confidence interval [CI]: 0.32-0.65)], with both immunodeficiency [aRR = 0.53 (95% CI: 0.39-0.73)] and immunosuppression [aRR = 0.40 (95% CI: 0.23-0.73)] subcategories independently associated with reduced risk. Compared to non-IC with other conditions, IC had a lower risk of severe COVID-19 [aRR = 0.35 (95% CI: 0.25-0.47)].
Conclusions:
Hospitalized IC exhibited a lower risk of severe COVID-19 than non-IC, potentially reflecting lower admission thresholds for IC with respiratory infections.
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