AHA statement outlines treatments for COVID-19-related CV complications in children
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The American Heart Association has published a scientific statement on the association between COVID-19 infection and CV complications among children and young adults.
Published in Circulation, the document provides an overview of the epidemiology, clinical presentation and treatment of COVID-19 and the associated CV complications of infection in children and young adults, including myocarditis, cardiogenic shock and multisystem inflammatory syndrome in children (MIS-C).
“The statement outlines available treatments for children with COVID-19, though there are no specific COVID-19 antiviral therapies,” Pei-Ni Jone, MD, FAHA, director of 3D Echocardiography, the Kawasaki Disease Clinic and Quality in Echocardiography at Children’s Hospital Colorado in Aurora, and chair of the statement writing group, told Healio. “These include remdesivir (Veklury, Gilead Sciences) and dexamethasone for children in certain age groups. Remdesivir is the only antiviral drug currently approved by the FDA for treatment of people ages 12 and older hospitalized with COVID-19 who have risk factors for severe disease and the need for supplemental oxygen, and it is most effective when given as soon as possible after symptoms began. Dexamethasone, which has been shown to reduce risk of death in adults with COVID-19, is suggested for children with more severe disease who require breathing support.”
Jone said children have accounted for less than 13% of total COVID-19 cases in the U.S. and approximately 0.1% of deaths from the disease.
Moreover, individuals aged 18 to 29 years accounted for less than 23% of total COVID-19 cases in the U.S. and 0.6% of deaths.
The statement offered several potential reasons why children may be less susceptible to severe COVID-19 infection:
- Cells in children’s bodies have fewer receptors to attach to the SARS-CoV-2 virus.
- Children may have a reduced immune response due to a different cytokine response.
- There is a better trained immunity from other vaccines and viral infections compared with adults.
“Children have mild symptoms from SARS-CoV-2 infection, though patients with [congenital heart disease] with genetic abnormalities may experience severe disease,” Jone told Healio. “Long-term consequences of long COVID and the impact of this disease on the heart in children and young adults will need to be elucidated.”
CV complications related to infection, vaccination
Jone said cases of CV complications related to SARS-CoV-2 infection include cardiogenic shock, pericarditis and arrhythmias.
CV manifestations of acute COVID-19 in children and young adults are uncommon, according to the statement.
A recent study published in Circulation reported low prevalence of acute myocarditis even in patients who were hospitalized with COVID-19 during the first 14 months of the pandemic.
As Healio previously reported, the odds of cardiac injury among male adolescents and young adults were elevated following the receipt of a messenger RNA-based COVID-19 vaccination compared with other individuals, although the absolute rates were low.
Among 192.4 million vaccinated adolescents and young adults in the U.S., researchers observed 1,991 cases of myocarditis after at least one dose, according to a prior study published in JAMA.
Another, albeit rare complication of COVID-19 among children and adolescents is MIS-C, a condition in which organ and systems such as the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs can become inflamed.
Jone said children with MIS-C can be treated with IV immune globulin or dual therapy with infliximab (Remicade, Janssen) or other immunomodulatory agents to improve cardiac outcomes. In additional, COVID-19 vaccines have been found to prevent severe infection and decrease the risk for developing MIS-C by approximately 91% among children aged 12 to 18 years.
“The data suggest it is safe for youth with mild or asymptomatic COVID-19 to return to sports after recovery from symptoms,” Jone told Healio. “For those with more serious infections, it’s reasonable to have heart exams including an echocardiogram, blood tests for heart enzyme levels and other heart function screening before resuming sports or strenuous physical exercise.”
Health disparities exacerbated by the pandemic
The statement also called attention to health disparities experienced by children and young adults amid the COVID-19 pandemic.
“The development of novel antiviral therapies and indications for immunomodulators are needed for outcomes to improve, and these agents need to be tested in children in clinical trials. Health disparity will need to be addressed to take care of the inequity in children,” Jone told Healio. “Health disparity has been highlighted in the pandemic and this will need to be addressed so all children can get access to equal care.”
For young children, preexisting disparities worsened due to their dependence on adult caregivers. Contributing factors included the overrepresentation of Black and Hispanic individuals among essential workers who were unable to social distance as well as those with employers who enacted work-from-home or paid-leave policies, the authors wrote.
Preexisting disparities in access to care now extended inadequate access to COVID-19 testing, lack of transportation and lack of insurance coverage, according to the statement.
The statement highlighted that the burden of illness and death was greater among Black, Native Hawaiian, Pacific Islander, American Indian, Alaska Native and Hispanic individuals. Inequities such as these are related to disparate concomitant comorbidities and social determinants of health in these populations, the authors wrote.
“Although much has been learned about how the virus impacts children’s and young adult’s hearts, how to best treat cardiovascular complications and prevent severe illness and continued clinical research trials are needed to better understand the long-term cardiovascular impacts,” Jone said in a press release. “It is also important to address health disparities that have become more apparent during the pandemic. We must work to ensure all children receive equal access to vaccination and high-quality care.”
See the full statement more information about the relationship between COVID-19 infection and CV complications among children and young adults.
Reference:
- Heart issues after COVID-19 uncommon in children & young adults, more research needed. newsroom.heart.org/news/heart-issues-after-covid-19-uncommon-in-children-young-adults-more-research-needed. Published April 11, 2022. Accessed April 15, 2022.
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