Who is at a Higher Risk? A brief review of Recent Evidence on comorbidities in children infected with COVID-19.
AbstractBackground: COVID-19 has affected both adults and children with variable presentations and disease severity. Children can present with mild symptoms of fever, cough and shortness of breath, and rapidly progress to severe pneumonia, requiring mechanical ventilation. This population includes children who are younger than one year and older adolescents who have an underlying comorbidity-specifically immunosuppression or prior cardio-respiratory infections. In this review, we discuss the determinants of severe disease among the paediatric patients- primarily asthma, immune-status, obesity and multisystem inflammatory syndrome in children (MIS-C). Asthma and underlying lung pathologies can be a strong predictor (~20% prevalence) for development of severe COVID-19 infection, irrespective of age. However, as compared to asthma, a higher mortality rate was reported in immune-compromised patients. With a weakened immune system, immunosuppressed individuals were 1.55 times and immunocompromised patients 3.29 times more vulnerable to developing severer COVID-19 disease. Similarly, evidence suggests that a BMI of greater than 35 kg/m2 renders individuals more susceptible to developing COVID-19-related complications. This observation is based on the negative impacts obesity has on pulmonary functions and in downplaying the immune system. Furthermore, a possible association of COVID-19 and MIS-C has been reported by multiple studies across the globe but it needs further studies to strengthen its stance due to the scarcity of data when compared with the other determinants discussed in this article. Authors recommend researchers directing attention on synthesizing the evolving evidence to fill the knowledge void in the paediatric population, which will better enable paediatricians to make informed decisions. Keywords: COVID-19; children; asthma; immunosuppression; obesity; comorbidities
Worldometer. COVID-19 Coronavirus Pandemic. Available at: https://www.worldometers.info/coronavirus/. Accessed on: 20th July 2020. 2020.
WHO. Coronavirus Disease (COVID-19) Dashboard. Available at: https://covid19.who.int/. Accessed on: 7th June 2020. 2020.
Y Dong XM, Y Hu, X Qi, F Jiang, Z Jiang, S Tong. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. . Pediatrics. 2020.
CD Covid CC, C COVID, S Bialek, R Gierke, M Hughes, LA McNamara, T Pilishvili, T Skoff. Coronavirus Disease 2019 in Children—United States, February 12–April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(14):422.
ECDC. COVID-19 cases. Available at: https://qap.ecdc.europa.eu/public/extensions/COVID-19/COVID-19.html. Accessed on: 6th July 2020. 2020.
Ludvigsson J. Systematic review of COVID‐19 in children shows milder cases and a better prognosis than adults. . Acta Paediatrica. 2020;109(6):1088-95.
X Lu LZ, H Du, J Zhang, YY Li, J Qu, W Zhang, Y Wang, S Bao, Y Li, C Wu. SARS-CoV-2 infection in children. N Engl J Med. 2020;382(17):1663-5.
A Hoang KC, A Moreira, M Evans, F Burmeister-Morton, F Burmeister, R Naqvi, M Petershack, A Moreira A. COVID-19 in 7780 pediatric patients: A systematic review. EClinicalMedicine 2020:100433.
WHO. Multisystem inflammatory syndrome in children and adolescents with COVID-19. Available at: https://www.who.int/publications/i/item/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19. Accessed on: 15th May 2020. 2020.
LS Shekerdemian NM, KK Wolfe, BJ Riggs, CE Ross, CA McKiernan, SM Heidemann, LC Kleinman, AI Sen, MW Hall, MA Priestley. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. 2020.
CDC. Resources for Emergency Health Professionals. Health Alert Network. Available at: https://emergency.cdc.gov/health-professionals.asp. Accessed on: 20th July 2020. 2020.
Chao JY, Derespina KR, Herold BC, Goldman DL, Aldrich M, Weingarten J, et al. Clinical Characteristics and Outcomes of Hospitalized and Critically Ill Children and Adolescents with Coronavirus Disease 2019 (COVID-19) at a Tertiary Care Medical Center in New York City. J Pediatr 2020.
Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395(10237):1607-8.
Sun D, Li H, Lu X-X, Xiao H, Ren J, Zhang F-R, et al. Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center's observational study. World J Pediatr. 2020;16(3):251-9.
Tagarro A, Epalza C, Santos M, Sanz-Santaeufemia FJ, Otheo E, Moraleda C, et al. Screening and Severity of Coronavirus Disease 2019 (COVID-19) in Children in Madrid, Spain. JAMA Pediatr. 2020.
Götzinger F, Santiago-García B, Noguera-Julián A, Lanaspa M, Lancella L, Calò Carducci FI, et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health. 2020:S2352-4642(20)30177-2.
See KC, Liew SM, Ng DCE, Chew EL, Khoo EM, Sam CH, et al. COVID-19: Four Paediatric Cases in Malaysia. Int J Infect Dis. 2020;94:125-7.
Williamson E, Walker AJ, Bhaskaran KJ, Bacon S, Bates C, Morton CE, et al. OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. medRxiv. 2020:2020.05.06.20092999.
EK Stokes LZ, KN Anderson, EP Marder, KM Raz, SE Felix, Y Tie, KE Fullerton. Coronavirus Disease 2019 Case Surveillance—United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(24):759.
WHO. COVID-19 weekly surveillance report. 25 – 31 May 2020. Available at: https://www.euro.who.int/__data/assets/pdf_file/0006/445920/Week-22-COVID-19-surveillancer-eport-eng.pdf. Accessed on: 1st June 2020 2020.
Jamie Hartmann-Boyce AO, Jonny Drake, Jana Suklan, Ella Schofield, Jade Kinton, James Gunnell, Andrew Menzies-Gow, Matt Inada-Kim, Richard Hobbs, Paddy Dennison. Asthma and COVID-19: risks and management considerations. The Centre for Evidence-Based Medicine. Available at: https://www.cebm.net/covid-19/asthma-and-covid-19-risks-and-management-considerations/. Accessed on: 22nd July 2020. 2020.
UK A. Shielding advice for very high-risk groups. Available at: https://www.asthma.org.uk/advice/triggers/coronavirus-covid-19/shielding-advice-high-risk/. Accessed on: 22nd July 2020. 2020.
Society BT. COVID-19: information for the respiratory community. Available at: https://www.brit-thoracic.org.uk/about-us/covid-19-information-for-the-respiratory-community/. Accessed on: 22nd July 2020. 2020.
CDC. People with Moderate to Severe Asthma. Available at: https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/asthma.html. Accessed on: 2nd April 2020. . 2020.
Barsoum Z. Pediatric Asthma & Coronavirus (COVID-19)-Clinical Presentation in an Asthmatic Child—Case Report. SN Compr Clin Med. 2020:1-3.
HSS. Immunosuppression. Available at: https://aidsinfo.nih.gov/understanding-hiv-aids/glossary/364/immunosuppression. Accessed on: 6th July 2020. . 2020.
CDC. If you are immunocompromised, protect yourself from COVID-19. Available at: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/immunocompromised.html. Accessed on: 14th May 2020. . 2020.
Gao Y, Chen Y, Liu M, Shi S, Tian J. Impacts of immunosuppression and immunodeficiency on COVID-19: A systematic review and meta-analysis. J Infect. 2020:S0163-4453(20)30294-2.
Marlais M, Wlodkowski T, Vivarelli M, Pape L, Tönshoff B, Schaefer F, et al. The severity of COVID-19 in children on immunosuppressive medication. Lancet Child Adolesc Health. 2020;4(7):e17-e8.
Akalin E, Azzi Y, Bartash R, Seethamraju H, Parides M, Hemmige V, et al. Covid-19 and Kidney Transplantation. N Engl J Med. 2020;382(25):2475-7.
Sajid MI, Altaf S, Mushtaq N, Belgaumi A, Fadoo Z. Pediatric hematology oncology during SARS-CoV-2: A brief communication of 28 patients and changes in clinical practice from a single institute in Pakistan. Pediatr Blood Cancer. 2020:e28527-e.
Sullivan M, Bouffet E, Rodriguez-Galindo C, Luna-Fineman S, Khan MS, Kearns P, et al. The COVID-19 pandemic: A rapid global response for children with cancer from SIOP, COG, SIOP-E, SIOP-PODC, IPSO, PROS, CCI, and St Jude Global. Pediatr Blood Cancer. 2020;67(7):e28409.
Zhang L, Zhu F, Xie L, Wang C, Wang J, Chen R, et al. Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China. Ann Oncol. 2020;31(7):894-901.
Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335-7.
Kronbichler A, Gauckler P, Windpessl M, Il Shin J, Jha V, Rovin BH, et al. COVID-19: implications for immunosuppression in kidney disease and transplantation. Nat Rev Nephrol. 2020;16(7):365-7.
Sjøqvist C, Snarski E. Inflammatory markers in patients after hematopoietic stem cell transplantation. Archivum immunologiae et therapiae experimentalis. 2013;61(4):301-7.
Huttunen R, Syrjänen J. Obesity and the risk and outcome of infection. Int J Obes. 2013;37(3):333-40.
Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, et al. High Prevalence of Obesity in Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Requiring Invasive Mechanical Ventilation. Obesity. 2020;28(7):1195-9.
Zachariah P, Johnson CL, Halabi KC, Ahn D, Sen AI, Fischer A, et al. Epidemiology, Clinical Features, and Disease Severity in Patients With Coronavirus Disease 2019 (COVID-19) in a Children’s Hospital in New York City, New York. JAMA Pediatr. 2020:e202430-e.
Dietz W, Santos-Burgoa C. Obesity and its Implications for COVID-19 Mortality. Obesity. 2020;28(6):1005.
Dixon AE, Peters U. The effect of obesity on lung function. Expert Rev Respir Med. 2018;12(9):755-67.
Wu J, Li W, Shi X, Chen Z, Jiang B, Liu J, et al. Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19). J Intern Med. 2020;288(1):128-38.
CDC. Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. Available at: https://emergency.cdc.gov/han/2020/han00432.asp. Accessed on: 14th May 2020. . 2020.
Cheung EW, Zachariah P, Gorelik M, Boneparth A, Kernie SG, Orange JS, et al. Multisystem Inflammatory Syndrome Related to COVID-19 in Previously Healthy Children and Adolescents in New York City. JAMA. 2020.
Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J, et al. Multisystem Inflammatory Syndrome in Children in New York State. N Engl J Med. 2020.
Toubiana J, Poirault C, Corsia A, Bajolle F, Fourgeaud J, Angoulvant F, et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ. 2020;369:m2094.