Q&A: What to know about the new pediatric guidance for COVID-19
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Key takeaways:
- Experts have published the first comprehensive pediatric COVID-19 guidance in the vaccine era.
- Initial guidance published in 2020 was based on limited available data, one author said.
A task force supported by the Pediatric Infectious Diseases Society recently published the first guidance for the prevention and treatment of COVID-19 in children in the vaccine era.
We spoke with Joshua Wolf, MBBS, PhD, FRACP, a pediatric infectious diseases physician and director of the division of hematology and oncology infectious diseases at St. Jude Children’s Research Hospital, about the project and the major changes to the guidance.
Healio: What prompted you and your colleagues to embark on this?
Wolf: The Pediatric Infectious Disease Society’s Pediatric COVID-19 Therapies Taskforce was the formalization of an ad hoc group of North American pediatric infectious disease, ICU, clinical pharmacy and hematology experts who formed in March 2020 to develop a consensus for expert opinion of the treatment of COVID-19 in kids. The initial guidance was published in Journal of the Pediatric Infectious Diseases Society in April 2020, and was based on very limited available data.
Healio: Are any of the guidelines new, or is this just about putting everything in one place?
Wolf: This guidance document is entirely new. It is the first comprehensive group of pediatric-specific recommendations for risk-stratification, prevention and treatment of COVID-19 in kids in the current era of vaccines and multiple available therapies.
Healio: What were some of the challenges in putting this together?
Wolf: The philosophy of the group has always been that in the absence of very high-quality evidence in the pediatric population, and reliance on some extrapolation of information about infections in kids or COVID-19 in adults, that the expertise of the participants was the most important factor providing weight to the recommendations. Therefore, we required consensus on all recommendations rather than a majority vote. This led to crucial discussions about how we value and interpret available evidence.
Further, the field is constantly changing as new agents and data become available, and the virus evolves to avoid immune therapies. These challenges are also the main reason we felt that this guidance update is so important for clinicians to be aware of.
Healio: What are the major recommendations that every physician should know?
Wolf: Most kids with COVID-19 will have a only cold and require symptomatic therapy only.
Risk-stratification approaches can identify kids at high risk of progression to serious illness, ICU admission or death.
Important risk factors include severe immunocompromise, prematurity, obesity, pre-existing cardiac, respiratory and neurologic conditions.
Multiple or severe pre-existing conditions are likely important predictors of severe illness.
The risk is highest in kids without pre-existing immunity from recent vaccination or infection and those with immunocompromise that affects their ability to mount an immune response.
Early intervention with antivirals in high-risk patients can prevent progression of illness. The options in kids aged younger than 18 include remdesivir, nirmatrelvir and convalescent plasma.
The treatment of kids requiring hospitalization for COVID-19 with antivirals and immunomodulators can prevent worsening or death. There are clear indications for when these treatments are most appropriate.
Healio: Is the expectation that these guidelines will need to be updated frequently?
Wolf: It is likely that new information will become available — we are aiming to have an updated version on the Pediatric Infectious Diseases Society website.
References:
Chiotos K, et al. J Pediatr Infect Dis Soc. 2020;doi: 10.1093/jpids/piaa045.
Willis ZI, et al. J Pediatr Infect Dis Soc. 2024;doi:10.1093/jpids/piad116.
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