Affiliation:
1. Ann & Robert H. Lurie Children’s Hospital of Chicago , Chicago, IL , USA
2. Northwestern University Feinberg School of Medicine , Chicago, IL , USA
3. Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health , Chicago, IL , USA
Abstract
Abstract
Background
Recent COVID-19 surges are attributed to emergence of more transmissible SARS-CoV-2 variants of concern (VOCs). The relative severity of VOCs in children is unknown.
Methods
We performed a single-center retrospective cohort study of children ≤18 years old diagnosed with COVID-19 from October 2020–February 2022 and whose SARS-CoV-2 isolate underwent Illumina sequencing. We measured the frequency of five markers of COVID-19 severity. Logistic regression models were fitted to estimate the odds of each severity marker with each VOC.
Results
Among 714 children, 471 (66.0%) were infected with a VOC: 96 (13.4%) alpha, 38 (5.3%) gamma, 119 (16.7%) delta, and 215 (30.1%) omicron. High-risk medical conditions and increasing age were independently associated with COVID-19 severity. After adjusting for age, race, ethnicity, high-risk medical conditions, and COVID-19 community incidence, neither alpha, delta, nor omicron was associated with severe COVID-19. Gamma was independently associated with hospitalization (OR 6.7, 95% CI 2.0–22.1); pharmacologic treatment (OR 5.7, 95% CI 1.2–26.8); respiratory support (OR 11.9, 95% CI 2.7–62.4); and severe disease per the WHO Clinical Progression Scale (OR 11.7, 95% CI 2.1–90.5). Upon subgroup analyses, omicron was independently associated with ICU admission and severe disease per the WHO Clinical Progression Scale in children without SARS-CoV-2 immunization or prior COVID-19 infection.
Conclusions
Compared to non-VOC COVID-19, the gamma VOC was independently associated with increased COVID-19 severity, as was omicron in children without SARS-CoV-2 immunization or prior COVID-19 infection. SARS-CoV-2 vaccination and prior COVID-19 prevented severe outcomes during the omicron surge.
Funder
Walder Foundation’s Chicago Coronavirus Assessment Network
National Institutes of Health
National Center for Advancing Translational Sciences
Dixon Family Foundation
NIH CTSA
Northwestern University Cancer Center
NIH
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,General Medicine,Pediatrics, Perinatology and Child Health
Cited by
12 articles.
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