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Powell AA, Dowell AC, Moss P, Ladhani SN. Current state of COVID-19 in children: 4 years on. J Infect 2024; 88:106134. [PMID: 38432584 DOI: 10.1016/j.jinf.2024.106134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
Children have been disproportionately affected by the COVID-19 pandemic. Despite evidence of a very low risk of severe disease, children were subjected to extensive lockdown, restriction and mitigation measures, including school closures, to control the rapid spread of SARS-CoV-2 in most parts of the world. In this review we summarise the UK experience of COVID-19 in children four years into the largest and longest pandemic of this century. We address the risks of SARS-CoV-2 infection, immunity, transmission, severity and outcomes in children. We also assess the implementation, uptake, effectiveness and impact of COVID-19 vaccination, as well as the emergence, evolution and near disappearance of PIMS-TS (paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2) and current understanding of long COVID in children. This review consolidates current knowledge on childhood COVID-19 and emphasises the importance of continued research and the need for research-driven public health actions and policy decisions, especially in the context of new variants and future vaccines.
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Affiliation(s)
- Annabel A Powell
- Public Health Programmes, UK Health Security Agency, London, UK.
| | - Alexander C Dowell
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Paul Moss
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Shamez N Ladhani
- Public Health Programmes, UK Health Security Agency, London, UK; Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
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2
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Soriano-Arandes A. COVID-19 clinical manifestations in children: What is the impact of the different SARS-CoV-2 variants and do we need to distinguish between different respiratory viruses? Acta Paediatr 2024; 113:640-642. [PMID: 38333991 DOI: 10.1111/apa.17149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Children's Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
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3
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Thors V, Bjornsdottir KL, Love TJ, Haraldsson A. Long COVID in Icelandic Children: A Matched Cohort Study of Nonspecific Symptoms Following SARS-CoV-2 Infection. Pediatr Infect Dis J 2024; 43:226-233. [PMID: 37991394 DOI: 10.1097/inf.0000000000004187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
PURPOSE Pediatric severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections are usually mild and the mortality rates are low, but concerns have been raised about long-term symptoms that may resemble other postinfectious syndromes. Studies with robust control groups and high response rates have been few. METHODS We obtained identifiers for all 837 Icelandic children diagnosed with SARS-CoV-2 by PCR between March 2020 and June 2021 and contacted them by telephone. We asked about 10 physical and mental symptoms being present at least twice weekly for at least 2 months. Participants who reported symptoms were contacted again a year later. For each subject who completed the questionnaire, an age- and sex-matched comparator without SARS-CoV-2 infection was asked to complete the same questionnaire, and the risk difference was calculated. RESULTS Responses from 643 cases and 602 comparators were analyzed. Children who had been infected with SARS-CoV-2 were more likely to report one or more symptoms, except for anxiety/depression and sleep disturbances. Fatigue and loss of concentration were evidently more common in cases among teenagers (risk difference: 15%; 95% CI: 7-22% and 15%; 95% CI: 7-23%, respectively). At the second follow-up, close to a third of Long COVID cases had resolved but some participants had developed new persistent symptoms. CONCLUSION Symptoms of Long COVID in children are common and impact their quality of life. The importance of further unraveling the pathophysiology of acute and long-term symptoms following SARS-CoV-2 infection in children is vital as well as potential preventive measures.
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Affiliation(s)
- Valtyr Thors
- From the Children's Hospital Iceland, Landspitali, University Hospital Reykjavik, Iceland
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | | | - Thorvardur Jon Love
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland
- Landspitali, University Hospital, Reykjavik, Iceland
| | - Asgeir Haraldsson
- From the Children's Hospital Iceland, Landspitali, University Hospital Reykjavik, Iceland
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland
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4
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Munro APS, Jones CE, Faust SN. Vaccination against COVID-19 - risks and benefits in children. Eur J Pediatr 2024; 183:1107-1112. [PMID: 38169007 PMCID: PMC10950962 DOI: 10.1007/s00431-023-05380-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/01/2023] [Accepted: 12/10/2023] [Indexed: 01/05/2024]
Abstract
Countries in Europe and around the world have taken varying approaches to their policies on COVID-19 vaccination for children. The low risk of severe illness from COVID-19 means that even small risks from vaccination warrant careful consideration. Vaccination appears to result in a decreased risk of severe illness including the paediatric multi-system inflammatory syndrome known to be associated with COVID-19. These risks have already decreased significantly with the emergence of the Omicron variant and its subvariants, and due to widespread population immunity through previous infection. There is a relatively high risk of myocarditis following second doses of mRNA vaccines in adolescent males, although the general course of this condition appears mild. Conclusion: COVID-19 vaccination only provides a transient reduction in transmission. Currently, insufficient evidence exists to determine the impact of vaccination on post-acute COVID syndromes in children, which are uncommon. What is Known: • Vaccines against COVID-19 have significantly reduced morbidity and mortality around the world. • Whilst countries have universally recommended vaccines for adults and continue to recommend them for vulnerable populations, there has been more variability in recommendations for children. What is New: • In the setting of near universal existing immunity from infection, the majority of the initial benefit in protecting against severe illness has been eroded. • The risks of myocarditis following mRNA vaccination for children is low, but an important consideration given the modest benefits.
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Affiliation(s)
- Alasdair P S Munro
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Christine E Jones
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Saul N Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK.
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Korzeniewska-Eksterowicz A, Brzezinska O, Dryja U, Matczak D, Sopilnyak A, Szuszkiewicz E, Przysło Ł, Szmyd K, Jabłońska K, Krych P, Wojtków-Zielińska A, Wąsińska E, Niedźwiecki M. COVID-19 in pediatric palliative care patients: Multicenter, retrospective cohort study. Palliat Med 2024; 38:150-155. [PMID: 37937380 DOI: 10.1177/02692163231206928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Studies have shown the risk factors for COVID-19 severity in children, including comorbidities, but information on the infection course in children with life-limiting conditions is sparse. AIM To describe the effect of COVID-19 on pediatric patients receiving palliative care due to life-limiting conditions. DESIGN We conducted retrospective cohort study. The WHO Clinical Progression Scale was used to measure COVID-19 severity. SETTING/PARTICIPANTS Seven of the 24 invited pediatric palliative care centers participated in this study. We analyzed the medical records of children under palliative care with confirmed COVID-19 (January 2020-April 2022). RESULTS Records of 60 patients with COVID-19 aged 0.24 to 21.6 years (mean (SD); 9.8 (6.6)) were collected. The largest group of patients with COVID-19 was children with congenital malformations and chromosomal abnormalities (42%); the most common manifestation was fever (85%). Bacterial coinfection was confirmed in 17 (28%) children. Fifteen (25%) children required hospitalization, including four admitted to the Intensive Care Unit. Mild COVID-19 was identified in 44 (73%) children, moderate in 11 (18%), severe in 3 (5%), and death in 2 (3%). Six of the 20 eligible children were vaccinated against SARS-CoV-2, followed by 16 mothers and fathers. CONCLUSION In the study population initial presentation of COVID-19 was predominantly a mild; however, the small sample size precluded definitive conclusions. For children under palliative care, we should identify if they have an advance care plan for COVID-19, such as desires for intensive care support. Further studies are needed to define the short and long-term effects of COVID-19 in children with life-limiting conditions.
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Affiliation(s)
- Aleksandra Korzeniewska-Eksterowicz
- Pediatric Palliative Care Unit, Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
- Gajusz Foundation-Pediatric Palliative Care Center, Lodz, Poland
| | - Olga Brzezinska
- Department of Rheumatology With Subdepartment of Internal Medicine, Medical University of Lodz, Lodz, Poland
| | - Urszula Dryja
- Gajusz Foundation-Pediatric Palliative Care Center, Lodz, Poland
| | - Dominka Matczak
- Gajusz Foundation-Pediatric Palliative Care Center, Lodz, Poland
| | - Andriy Sopilnyak
- Pediatric Palliative Care Unit, Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
- Gajusz Foundation-Pediatric Palliative Care Center, Lodz, Poland
| | | | - Łukasz Przysło
- Department of Developmental Neurology and Epileptology, Research Institute of Polish Mother's Memorial Hospital, Lodz, Poland
| | - Krzystof Szmyd
- Hospice for Children of Lower Silesia "Formula Dobra," Wrocław, Poland
| | | | - Piotr Krych
- Home Children's Hospice Promyczek, Otwock, Poland
| | | | | | - Maciej Niedźwiecki
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
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Shukla N, Shamim U, Agarwal P, Pandey R, Narayan J. From bench to bedside: potential of translational research in COVID-19 and beyond. Brief Funct Genomics 2023:elad051. [PMID: 37986554 DOI: 10.1093/bfgp/elad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19) have been around for more than 3 years now. However, due to constant viral evolution, novel variants are emerging, leaving old treatment protocols redundant. As treatment options dwindle, infection rates continue to rise and seasonal infection surges become progressively common across the world, rapid solutions are required. With genomic and proteomic methods generating enormous amounts of data to expand our understanding of SARS-CoV-2 biology, there is an urgent requirement for the development of novel therapeutic methods that can allow translational research to flourish. In this review, we highlight the current state of COVID-19 in the world and the effects of post-infection sequelae. We present the contribution of translational research in COVID-19, with various current and novel therapeutic approaches, including antivirals, monoclonal antibodies and vaccines, as well as alternate treatment methods such as immunomodulators, currently being studied and reiterate the importance of translational research in the development of various strategies to contain COVID-19.
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Affiliation(s)
- Nityendra Shukla
- CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), Mall Road, Near Jubilee Hall, New Delhi, 110007, India
| | - Uzma Shamim
- CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), Mall Road, Near Jubilee Hall, New Delhi, 110007, India
| | - Preeti Agarwal
- CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), Mall Road, Near Jubilee Hall, New Delhi, 110007, India
| | - Rajesh Pandey
- CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), Mall Road, Near Jubilee Hall, New Delhi, 110007, India
| | - Jitendra Narayan
- CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), Mall Road, Near Jubilee Hall, New Delhi, 110007, India
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7
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Shin A, Kim DW, Kim YE, Kim DR, Jung J, Kim YJ. COVID-19 Vaccination Status Among Korean Pediatric Population With Comorbidities. J Korean Med Sci 2023; 38:e248. [PMID: 37582498 PMCID: PMC10427210 DOI: 10.3346/jkms.2023.38.e248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/20/2023] [Indexed: 08/17/2023] Open
Abstract
The pediatric population with comorbidities is a high-risk group for severe coronavirus disease 2019 (COVID-19). As of January 2023, the COVID-19 vaccination rate for at least two doses among Korean children 5-11 years is low at 1.1%. We summarized the COVID-19 vaccination status for the pediatric population (5-17 years) with comorbidities through July 2022 using the National Health Insurance Service database. Pediatric patients with comorbidities had higher vaccination rates than the general pediatric population (2.4% vs. 1.1% in 5-11-year-olds [P < 0.001], 76.5% vs. 66.1% in 12-17-year-olds [P < 0.001]). However, there were substantial differences according to comorbidity category, and the 2-dose vaccination rate was lowest among children with immunodeficiency in all age groups (1.1% in 5-11-year-olds, 51.2% in 12-17-year-olds). The COVID-19 vaccination rate among Korean children has remained stagnant at a low proportion despite ongoing outreach. Thus, more proactive strategies are needed alongside continuous surveillance.
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Affiliation(s)
- Areum Shin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Wook Kim
- Department of Information and Statistics, Department of Bio & Medical Big Data, Research Institute of Natural Science, Gyeongsang National University, Jinju, Korea
| | - Young-Eun Kim
- Department of Big Data Strategy, National Health Insurance Service, Wonju, Korea
| | - Doo Ri Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaehun Jung
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Seoul, Korea.
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8
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Soriano-Arandes A, Brett A, Buonsenso D, Emilsson L, de la Fuente Garcia I, Gkentzi D, Helve O, Kepp KP, Mossberg M, Muka T, Munro A, Papan C, Perramon-Malavez A, Schaltz-Buchholzer F, Smeesters PR, Zimmermann P. Policies on children and schools during the SARS-CoV-2 pandemic in Western Europe. Front Public Health 2023; 11:1175444. [PMID: 37564427 PMCID: PMC10411527 DOI: 10.3389/fpubh.2023.1175444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/26/2023] [Indexed: 08/12/2023] Open
Abstract
During the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mitigation policies for children have been a topic of considerable uncertainty and debate. Although some children have co-morbidities which increase their risk for severe coronavirus disease (COVID-19), and complications such as multisystem inflammatory syndrome and long COVID, most children only get mild COVID-19. On the other hand, consistent evidence shows that mass mitigation measures had enormous adverse impacts on children. A central question can thus be posed: What amount of mitigation should children bear, in response to a disease that is disproportionally affecting older people? In this review, we analyze the distinct child versus adult epidemiology, policies, mitigation trade-offs and outcomes in children in Western Europe. The highly heterogenous European policies applied to children compared to adults did not lead to significant measurable differences in outcomes. Remarkably, the relative epidemiological importance of transmission from school-age children to other age groups remains uncertain, with current evidence suggesting that schools often follow, rather than lead, community transmission. Important learning points for future pandemics are summarized.
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Affiliation(s)
- Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ana Brett
- Infectious Diseases Unit and Emergency Service, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Milan, Italy
| | - Louise Emilsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Isabel de la Fuente Garcia
- Pediatric Infectious Diseases, National Pediatric Center, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Despoina Gkentzi
- Department of Paediatrics, Patras Medical School, Patras, Greece
| | - Otto Helve
- Department of Health Security, Institute for Health and Welfare, Helsinki, Finland
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Kasper P. Kepp
- Section of Biophysical and Biomedicinal Chemistry, DTU Chemistry, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Maria Mossberg
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Epistudia, Bern, Switzerland
| | - Alasdair Munro
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Faculty of Medicine, Institute of Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Cihan Papan
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Aida Perramon-Malavez
- Computational Biology and Complex Systems (BIOCOM-SC) Group, Department of Physics, Universitat Politècnica de Catalunya (UPC·BarcelonaTech), Barcelona, Spain
| | | | - Pierre R. Smeesters
- Department of Pediatrics, University Hospital Brussels, Academic Children’s Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Petra Zimmermann
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland
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9
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Lalia JK, Schild R, Lütgehetmann M, Dunay GA, Kallinich T, Kobbe R, Massoud M, Oh J, Pietzsch L, Schulze-Sturm U, Schuetz C, Sibbertsen F, Speth F, Thieme S, Witkowski M, Berner R, Muntau AC, Gersting SW, Toepfner N, Pagel J, Paul K. Reduced Humoral and Cellular Immune Response to Primary COVID-19 mRNA Vaccination in Kidney Transplanted Children Aged 5-11 Years. Viruses 2023; 15:1553. [PMID: 37515239 PMCID: PMC10384144 DOI: 10.3390/v15071553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
The situation of limited data concerning the response to COVID-19 mRNA vaccinations in immunocom-promised children hinders evidence-based recommendations. This prospective observational study investigated humoral and T cell responses after primary BNT162b2 vaccination in secondary immunocompromised and healthy children aged 5-11 years. Participants were categorized as: children after kidney transplantation (KTx, n = 9), proteinuric glomerulonephritis (GN, n = 4) and healthy children (controls, n = 8). Expression of activation-induced markers and cytokine secretion were determined to quantify the T cell response from PBMCs stimulated with peptide pools covering the spike glycoprotein of SARS-CoV-2 Wuhan Hu-1 and Omicron BA.5. Antibodies against SARS-CoV-2 spike receptor-binding domain were quantified in serum. Seroconversion was detected in 56% of KTx patients and in 100% of the GN patients and controls. Titer levels were significantly higher in GN patients and controls than in KTx patients. In Ktx patients, the humoral response increased after a third immunization. No differences in the frequency of antigen-specific CD4+ and CD8+ T cells between all groups were observed. T cells showed a predominant anti-viral capacity in their secreted cytokines; however, this capacity was reduced in KTx patients. This study provides missing evidence concerning the humoral and T cell response in immunocompromised children after COVID-19 vaccination.
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Affiliation(s)
- Jasmin K Lalia
- University Children's Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Raphael Schild
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Inhoffenstr. 7, 38124 Brauschweig, Germany
| | - Gabor A Dunay
- University Children's Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Tilmann Kallinich
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Robin Kobbe
- Institute for Infection Research and Vaccine Development (IIRVD), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- Department of Infectious Disease Epidemiology, Bernhard-Nocht-Institute for Tropical Medicine, Bernhard-Nocht-Straße 74, 20359 Hamburg, Germany
| | - Mona Massoud
- Therapeutic Gene Regulation, Deutsches Rheuma-Forschungszentrum (DRFZ), An Institute of the Leibniz Association, Charitéplatz 1, 10117 Berlin, Germany
| | - Jun Oh
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Leonora Pietzsch
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Ulf Schulze-Sturm
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Catharina Schuetz
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Freya Sibbertsen
- University Children's Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Fabian Speth
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Sebastian Thieme
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Mario Witkowski
- Institute of Microbiology, Infectious Diseases and Immunology, Laboratory of Innate Immunity, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Mucosal and Developmental Immunology, Deutsches Rheuma-Forschungszentrum (DRFZ), An Institute of the Leibniz Association, Charitéplatz 1, 10117 Berlin, Germany
| | - Reinhard Berner
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Ania C Muntau
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Søren W Gersting
- University Children's Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Nicole Toepfner
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Julia Pagel
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Inhoffenstr. 7, 38124 Brauschweig, Germany
- Division of Pediatric Stem Cell Transplantation, Immunology and Rheumatology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Kevin Paul
- University Children's Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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10
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Wilde H, Tomlinson C, Mateen BA, Selby D, Kanthimathinathan HK, Ramnarayan P, Du Pre P, Johnson M, Pathan N, Gonzalez-Izquierdo A, Lai AG, Gurdasani D, Pagel C, Denaxas S, Vollmer S, Brown K. Hospital admissions linked to SARS-CoV-2 infection in children and adolescents: cohort study of 3.2 million first ascertained infections in England. BMJ 2023; 382:e073639. [PMID: 37407076 PMCID: PMC10318942 DOI: 10.1136/bmj-2022-073639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To describe hospital admissions associated with SARS-CoV-2 infection in children and adolescents. DESIGN Cohort study of 3.2 million first ascertained SARS-CoV-2 infections using electronic health care record data. SETTING England, July 2020 to February 2022. PARTICIPANTS About 12 million children and adolescents (age <18 years) who were resident in England. MAIN OUTCOME MEASURES Ascertainment of a first SARS-CoV-2 associated hospital admissions: due to SARS-CoV-2, with SARS-CoV-2 as a contributory factor, incidental to SARS-CoV-2 infection, and hospital acquired SARS-CoV-2. RESULTS 3 226 535 children and adolescents had a recorded first SARS-CoV-2 infection during the observation period, and 29 230 (0.9%) infections involved a SARS-CoV-2 associated hospital admission. The median length of stay was 2 (interquartile range 1-4) days) and 1710 of 29 230 (5.9%) SARS-CoV-2 associated admissions involved paediatric critical care. 70 deaths occurred in which covid-19 or paediatric inflammatory multisystem syndrome was listed as a cause, of which 55 (78.6%) were in participants with a SARS-CoV-2 associated hospital admission. SARS-CoV-2 was the cause or a contributory factor in 21 000 of 29 230 (71.8%) participants who were admitted to hospital and only 380 (1.3%) participants acquired infection as an inpatient and 7855 (26.9%) participants were admitted with incidental SARS-CoV-2 infection. Boys, younger children (<5 years), and those from ethnic minority groups or areas of high deprivation were more likely to be admitted to hospital (all P<0.001). The covid-19 vaccination programme in England has identified certain conditions as representing a higher risk of admission to hospital with SARS-CoV-2: 11 085 (37.9%) of participants admitted to hospital had evidence of such a condition, and a further 4765 (16.3%) of participants admitted to hospital had a medical or developmental health condition not included in the vaccination programme's list. CONCLUSIONS Most SARS-CoV-2 associated hospital admissions in children and adolescents in England were due to SARS-CoV-2 or SARS-CoV-2 was a contributory factor. These results should inform future public health initiatives and research.
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Affiliation(s)
- Harrison Wilde
- Department of Statistics, University of Warwick, Warwick, UK
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
| | - Christopher Tomlinson
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
- UCL UK Research and Innovation Centre for Doctoral Training in AI-enabled Healthcare Systems, UCL, London, UK
- University College London Hospitals Biomedical Research Centre, UCL, London, UK
| | - Bilal A Mateen
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
- University College London Hospitals Biomedical Research Centre, UCL, London, UK
- Wellcome Trust, London, UK
| | - David Selby
- Department for Data Science and its Applications, German Research Centre for Artificial Intelligence (DFKI), Kaiserslautern, Germany
- Department of Computer Science, TU Kaiserslautern, Kaiserslautern, Germany
| | | | - Padmanabhan Ramnarayan
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London UK Imperial College London, London, UK
| | - Pascale Du Pre
- Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK
| | - Mae Johnson
- Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK
| | - Nazima Pathan
- University Department of Paediatrics, Cambridge University, Cambridge, UK
| | | | - Alvina G Lai
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
| | - Deepti Gurdasani
- William Harvey Institute, Queen Mary University of London, London, UK
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Spiros Denaxas
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
- University College London Hospitals Biomedical Research Centre, UCL, London, UK
| | - Sebastian Vollmer
- Department for Data Science and its Applications, German Research Centre for Artificial Intelligence (DFKI), Kaiserslautern, Germany
- Department of Computer Science, TU Kaiserslautern, Kaiserslautern, Germany
| | - Katherine Brown
- Institute of Cardiovascular Science, UCL, London, UK
- Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK
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11
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Hart JD, Ong DS, Chokephaibulkit K, Ong-Lim AT, Vereti I, Crawford NW, Russell F. Considerations for vaccinating children against COVID-19. BMJ Paediatr Open 2023; 7:e001964. [PMID: 37487674 PMCID: PMC10373744 DOI: 10.1136/bmjpo-2023-001964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/03/2023] [Indexed: 07/26/2023] Open
Abstract
COVID-19 vaccines have been introduced in children and adolescents in many countries. However, high levels of community transmission and infection-derived immunity make the decision to introduce COVID-19 vaccination of children in countries yet to do so particularly challenging. For example, other vaccine preventable diseases, including measles and polio, generally have far higher childhood morbidity and mortality in low-income and middle-income countries (LMICs) than COVID-19, and coverage with these vaccines has declined during the pandemic. Many countries are yet to introduce pneumococcal conjugate and rotavirus vaccines for children, which prevent common causes of childhood death, or human papillomavirus vaccine for adolescents. The Pfizer and Moderna COVID-19 vaccines that have been widely tested in children and adolescents have a positive risk-benefit profile. However, the benefit is less compared with other life-saving vaccines in this age group, particularly in LMICs and settings with widespread infection-derived immunity. The resources required for rollout may also pose a considerable challenge in LMICs. In this paper, we describe COVID-19 in children, with a focus on LMICs, and summarise the published literature on safety, efficacy and effectiveness of COVID-19 vaccination in children and adolescents. We highlight the complexity of decision-making regarding COVID-19 vaccination of children now that most of this low-risk population benefit from infection-derived immunity. We emphasise that at-risk groups should be prioritised for COVID-19 vaccination; and that if COVID-19 vaccines are introduced for children, the opportunity should be taken to improve coverage of routine childhood vaccines and preventative healthcare. Additionally, we highlight the paucity of epidemiological data in LMICs, and that for future epidemics, measures need to be taken to ensure equitable access to safe and efficacious vaccines before exposure to infection.
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Affiliation(s)
- John D Hart
- Infection, Immunity and Global Health Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Darren Suryawijaya Ong
- Infection, Immunity and Global Health Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kulkanya Chokephaibulkit
- Siriraj Institute of Clinical Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Paediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anna T Ong-Lim
- Division of Infectious and Tropical Disease in Pediatrics, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Ilisapeci Vereti
- Department of Paediatrics, Colonial War Memorial Hospital, Ministry of Health and Medical Services, Suva, Fiji
| | - Nigel W Crawford
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Fiona Russell
- Infection, Immunity and Global Health Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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12
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Hani E, Bertran M, Powell A, Williams H, Birrell P, DeAngelis D, Ramsay ME, Oligbu G, Ladhani SN. Significantly lower infection fatality rates associated with SARS-CoV-2 Omicron (B.1.1.529) infection in children and young people: Active, prospective national surveillance, January-March 2022, England. J Infect 2023; 86:397-398. [PMID: 36706963 PMCID: PMC9872565 DOI: 10.1016/j.jinf.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023]
Affiliation(s)
- Erjola Hani
- Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Marta Bertran
- Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Annabel Powell
- Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Hannah Williams
- Joint Modelling Team (JMT), UK Health Security Agency, UK; Emergency Preparedness, Response and Resilience, UK Health Security Agency, Porton Down, SP4 0JG, UK
| | - Paul Birrell
- Joint Modelling Team (JMT), UK Health Security Agency, UK; MRC Biostatistics Unit, University of Cambridge, School of Clinical Medicine, Cambridge Institute of Public Health, Cambridge, United Kingdom; Statistical Modelling and Economics, UK Health Security Agency, Colindale, United Kingdom
| | - Daniela DeAngelis
- MRC Biostatistics Unit, University of Cambridge, School of Clinical Medicine, Cambridge Institute of Public Health, Cambridge, United Kingdom
| | - Mary E Ramsay
- Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Godwin Oligbu
- Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, United Kingdom; Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom
| | - Shamez N Ladhani
- Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, United Kingdom; Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom.
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