International Pediatric COVID-19 Severity Over the Course of the Pandemic
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Published:2023-10-01
Issue:10
Volume:177
Page:1073
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ISSN:2168-6203
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Container-title:JAMA Pediatrics
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language:en
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Short-container-title:JAMA Pediatr
Author:
Zhu Yanshan12, Almeida Flávia Jacqueline34, Baillie J. Kenneth5678, Bowen Asha C.9, Britton Philip N.1011, Brizuela Martin Eduardo12, Buonsenso Danilo13, Burgner David141516, Chew Keng Yih1, Chokephaibulkit Kulkanya17, Cohen Cheryl1819, Cormier Stephania A.2021, Crawford Nigel1416, Curtis Nigel141522, Farias Camila G. A.4, Gilks Charles F.23, von Gottberg Anne1824, Hamer Diana25, Jarovsky Daniel34, Jassat Waasila26, Jesus Ana Rita27, Kemp Lisa S.25, Khumcha Benjawan17, McCallum Georgina1, Miller Jessica E.1415, Morello Rosa13, Munro Alasdair P. S.2829, Openshaw Peter J. M.3031, Padmanabhan Srivatsan3233, Phongsamart Wanatpreeya17, Reubenson Gary34, Ritz Nicole153536, Rodrigues Fernanda2737, Rungmaitree Supattra17, Russell Fiona1415, Sáfadi Marco A. P.34, Saner Christoph383940, Semple Malcolm G.4142, Prado da Silva Daniella Gregória Bomfim4, de Sousa Laíse Marine Moura3, Diogo Moço Souza Marília3, Spann Kirsten43, Walaza Sibongile1819, Wolter Nicole1824, Xia Yao44, Yeoh Daniel K.45, Zar Heather J.46, Zimmermann Petra47, Short Kirsty R.148, Alex Beatrice49, Andrikopoulos Petros49, Bach Benjamin49, Barclay Wendy S49, Bogaert Debby49, Chand Meera49, Chechi Kanta49, Cooke Graham S49, da Silva Filipe Ana49, de Silva Thushan49, Docherty Annemarie B49, dos Santos Correia Gonçalo49, Dumas Marc-Emmanuel49, Dunning Jake49, Fletcher Tom49, Green Christopher A49, Greenhalf William49, Griffin Julian49, Gupta Rishi K49, Harrison Ewen M49, Ho Antonia YW49, Holden Karl49, Horby Peter W49, Ijaz Samreen49, Khoo Say49, Klenerman Paul49, Law Andrew49, Lewis Matthew49, Liggi Sonia49, Lim Wei Shen49, Maslen Lynn49, Mentzer Alexander J49, Merson Laura49, Meynert Alison M49, Moore Shona C49, Noursadeghi Mahdad49, Olanipekun Michael49, Osagie Anthonia49, Palmarini Massimo49, Palmieri Carlo49, Paxton William A49, Pollakis Georgios49, Price Nicholas49, Rambaut Andrew49, Robertson David L49, Russell Clark D49, Sancho-Shimizu Vanessa49, Sands Caroline49, Scott Janet T49, Sigfrid Louise49, Solomon Tom49, Sriskandan Shiranee49, Stuart David49, Summers Charlotte49, Swann Olivia V49, Takats Zoltan49, Takis Panteleimon49, Tedder Richard S49, Thompson AA Roger49, Thomson Emma C49, Thwaites Ryan S49, Turtle Lance CW49, Zambon Maria49, Drake Thomas M49, Fairfield Cameron J49, Knight Stephen R49, Mclean Kenneth A49, Murphy Derek49, Norman Lisa49, Pius Riinu49, Shaw Catherine A49, Connor Marie49, Dalton Jo49, Gamble Carrol49, Girvan Michelle49, Halpin Sophie49, Harrison Janet49, Jackson Clare49, Lee James49, Marsh Laura49, Plotkin Daniel49, Roberts Stephanie49, Saviciute Egle49, Clohisey Sara49, Hendry Ross49, Knight Susan49, Lahnsteiner Eva49, Leeming Gary49, Norris Lucy49, Scott-Brown James49, Tait Sarah49, Wham Murray49, Clark Richard49, Coutts Audrey49, Donelly Lorna49, Fawkes Angie49, Gilchrist Tammy49, Hafezi Katarzyna49, MacGillivray Louise49, Maclean Alan49, McCafferty Sarah49, Morrice Kirstie49, Murphy Lee49, Wrobel Nicola49, Carson Gail49, Adeniji Kayode49, Agranoff Daniel49, Agwuh Ken49, Ail Dhiraj49, Aldera Erin L.49, Alegria Ana49, Allen Sam49, Angus Brian49, Ashish Abdul49, Atkinson Dougal49, Bari Shahedal49, Barlow Gavin49, Barnass Stella49, Barrett Nicholas49, Bassford Christopher49, Basude Sneha49, Baxter David49, Beadsworth Michael49, Bernatoniene Jolanta49, Berridge John49, Berry Colin49, Best Nicola49, Bothma Pieter49, Brittain-Long Robin49, Bulteel Naomi49, Burden Tom49, Burtenshaw Andrew49, Caruth Vikki49, Chadwick David49, Chambler Duncan49, Chee Nigel49, Child Jenny49, Chukkambotla Srikanth49, Clark Tom49, Collini Paul49, Cosgrove Catherine49, Cupitt Jason49, Cutino-Moguel Maria-Teresa49, Dark Paul49, Dawson Chris49, Dervisevic Samir49, Donnison Phil49, Douthwaite Sam49, Drummond Andrew49, DuRand Ingrid49, Dushianthan Ahilanadan49, Dyer Tristan49, Evans Cariad49, Eziefula Chi49, Fegan Chrisopher49, Finn Adam49, Fullerton Duncan49, Garg Sanjeev49, Garg Atul49, Gkrania-Klotsas Effrossyni49, Godden Jo49, Goldsmith Arthur49, Graham Clive49, Grammatikopoulos Tassos49, Hardy Elaine49, Hartshorn Stuart49, Harvey Daniel49, Havalda Peter49, Hawcutt Daniel B49, Hobrok Maria49, Hodgson Luke49, Hormis Anil49, Howard Joanne49, Jacobs Michael49, Jain Susan49, Jennings Paul49, Kaliappan Agilan49, Kasipandian Vidya49, Kegg Stephen49, Kelsey Michael49, Kendall Jason49, Kerrison Caroline49, Kerslake Ian49, Koch Oliver49, Koduri Gouri49, Koshy George49, Laha Shondipon49, Laird Steven49, Larkin Susan49, Leiner Tamas49, Lillie Patrick49, Limb James49, Linnett Vanessa49, Little Jeff49, Lyttle Mark49, MacMahon Michael49, MacNaughton Emily49, Mankregod Ravish49, Masson Huw49, Matovu Elijah49, McCullough Katherine49, McEwen Ruth49, Meda Manjula49, Mills Gary49, Minton Jane49, Mohandas Kavya49, Mok Quen49, Moon James49, Moore Elinoor49, Morgan Patrick49, Morris Craig49, Mortimore Katherine49, Moses Samuel49, Mpenge Mbiye49, Mulla Rohinton49, Murphy Michael49, Nagarajan Thapas49, Nagel Megan49, Nelson Mark49, Norris Lillian49, O'Shea Matthew K.49, Ostermann Marlies49, Otahal Igor49, Pais Mark49, Panchatsharam Selva49, Papakonstantinou Danai49, Papineni Padmasayee49, Paraiso Hassan49, Patel Brij49, Pattison Natalie49, Pepperell Justin49, Peters Mark49, Phull Mandeep49, Pintus Stefania49, Planche Tim49, Post Frank49, Price David49, Prout Rachel49, Rae Nikolas49, Reschreiter Henrik49, Reynolds Tim49, Richardson Neil49, Roberts Mark49, Roberts Devender49, Rose Alistair49, Rousseau Guy49, Ruge Bobby49, Ryan Brendan49, Saluja Taranprit49, Sarah Sarah49, Schmid Matthias49, Shah Aarti49, Shankar-Hari Manu49, Shanmuga Prad49, Sharma Anil49, Shawcross Anna49, Singh Pooni Jagtur49, Sizer Jeremy49, Smith Richard49, Snelson Catherine49, Spittle Nick49, Staines Nikki49, Stambach Tom49, Stewart Richard49, Subudhi Pradeep49, Szakmany Tamas49, Tatham Kate49, Thomas Jo49, Thompson Chris49, Thompson Robert49, Tridente Ascanio49, Tupper-Carey Darell49, Twagira Mary49, Vallotton Nick49, Vancheeswaran Rama49, Vincent Rachel49, Vincent-Smith Lisa49, Visuvanathan Shico49, Vuylsteke Alan49, Waddy Sam49, Wake Rachel49, Walden Andrew49, Welters Ingeborg49, Whitehouse Tony49, Whittaker Paul49, Whittington Ashley49, Wijesinghe Meme49, Williams Martin49, Wilson Lawrence49, Winchester Stephen49, Wiselka Martin49, Wolverson Adam49, Wootton Daniel G49, Workman Andrew49, Yates Bryan49, Young Peter49, McDonald Sarah E49, Shaw Victoria49, Ahmed Katie A.49, Armstrong Jane A49, Ashworth Milton49, Asiimwe Innocent G49, Bakshi Siddharth49, Barlow Samantha L49, Booth Laura49, Brennan Benjamin49, Bullock Katie49, Carlucci Nicola49, Cass Emily49, Catterall Benjamin WA49, Clark Jordan J49, Clarke Emily A49, Cole Sarah49, Cooper Louise49, Cox Helen49, Davis Christopher49, Dincarslan Oslem49, Doce Carracedo Alejandra49, Dunn Chris49, Dyer Philip49, Elliott Angela49, Evans Anthony49, Finch Lorna49, Fisher Lewis WS49, Flaherty Lisa49, Foster Terry49, Garcia-Dorival Isabel49, Gunning Philip49, Hartley Catherine49, Holmes Anthony49, Jensen Rebecca L49, Jones Christopher B49, Jones Trevor R49, Khandaker Shadia49, King Katharine49, Kiy Robyn T.49, Koukorava Chrysa49, Lake Annette49, Lant Suzannah49, Latawiec Diane49, Lavelle-Langham Lara49, Lefteri Daniella49, Lett Lauren49, Livoti Lucia A49, Mancini Maria49, Massey Hannah49, Maziere Nicole49, McDonald Sarah49, McEvoy Laurence49, McLauchlan John49, Metelmann Soeren49, Miah Nahida S49, Middleton Joanna49, Mitchell Joyce49, Murphy Ellen G49, Penrice-Randal Rebekah49, Pilgrim Jack49, Prince Tessa49, Reynolds Will49, Ridley P. Matthew49, Sales Debby49, Shaw Victoria E49, Shears Rebecca K49, Small Benjamin49, Subramaniam Krishanthi S49, Szemiel Agnieska49, Taggart Aislynn49, Tanianis-Hughes Jolanta49, Thomas Jordan49, Trochu Erwan49, van Tonder Libby49, Wilcock Eve49, Zhang J. Eunice49, Keating Seán49, Donegan Cara49, Spencer Rebecca G49, Donohue Chloe49, Griffiths Fiona49, Hardwick Hayley49, Oosthuyzen Wilna49, Glover Catherine49, Carr Jeremy49, Clark Julia49, Marshall Helen49, McMullan Brendan49, Francis Joshua R.49, Blyth Christopher C.49, Macartney Kristine49, Carey Emma49, Wood Nicholas49, Buttery Jim49, Vasilunas Nan49, Elliott Elizabeth49, Richmond Peter49, Wadia Ushma49, McMinn Alissa49, Bellamy Karen49, Hunter Guillian49, Meredith Kathryn49, Rost Laura49, Kerly Nicole49, Dougherty Sonia49, Cook Sara49, Doran Natasha49, Francis Laura49, Heath Christine49, Finucane Carolyn49,
Affiliation:
1. School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia 2. Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia 3. Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil 4. Hospital Infantil Sabará, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil 5. Baillie Gifford Pandemic Science Hub, Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom 6. Roslin Institute, University of Edinburgh, Easter Bush, Edinburgh, United Kingdom 7. MRC Human Genetics Unit, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom 8. Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom 9. Department of Infectious Diseases, Perth Children’s Hospital, Perth, Western Australia, Australia 10. Department of Infectious Diseases and Microbiology, the Children’s Hospital, Westmead, New South Wales, Australia 11. Sydney Medical School and Sydney Infectious Diseases, University of Sydney, Sydney, New South Wales, Australia 12. Hospital General de Agudos Velez Sarsfield, Buenos Aires, Argentina 13. Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy 14. Infection and Immunity, Murdoch Children’s Research Institute, Parkville, Victoria, Australia 15. Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia 16. Department of General Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia 17. Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 18. Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa 19. School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa 20. Department of Biological Sciences, Louisiana State University, Baton Rouge, Louisiana 21. Pennington Biomedical Research Center, Baton Rouge, Louisiana 22. Infectious Diseases, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia 23. School of Public Health, The University of Queensland, Brisbane, Queensland, Australia 24. School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa 25. Our Lady of the Lake Children’s Hospital, Baton Rouge, Louisiana 26. Division of the National Health Laboratory Services, National Institute of Communicable Diseases, Johannesburg, South Africa 27. Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal 28. NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom 29. Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom 30. National Heart and Lung Institute, Imperial College London, London, United Kingdom 31. Imperial College Healthcare NHS Trust: London, London, United Kingdom 32. Elson S. Floyd College of Medicine, Washington State University, Tacoma, Washington 33. St Joseph Medical Center, Tacoma, Washington 34. Empilweni Service & Research Unit, Rahima Moosa Mother & Child Hospital, Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa 35. Mycobacterial and Migrant Health Research Group, University of Basel Children’s Hospital Basel and Department of Clinical Research, University of Basel, Basel, Switzerland 36. Department of Pediatrics and Pediatric Infectious Diseases, Children’s Hospital Lucerne and Faculty of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland 37. Faculty of Medicine, University of Coimbra, Coimbra, Portugal 38. Murdoch Children’s Research Institute, The Royal Children’s Hospital, Parkville, Victoria, Australia 39. Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, University Hospital Inselspital, University of Bern, Bern, Switzerland 40. Department of Biomedical Research, University of Bern, Bern, Switzerland 41. NIHR Health Protection Research Unit, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom 42. Respiratory Medicine, Alder Hey Children’s Hospital, Institute in The Park, University of Liverpool, Alder Hey Children’s Hospital, Liverpool, United Kingdom 43. Centre for Immunology and Infection Control, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia 44. Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China 45. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia 46. Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, SA- MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa 47. Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland 48. Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Queensland, Australia 49. for the International Severe Acute Respiratory and Emerging Infection Consortium Comprehensive Clinical Characterisation Collaboration (ISARIC4C) investigatorsPediatric Active Enhanced Disease Surveillance (PAEDS) Network group
Abstract
ImportanceMultiple SARS-CoV-2 variants have emerged over the COVID-19 pandemic. The implications for COVID-19 severity in children worldwide are unclear.ObjectiveTo 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 ParticipantsClinical 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.ExposuresSARS-CoV-2 hospitalization during the stipulated time frame.Main Outcomes and MeasuresThe severity of disease was assessed by admission to intensive care unit (ICU), the need for ventilatory support, or oxygen therapy.ResultsAmong 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 RelevanceThis 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.
Publisher
American Medical Association (AMA)
Subject
Pediatrics, Perinatology and Child Health
Cited by
12 articles.
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