Pre-existing illness strongest indicator of risk for severe COVID-19 in children

ANAHEIM, Calif. — A study found that having a pre-existing comorbidity was the strongest indicator of risk for severe COVID-19 in children, according to data reported here.

Milan Ho, a medical student at the University of Texas Southwestern Medical Center, presented findings from the study at the AAP National Conference & Exhibition.

Milan Ho

“Though severe COVID-19 is rarer in children than in adults, we wanted to understand what factors — including demographics, clinical factors, and vaccination status — affect the likelihood of a child with COVID-19 experiencing a severe outcome such as hospitalization, ICU admission, invasive respiratory support, or death,” Ho told Healio.

Ho and colleagues conducted a retrospective observational study that examined the effect of clinical and demographic factors and vaccination on COVID-19 outcomes among children aged younger than 18 years. They studied data on children who tested positive by PCR or antigen test from March 12, 2020, through Jan. 20, 2022.

Among the 218,759 children who tested positive, 4% were either hospitalized, required ICU care or ventilation, or died. “By far,” the researchers reported, the strongest predictors of these severe outcomes in all groups were higher a score on the pediatric comorbidity index — with ORs of 2.27 (95% CI, 2.02-2.56), 4.21 (95% CI, 3.62-4.91] and 5.33 (95% CI, 4.75-5.97), respectively — or residency in the South.

Additionally, the researchers noted that in all groups, "unknown insurance status," infection with the alpha variant, and Black race were “borderline clinically significant predictors of severe outcome” (P < .0001). They also observed that the OR of severe disease when comparing at least one vaccine dose with no known vaccination was 0.55 (95% CI, 0.48-0.63) in the vaccine-eligible cohort.

“This information could help clinicians determine who is at highest risk for severe COVID-19 and [allocate] resources and therapeutics appropriately,” co-author Zachary Most, MD, an assistant professor of pediatrics at UT Southwestern Medical Center, told Healio.

“Additionally, it could provide more real-world data on the effectiveness of COVID-19 vaccines in preventing severe disease in children.”