International Pediatric COVID-19 Severity over the Course of the Pandemic
Issued Date
2023-10-02
Resource Type
ISSN
21686203
eISSN
21686211
Scopus ID
2-s2.0-85173237944
Pubmed ID
37603343
Journal Title
JAMA Pediatrics
Volume
177
Issue
10
Start Page
1073
End Page
1084
Rights Holder(s)
SCOPUS
Bibliographic Citation
JAMA Pediatrics Vol.177 No.10 (2023) , 1073-1084
Suggested Citation
Zhu Y., Almeida F.J., Baillie J.K., Bowen A.C., Britton P.N., Brizuela M.E., Buonsenso D., Burgner D., Chew K.Y., Chokephaibulkit K., Cohen C., Cormier S.A., Crawford N., Curtis N., Farias C.G.A., Gilks C.F., Von Gottberg A., Hamer D., Jarovsky D., Jassat W., Jesus A.R., Kemp L.S., Khumcha B., McCallum G., Miller J.E., Morello R., Munro A.P.S., Openshaw P.J.M., Padmanabhan S., Phongsamart W., Reubenson G., Ritz N., Rodrigues F., Rungmaitree S., Russell F., Sáfadi M.A.P., Saner C., Semple M.G., Prado Da Silva D.G.B., De Sousa L.M.M., Diogo Moço Souza M., Spann K., Walaza S., Wolter N., Xia Y., Yeoh D.K., Zar H.J., Zimmermann P., Short K.R. International Pediatric COVID-19 Severity over the Course of the Pandemic. JAMA Pediatrics Vol.177 No.10 (2023) , 1073-1084. 1084. doi:10.1001/jamapediatrics.2023.3117 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/90504
Title
International Pediatric COVID-19 Severity over the Course of the Pandemic
Author(s)
Zhu Y.
Almeida F.J.
Baillie J.K.
Bowen A.C.
Britton P.N.
Brizuela M.E.
Buonsenso D.
Burgner D.
Chew K.Y.
Chokephaibulkit K.
Cohen C.
Cormier S.A.
Crawford N.
Curtis N.
Farias C.G.A.
Gilks C.F.
Von Gottberg A.
Hamer D.
Jarovsky D.
Jassat W.
Jesus A.R.
Kemp L.S.
Khumcha B.
McCallum G.
Miller J.E.
Morello R.
Munro A.P.S.
Openshaw P.J.M.
Padmanabhan S.
Phongsamart W.
Reubenson G.
Ritz N.
Rodrigues F.
Rungmaitree S.
Russell F.
Sáfadi M.A.P.
Saner C.
Semple M.G.
Prado Da Silva D.G.B.
De Sousa L.M.M.
Diogo Moço Souza M.
Spann K.
Walaza S.
Wolter N.
Xia Y.
Yeoh D.K.
Zar H.J.
Zimmermann P.
Short K.R.
Almeida F.J.
Baillie J.K.
Bowen A.C.
Britton P.N.
Brizuela M.E.
Buonsenso D.
Burgner D.
Chew K.Y.
Chokephaibulkit K.
Cohen C.
Cormier S.A.
Crawford N.
Curtis N.
Farias C.G.A.
Gilks C.F.
Von Gottberg A.
Hamer D.
Jarovsky D.
Jassat W.
Jesus A.R.
Kemp L.S.
Khumcha B.
McCallum G.
Miller J.E.
Morello R.
Munro A.P.S.
Openshaw P.J.M.
Padmanabhan S.
Phongsamart W.
Reubenson G.
Ritz N.
Rodrigues F.
Rungmaitree S.
Russell F.
Sáfadi M.A.P.
Saner C.
Semple M.G.
Prado Da Silva D.G.B.
De Sousa L.M.M.
Diogo Moço Souza M.
Spann K.
Walaza S.
Wolter N.
Xia Y.
Yeoh D.K.
Zar H.J.
Zimmermann P.
Short K.R.
Author's Affiliation
Faculty of Science and Medicine
Siriraj Hospital
Elson S. Floyd College of Medicine
Perth Children's Hospital
The University of Sydney School of Medicine
Imperial College Healthcare NHS Trust
The University of Hong Kong Li Ka Shing Faculty of Medicine
St Joseph Hospital, Tacoma
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Universidade de Coimbra, Faculdade de Medicina
National Institute for Communicable Diseases
The University of Queensland
The Children's Hospital at Westmead
University of Melbourne
Royal Children's Hospital, Melbourne
University of Edinburgh, Roslin Institute
University of Southampton, Faculty of Medicine
Hospital General de Agudos Carlos G. Durand
Pennington Biomedical Research Center
Our Lady of the Lake Regional Medical Center
University of Liverpool
University of Bern
Centro Hospitalar e Universitário de Coimbra
MRC Centre for Inflammation Research
Universität Luzern
School of Pathology
Red Cross War Memorial Children's Hospital
MRC Human Genetics Unit
Wits School of Public Health
Queensland University of Technology
University Hospital Bern
National Heart and Lung Institute
Murdoch Children's Research Institute
Louisiana State University
Universitäts-Kinderspital Beider Basel
Rahima Moosa Mother and Child Hospital
Royal Infirmary of Edinburgh
University Hospital Southampton NHS Foundation Trust
Telethon Kids Institute
Hospital Infantil Sabará
Santa Casa de São Paulo School of Medical Sciences
Siriraj Hospital
Elson S. Floyd College of Medicine
Perth Children's Hospital
The University of Sydney School of Medicine
Imperial College Healthcare NHS Trust
The University of Hong Kong Li Ka Shing Faculty of Medicine
St Joseph Hospital, Tacoma
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Universidade de Coimbra, Faculdade de Medicina
National Institute for Communicable Diseases
The University of Queensland
The Children's Hospital at Westmead
University of Melbourne
Royal Children's Hospital, Melbourne
University of Edinburgh, Roslin Institute
University of Southampton, Faculty of Medicine
Hospital General de Agudos Carlos G. Durand
Pennington Biomedical Research Center
Our Lady of the Lake Regional Medical Center
University of Liverpool
University of Bern
Centro Hospitalar e Universitário de Coimbra
MRC Centre for Inflammation Research
Universität Luzern
School of Pathology
Red Cross War Memorial Children's Hospital
MRC Human Genetics Unit
Wits School of Public Health
Queensland University of Technology
University Hospital Bern
National Heart and Lung Institute
Murdoch Children's Research Institute
Louisiana State University
Universitäts-Kinderspital Beider Basel
Rahima Moosa Mother and Child Hospital
Royal Infirmary of Edinburgh
University Hospital Southampton NHS Foundation Trust
Telethon Kids Institute
Hospital Infantil Sabará
Santa Casa de São Paulo School of Medical Sciences
Other Contributor(s)
Abstract
Importance: Multiple SARS-CoV-2 variants have emerged over the COVID-19 pandemic. The implications for COVID-19 severity in children worldwide are unclear. Objective: To 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 Participants: Clinical 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. Exposures: SARS-CoV-2 hospitalization during the stipulated time frame. Main Outcomes and Measures: The severity of disease was assessed by admission to intensive care unit (ICU), the need for ventilatory support, or oxygen therapy. Results: Among 31785 hospitalized children and adolescents, the median age was 4 (IQR 1-12) years and 16639 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 Relevance: This 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..