UK study shows ‘epidemiologic nuances’ of COVID-19 in children

Key takeaways:

• During the pandemic, children with comorbidities were most likely to be hospitalized.
• Omicron was associated with the lowest rates of hospitalization.

A large study in the United Kingdom revealed some “epidemiologic nuances” of COVID-19 in children, experts said.

The study found that the risk for severe COVID-19 among children remained low throughout the first 2 years of the pandemic, and that patients with multiple comorbidities were at the highest risk for severe outcomes after SARS-CoV-2 infection during each variant wave, according to findings published in JAMA Pediatrics.

“An increase in hospitalizations among children and adolescents with the delta (B.1.617.2) variant in summer 2021, and particularly after the emergence of the omicron (B.1.1.529) variant in December 2021 led to concerns that children and adolescents may have become more vulnerable to serious disease,” the researchers wrote. “However, rise in hospitalizations may reflect variation in community infection rates and higher incidental infections among hospitalized children and adolescents rather than more severe disease.”

The examined risk factors associated with COVID-19 hospitalization or multisystem inflammatory syndrome in children (MIS-C) and how those factors changed over the first 2 years of COVID-19 using U.K. data covering a majority of nationwide inpatient activity from Feb. 1, 2020, to Jan. 31, 2022.

Overall, the study included 10,540 hospitalizations due to COVID-19 and 997 due to MIS-C. Overall, 93.2% of hospitalizations occurred among patients without prior COVID-19 exposure or vaccination and 4.3% ended up in pediatric ICUs (PICUs).

Th proportion of patients hospitalized with COVID-19 or MIS-C who required a stay in the PICU declined through each successive wave of the pandemic, from 9.9% with the original SARS-CoV-2 virus down to 1.7% during the omicron wave.

As other research has shown, despite the high infectiousness of omicron, the variant was association with the lowest rates of hospitalizations and PICU admissions

“We found that the proportion of children and adolescents with COVID-19 requiring PICU admission declined steeply from the start of the pandemic across all age groups, despite later higher community infection rates,” they wrote. “Most children and adolescents who required PICU admission had medical comorbidities, as did all those who died within 28 days of hospitalization for COVID-19.”

In an accompanying editorial, Kathleen Chiotos, MD, MSCE, and Julie C. Fitzgerald, MD, PhD, MSCE, both of the division of critical care medicine at The Children’s Hospital of Philadelphia, said the study “captures several epidemiologic nuances with implications for public health, pandemic preparedness, and clinical care for children with COVID-19.”

“At a stage of the pandemic where severe illness from SARS-CoV-2 is fortunately exceedingly rare in children, it is perhaps that which is not measured in this report that represents our greatest imperative: addressing the decrement in child physical and mental health indirectly related to the COVID-19 pandemic and the resulting mitigation strategies,” they wrote.

“Overcoming these secondary pandemic effects will require complex solutions, including expanding child mental health services, promoting access to routine child vaccinations and preventive health care, and investments in community and public school-based programs, particularly those focused on sociodemographically disadvantaged groups who have been impacted by widened health care disparities during the pandemic.”

They added that although many consider the pandemic to be over, overcoming “secondary pandemic effects” is important.

“We must now look beyond counts of pediatric COVID-19 cases to understand, measure, and reduce the deleterious indirect impacts of the COVID-19 pandemic on children — and at a time when many have declared the COVID-19 pandemic ‘over,’ our efforts to overcome these secondary pandemic effects have only just begun,” they wrote.

References:

Chiotos K, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2023.2354.

Ward JL, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2023.2357.