Severe Acute Respiratory Syndrome Among Children

Author:

Leung Chi-wai1,Kwan Yat-wah1,Ko Po-wan2,Chiu Susan S.3,Loung Po-yee1,Fong Nai-chung1,Lee Lai-ping1,Hui Yim-wo1,Law Helen K.W.3,Wong Wilfred H.S.3,Chan Kwok-hung4,Peiris J.S. Malik4,Lim Wilina W.L.5,Lau Yu-lung3,Chiu Man-chun1

Affiliation:

1. Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong

2. Department of Paediatrics and Adolescent Medicine, Our Lady of Maryknoll Hospital, Hong Kong

3. Departments of Paediatrics and Adolescent Medicine

4. Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong

5. Government Virus Unit, Public Health Laboratory Centre, Department of Health, Hong Kong

Abstract

Objective. To study the epidemiologic, clinical, laboratory, and radiologic features, prognostic indicators, and short-term to medium-term outcomes for children with severe acute respiratory syndrome (SARS) and to validate the performance characteristics of a clinical case definition, calculated with respect to SARS-associated coronavirus (SARS-CoV) seroconversion. Methods. Children <18 years of age, from a single-site outbreak, who satisfied a clinical case definition for SARS, with subsequent serologic confirmation, were treated according to a standard protocol and prospectively monitored. Results. Forty-four children were included. The median age was 12 years. Forty-two children (95.5%) demonstrated an epidemiologic link. Fever, cough, malaise, coryza, sputum production, headache, myalgia, lymphopenia, and elevated lactate dehydrogenase levels were common presenting features. Radiographic findings were nonspecific, but high-resolution computed tomography of the thorax was an early diagnostic aid. A specific reverse transcription-polymerase chain reaction assay for SARS-CoV yielded positive results for <50% of children. Of 9 children who developed hypoxemia, 8 were treated with methylprednisolone. Of 5 children who received intensive care, 3 required assisted ventilation. All children recovered, and serious adverse events in response to treatment were not observed. The outcomes at 3 to 6 months after disease onset, including exercise tolerance, pulmonary functions, and psychologic status, were favorable. An age of >12 years was associated with methylprednisolone therapy for severe illness. After exclusion of the only infant, an age of >12 years was associated with oxygen requirements. Sore throat, high neutrophil count at presentation, and peak neutrophilia were independent factors predicting severe illness. The clinical case definition demonstrated good sensitivity, specificity, and positive and negative predictive values (97.8%, 92.7%, 88%, and 98.7%, respectively) for diagnostic accuracy. Conclusions. Children are susceptible to SARS-CoV infection. Teenagers resemble adults with respect to disease progression and may develop severe illness. The short-term to medium-term outcomes are good. Sore throat and initial and peak neutrophilia seem to be predictors of severe illness. Our clinical case definition performed well in the epidemic.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference29 articles.

1. World Health Organization. Cumulative number of reported probable cases of SARS. Available at: www.who.int/csr/sars/country/2003_06_23/en/. Accessed October 10, 2003

2. Hon KLE, Leung CW, Cheng WTF, et al. Clinical presentations and outcome of severe acute respiratory syndrome in children. Lancet.2003;361:1701–1703

3. Chiu WK, Cheung PCH, Ng KL, et al. Severe acute respiratory syndrome in children: experience in a regional hospital in Hong Kong. Pediatr Crit Care Med.2003;4:279–283

4. Bitnun A, Allen U, Heurter H, et al. Children hospitalized with severe acute respiratory syndrome-related illness in Toronto. Pediatrics.2003;112(4). Available at: www.pediatrics.org/cgi/content/full/112/4/e261

5. World Health Organization. Case definitions for surveillance of severe acute respiratory syndrome (SARS). Available at: www.who.int/csr/sars/casedefinition/en. Accessed October 10, 2003

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