International Pediatric COVID-19 Severity over the Course of the Pandemic

Authors

Yanshan Zhu, The University of Queensland
Flávia Jacqueline Almeida, Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo
J. Kenneth Baillie, MRC Centre for Inflammation Research
Asha C. Bowen, The Kids Research Institute Australia
Philip N. Britton, The Children's Hospital at Westmead
Martin Eduardo Brizuela, Hospital General de Agudos Velez Sarsfield
Danilo Buonsenso, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
David Burgner, Murdoch Children's Research Institute
Keng Yih Chew, The University of Queensland
Kulkanya Chokephaibulkit, Siriraj Hospital
Cheryl Cohen, National Institute for Communicable Diseases
Stephania A. Cormier, Louisiana State University
Nigel Crawford, Murdoch Children's Research Institute
Nigel Curtis, Murdoch Children's Research Institute
Camila G.A. Farias, Hospital Infantil Sabará
Charles F. Gilks, The University of Queensland
Anne Von Gottberg, National Institute for Communicable Diseases
Diana Hamer, Our Lady of the Lake Regional Medical Center
Daniel Jarovsky, Hospital Infantil Sabará
Waasila Jassat, National Institute for Communicable Diseases
Ana Rita Jesus, Centro Hospitalar e Universitário de Coimbra
Lisa S. Kemp, Our Lady of the Lake Regional Medical Center
Benjawan Khumcha, Siriraj Hospital
Georgina McCallum, The University of Queensland
Jessica E. Miller, Murdoch Children's Research Institute
Rosa Morello, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Alasdair P.S. Munro, University Hospital Southampton NHS Foundation Trust
Peter J.M. Openshaw, National Heart and Lung Institute
Srivatsan Padmanabhan, Elson S. Floyd College of Medicine
Wanatpreeya Phongsamart, Siriraj Hospital
Gary Reubenson, Rahima Moosa Mother and Child Hospital
Nicole Ritz, University of Melbourne
Fernanda Rodrigues, Centro Hospitalar e Universitário de Coimbra
Supattra Rungmaitree, Siriraj Hospital

Document Type

Article

Publication Date

10-2-2023

Abstract

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 31785 hospitalized children and adolescents, the median age was 4 (IQR 1-12) years and 16639 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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