The clinical characteristics of pediatric coronavirus disease 2019 in 2020 in Japan

Nosocomial transmission of SARS-CoV-2 from infected children to uninfected caregivers: A retrospective cohort study in a Japanese tertiary children's hospital

BACKGROUND

The transmission rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear when caregivers accompany pediatric COVID-19 patients in the same isolation room in a hospital setting.

AIM

We investigated SARS-CoV-2 transmission from infected children to caregivers at our hospital.

METHODS

This retrospective cohort study included 34 discordant pairs of patients admitted between September 2020 and April 2022.

FINDINGS

The median ages of the children and caregivers were 3.7 years (interquartile range [IQR]: 1.6-8.1) and 33.1 years (IQR: 28.3-43.4), respectively. Of the 34 caregivers, 31 were mothers, two were fathers, and one was a relative. Sixteen caregivers received at least two doses of the mRNA vaccine. The mean duration of the hospital stays was 7.7 ± 4.1 days (range: 3-19). Two unvaccinated caregivers developed COVID-19 after admission; the onset was within 48 h after admission. It is likely that they had been infected in their household prior to admission, since the incubation period for COVID-19 is usually >2 days.

CONCLUSIONS

Nosocomial SARS-CoV-2 transmission from infected children to caregivers was not confirmed in this study. The combination of negative-pressure rooms, vaccinations, and infection-control bundles appears to be effective at preventing SARS-CoV-2 transmission. It is acceptable to allow caregivers to accompany pediatric COVID-19 patients in a hospital ward if they can comply with basic infection control measures.

Acute and Postacute Clinical Characteristics of Coronavirus Disease 2019 in Children in Japan

BACKGROUND

The clinical features of coronavirus disease 2019 (COVID-19) in children have been changing because of the emergence and rapid spread of variants of concern (VOC). The increase in cases infected with VOC has brought concern with persistent symptoms after COVID-19 in children. This survey aimed to analyze the clinical manifestations and persistent symptoms of pediatric COVID-19 cases in Japan.

METHODS

We analyzed the clinical manifestations of pediatric COVID-19 cases reported between February 2020 and April 2022 in Japan, using a dedicated database updated voluntarily by the members of the Japan Pediatric Society. Using the same database, we also analyzed persistent symptoms after COVID-19 in children who were diagnosed between February 2020 and November 2021.

RESULTS

A total of 5411 and 1697 pediatric COVID-19 cases were included for analyzing clinical manifestations and persistent symptoms, respectively. During the Omicron variant predominant period, the percentage of patients with seizures increased to 13.4% and 7.4% in patient groups 1-4 and 5-11 years of age, respectively, compared with the pre-Delta (1.3%, 0.4%) or Delta period (3.1%, 0.0%). Persistent and present symptoms after 28 days of COVID-19 onset were reported in 55 (3.2%).

CONCLUSIONS

Our survey showed that the rate of symptomatic pediatric COVID-19 cases increased gradually, especially during the Omicron variant predominant period, and a certain percentage of pediatric cases had persistent symptoms. Certain percentages of pediatric COVID-19 patients had severe complications or prolonged symptoms. Further studies are needed to follow such patients.

Factors affecting guardians' decision-making regarding the SARS-CoV-2 vaccine

BACKGROUND

In Japan, the vaccination rate against the SARS-CoV-2 vaccine for children was low. Therefore, in this study we investigated the factors influencing guardians' decision-making regarding vaccination of their children.

METHODS

From November 1, 2022 to March 31, 2023, pediatric clinics, departments, and midwifery clinics in Saitama Prefecture requested guardians of children under the age of 15 to complete an online questionnaire.

RESULTS

Responses were obtained from 894 guardians of children aged 6 months to 15 years; 142 had had one of their children vaccinated at least once and 629 had not had any of their children vaccinated. Among guardians who had not had any of their children vaccinated, "the Age of children" was significantly younger (p < 0.001) and "Prevalence" (p < 0.001), "Free vaccination" (p < 0.001), and "Intentions of national and local governments" (p = 0.005) were selected as reasons significantly less frequently in comparison to guardians who had vaccinated their children. "Japanese adverse reactions" (p < 0.001), "Japanese effectiveness" (p < 0.001), "Adverse reactions" (p < 0.001), "History of adverse reactions" (p < 0.001), and "Reputation of friends" (p = 0.006) were selected significantly more frequently by guardians who had not had any of their children vaccinated.

CONCLUSIONS

Guardians who had had one of their children vaccinated at least once emphasized the importance of prevalence and free vaccination. On the other hand, guardians who had not had any of their children vaccinated placed particular importance on adverse reactions and the Japanese data on effectiveness. To guide the decision-making of guardians, it is necessary to quickly collect and publish data on adverse reactions and effectiveness, particularly in Japanese individuals, so that citizens can decide whether to vaccinate themselves and their children.

Coronavirus Disease 2019 in Pediatric Emergency Room: The Dilemma of Cycle Threshold Value

Objective The havoc caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic could not have been predicted, with children being affected worldwide. Testing for SARS-CoV-2 infection helped to define the interventions against the spread of the disease. A polymerase chain reaction (PCR) test has been the mainstay of diagnostic testing. Cycle threshold (Ct) is a semiquantitative value that indicates approximately how much viral genetic material was in the sample. The aim of this study was to evaluate the impact of Ct values among children with SARS-CoV-2 infection.

Methods Between May 3, 2020 and August 3, 2020, clinical laboratory input and the data of patients with positive SARS-CoV-2 PCR tests were retrospectively studied.

Results There was no statistical significance between Ct values and the patient's status, symptoms other than fever, or other laboratory findings. However, the Ct value of patients who had symptoms at the time of admission to the hospital was significantly lower.

Conclusion In this study, symptomatic patients had lower Ct than asymptomatic patients that reflected higher viral loads. In evidence-based medicine applications, it might be useful to correlate the clinical history with laboratory test results. Even symptomatic patients with high Ct value coinfections, or an alternative acute infection, should be considered.

Updates on Coronavirus Disease 2019 in Children in Japan

This review provides updates on coronavirus disease 2019 (COVID-19) in children in Japan by summarizing published data. By the end of March 2022, Japan had experienced 6 waves of COVID-19 outbreaks. Over this time, the clinical features presented among children have changed in the context of the predominant variants. Although the COVID-19 pandemic affected children in terms of medical, physical and psychosocial aspects, the clinical outcomes have been favorable in Japan compared with those in some European countries and the United States, which may be partly due to a lower incidence of multisystem inflammatory syndromes in children and obesity. The COVID-19 vaccine has been available for children; however, the vaccination rate in children 5-11 years of age is lower than that in older children due to the government's lack of an active approach in this specific population. Further action is needed to improve the overall vaccination rates in children.

Descriptive epidemiology of COVID-19 in Japan 2020: insights from a multihospital database

BACKGROUND

Epidemiological data are essential for developing strategies against the current coronavirus disease 2019 (COVID-19) pandemic. Data on COVID-19 epidemiology in Japan are limited owing to a focus on specific regions and patient groups, particularly in the early phase of the pandemic.

METHODS

We investigated COVID-19 epidemiology in Japan in 2020 using a large nationwide multihospital database containing insurance claim records and medical records. Inclusion criteria were inpatient and outpatient referrals for COVID-19 in 2020. We analyzed demographic data, comorbidities, drug use, severe COVID-19 risk, and clinical course of hospitalized patients (including death).

RESULTS

We identified 11,868 COVID-19 cases from 56 institutions: 6,440 outpatients and 5,428 inpatients. Of the patients, 53.2% had comorbid conditions, the most common of which was tumor (22.1%), and 56.4% were classed as having a high risk of COVID-19. Pharmacological management patterns were generally consistent between the first and second half of 2020, except for glucocorticoid use. The use of unauthorized medications (hydroxychloroquine, ivermectin, and favipiravir) was infrequent. For hospitalized patients, the median length of stay was 10 days, and 2.4% of patients were admitted to intensive care units. Post-COVID-19 all-cause mortality, all-cause 30-day mortality, and in-hospital deaths were recorded for 7.9%, 5.4%, and 4.6% of patients, respectively. Patients with high-risk conditions had a lower survival probability.

CONCLUSIONS

This descriptive study of COVID-19 in 2020 identified differences in care across outpatient and inpatient settings and changes in care delivery as the pandemic progressed. These findings could inform strategies for future infectious disease pandemics.

Reasons for SARS-CoV-2 infection in children and their role in the transmission of infection according to age: a case-control study

BACKGROUND

The locations where children get exposed to SARS-CoV-2 infection and their contribution in spreading the infection are still not fully understood. Aim of the article is to verify the most frequent reasons for SARS-CoV-2 infection in children and their role in the secondary transmission of the infection.

METHODS

A case-control study was performed in all SARS-CoV-2 positive children (n = 81) and an equal number of age- and sex- matched controls who were referred to the S. Camillo-Forlanini Pediatric Walk-in Center of Rome. The results of all SARS-CoV-2 nasopharyngeal swabs performed in children aged < 18 years from October 16 to December 19, 2020 were analyzed.

RESULTS

School contacts were more frequent in controls than in cases (OR 0.49; 95% CI: 0.3-0.9), while household contacts were higher in cases (OR 5.09; 95% CI: 2.2-12.0). In both cases and controls, school contacts were significantly less frequent, while on the contrary household contacts seemed to be more frequent in nursery school children compared to primary school or middle/high school children. A multivariate logistic regression showed that the probability of being positive to SARS-CoV-2 was significantly lower in children who had school contacts or who had flu symptoms compared to children who had household contacts. Results showed a 30.6% secondary attack rate for household contacts.

CONCLUSION

In our study population, the two most frequent reasons for SARS-CoV-2 infection were school and home contacts. The risk of being positive was 5 times lower in children who had school contacts than in children who had household contacts.