International Pediatric COVID-19 Severity Over the Course of the Pandemic
Zhu Y., Almeida FJ., Baillie JK., Bowen AC., Britton PN., Brizuela ME., Buonsenso D., Burgner D., Chew KY., Chokephaibulkit K., Cohen C., Cormier SA., Crawford N., Curtis N., Farias CGA., Gilks CF., von Gottberg A., Hamer D., Jarovsky D., Jassat W., Jesus AR., Kemp LS., Khumcha B., McCallum G., Miller JE., Morello R., Munro APS., Openshaw PJM., Padmanabhan S., Phongsamart W., Reubenson G., Ritz N., Rodrigues F., Rungmaitree S., Russell F., Sáfadi MAP., Saner C., Semple MG., Prado da Silva DGB., de Sousa LMM., Diogo Moço Souza M., Spann K., Walaza S., Wolter N., Xia Y., Yeoh DK., Zar HJ., Zimmermann P., Short KR., Alex B., Andrikopoulos P., Bach B., Barclay WS., Bogaert D., Chand M., Chechi K., Cooke GS., da Silva Filipe A., de Silva T., Docherty AB., dos Santos Correia G., Dumas M-E., Dunning J., Fletcher T., Green CA., Greenhalf W., Griffin J., Gupta RK., Harrison EM., Ho AYW., Holden K., Horby PW., Ijaz S., Khoo S., Klenerman P., Law A., Lewis M., Liggi S., Lim WS., Maslen L., Mentzer AJ., Merson L., Meynert AM., Moore SC., Noursadeghi M., Olanipekun M., Osagie A., Palmarini M., Palmieri C., Paxton WA., Pollakis G., Price N., Rambaut A., Robertson DL., Russell CD., Sancho-Shimizu V., Sands C., Scott JT., Sigfrid L., Solomon T., Sriskandan S., Stuart D., Summers C., Swann OV., Takats Z., Takis P., Tedder RS., Thompson AAR., Thomson EC., Thwaites RS., Turtle LCW., Zambon M., Drake TM., Fairfield CJ., Knight SR., Mclean KA., Murphy D., Norman L., Pius R., Shaw CA., Connor M., Dalton J., Gamble C., Girvan M., Halpin S., Harrison J., Jackson C., Lee J., Marsh L., Plotkin D., Roberts S., Saviciute E., Clohisey S., Hendry R., Knight S., Lahnsteiner E., Leeming G., Norris L., Scott-Brown J., Tait S., Wham M., Clark R., Coutts A., Donelly L., Fawkes A., Gilchrist T., Hafezi K., MacGillivray L., Maclean A., McCafferty S., Morrice K., Murphy L., Wrobel N., Carson G., Adeniji K., Agranoff D., Agwuh K., Ail D., Aldera EL., Alegria A., Allen S., Angus B., Ashish A., Atkinson D., Bari S., Barlow G., Barnass S., Barrett N., Bassford C., Basude S., Baxter D., Beadsworth M., Bernatoniene J., Berridge J., Berry C., Best N., Bothma P., Brittain-Long R., Bulteel N., Burden T., Burtenshaw A., Caruth V., Chadwick D., Chambler D., Chee N., Child J., Chukkambotla S., Clark T., Collini P., Cosgrove C., Cupitt J., Cutino-Moguel M-T., Dark P., Dawson C., Dervisevic S., Donnison P., Douthwaite S., Drummond A., DuRand I., Dushianthan A., Dyer T., Evans C., Eziefula C., Fegan C., Finn A., Fullerton D., Garg S., Garg A., Gkrania-Klotsas E., Godden J., Goldsmith A., Graham C., Grammatikopoulos T., Hardy E., Hartshorn S., Harvey D., Havalda P., Hawcutt DB., Hobrok M., Hodgson L., Hormis A., Howard J., Jacobs M., Jain S., Jennings P., Kaliappan A., Kasipandian V., Kegg S., Kelsey M., Kendall J., Kerrison C., Kerslake I., Koch O., Koduri G., Koshy G., Laha S., Laird S., Larkin S., Leiner T., Lillie P., Limb J., Linnett V., Little J., Lyttle M., MacMahon M., MacNaughton E., Mankregod R., Masson H., Matovu E., McCullough K., McEwen R., Meda M., Mills G., Minton J., Mohandas K., Mok Q., Moon J., Moore E., Morgan P., Morris C., Mortimore K., Moses S., Mpenge M., Mulla R., Murphy M., Nagarajan T., Nagel M., Nelson M., Norris L., O'Shea MK., Ostermann M., Otahal I., Pais M., Panchatsharam S., Papakonstantinou D., Papineni P., Paraiso H., Patel B., Pattison N., Pepperell J., Peters M., Phull M., Pintus S., Planche T., Post F., Price D., Prout R., Rae N., Reschreiter H., Reynolds T., Richardson N., Roberts M., Roberts D., Rose A., Rousseau G., Ruge B., Ryan B., Saluja T., Sarah S., Schmid M., Shah A., Shankar-Hari M., Shanmuga P., Sharma A., Shawcross A., Singh Pooni J., Sizer J., Smith R., Snelson C., Spittle N., Staines N., Stambach T., Stewart R., Subudhi P., Szakmany T., Tatham K., Thomas J., Thompson C., Thompson R., Tridente A., Tupper-Carey D., Twagira M., Vallotton N., Vancheeswaran R., Vincent R., Vincent-Smith L., Visuvanathan S., Vuylsteke A., Waddy S., Wake R., Walden A., Welters I., Whitehouse T., Whittaker P., Whittington A., Wijesinghe M., Williams M., Wilson L., Winchester S., Wiselka M., Wolverson A., Wootton DG., Workman A., Yates B., Young P., McDonald SE., Shaw V., Ahmed KA., Armstrong JA., Ashworth M., Asiimwe IG., Bakshi S., Barlow SL., Booth L., Brennan B., Bullock K., Carlucci N., Cass E., Catterall BWA., Clark JJ., Clarke EA., Cole S., Cooper L., Cox H., Davis C., Dincarslan O., Doce Carracedo A., Dunn C., Dyer P., Elliott A., Evans A., Finch L., Fisher LWS., Flaherty L., Foster T., Garcia-Dorival I., Gunning P., Hartley C., Holmes A., Jensen RL., Jones CB., Jones TR., Khandaker S., King K., Kiy RT., Koukorava C., Lake A., Lant S., Latawiec D., Lavelle-Langham L., Lefteri D., Lett L., Livoti LA., Mancini M., Massey H., Maziere N., McDonald S., McEvoy L., McLauchlan J., Metelmann S., Miah NS., Middleton J., Mitchell J., Murphy EG., Penrice-Randal R., Pilgrim J., Prince T., Reynolds W., Ridley PM., Sales D., Shaw VE., Shears RK., Small B., Subramaniam KS., Szemiel A., Taggart A., Tanianis-Hughes J., Thomas J., Trochu E., van Tonder L., Wilcock E., Zhang JE., Keating S., Donegan C., Spencer RG., Donohue C., Griffiths F., Hardwick H., Oosthuyzen W., Glover C., Carr J., Clark J., Marshall H., McMullan B., Francis JR., Blyth CC., Macartney K., Carey E., Wood N., Buttery J., Vasilunas N., Elliott E., Richmond P., Wadia U., McMinn A., Bellamy K., Hunter G., Meredith K., Rost L., Kerly N., Dougherty S., Cook S., Doran N., Francis L., Heath C., Finucane C.
ImportanceMultiple SARS-CoV-2 variants have emerged over the COVID-19 pandemic. The implications for COVID-19 severity in children worldwide are unclear.ObjectiveTo determine whether the dominant circulating SARS-CoV-2 variants of concern (VOCs) were associated with differences in COVID-19 severity among hospitalized children.Design, Setting, and ParticipantsClinical data from hospitalized children and adolescents (younger than 18 years) who were SARS-CoV-2 positive were obtained from 9 countries (Australia, Brazil, Italy, Portugal, South Africa, Switzerland, Thailand, UK, and the US) during 3 different time frames. Time frames 1 (T1), 2 (T2), and 3 (T3) were defined to represent periods of dominance by the ancestral virus, pre-Omicron VOCs, and Omicron, respectively. Age groups for analysis were younger than 6 months, 6 months to younger than 5 years, and 5 to younger than 18 years. Children with an incidental positive test result for SARS-CoV-2 were excluded.ExposuresSARS-CoV-2 hospitalization during the stipulated time frame.Main Outcomes and MeasuresThe severity of disease was assessed by admission to intensive care unit (ICU), the need for ventilatory support, or oxygen therapy.ResultsAmong 31 785 hospitalized children and adolescents, the median age was 4 (IQR 1-12) years and 16 639 were male (52.3%). In children younger than 5 years, across successive SARS-CoV-2 waves, there was a reduction in ICU admission (T3 vs T1: risk ratio [RR], 0.56; 95% CI, 0.42-0.75 [younger than 6 months]; RR, 0.61, 95% CI; 0.47-0.79 [6 months to younger than 5 years]), but not ventilatory support or oxygen therapy. In contrast, ICU admission (T3 vs T1: RR, 0.39, 95% CI, 0.32-0.48), ventilatory support (T3 vs T1: RR, 0.37; 95% CI, 0.27-0.51), and oxygen therapy (T3 vs T1: RR, 0.47; 95% CI, 0.32-0.70) decreased across SARS-CoV-2 waves in children 5 years to younger than 18 years old. The results were consistent when data were restricted to unvaccinated children.Conclusions and RelevanceThis study provides valuable insights into the impact of SARS-CoV-2 VOCs on the severity of COVID-19 in hospitalized children across different age groups and countries, suggesting that while ICU admissions decreased across the pandemic in all age groups, ventilatory and oxygen support generally did not decrease over time in children aged younger than 5 years. These findings highlight the importance of considering different pediatric age groups when assessing disease severity in COVID-19.