News & Views: COVID-19 and Kids — What Do We Know?
Published on in Vaccine Update for Healthcare Providers
Published on in Vaccine Update for Healthcare Providers
As time passes and cases of COVID-19 increase, we are learning more about SARS-CoV-2 infections in children and young adults.
While children are less likely to suffer from severe illness when infected with SARS-CoV-2, they can still be infected, and a small percentage will suffer complications and death (described below).
As of Sept. 10, 2020, more than half a million cases of COVID-19 have been diagnosed in children. This represents about 10% of all cases. To see updates, visit the state-level data reports being offered by the American Academy of Pediatrics and the Children’s Hospital Association.
Data are still being compiled related to the percent of asymptomatic infections in children, but is likely to be between 16% and 45%, according to the Centers for Disease Control and Prevention (CDC).
While evidence suggests that children are less likely to experience symptoms of infection, it is also becoming clear that they can be infected and have high quantities of virus, particularly in their nasopharynx or oropharynx:
Based on a 14-state hospitalization network, almost 600 children less than 18 years of age were hospitalized with COVID-19 between March 1 and July 25, 2020, according to an August 14, 2020 report in Morbidity and Mortality Weekly Report (MMWR). This represents a hospitalization rate of about 8 per 100,000 population, compared with 164.5 per 100,000 adults.
Those most at risk for hospitalization include:
About one-third of children who were hospitalized were placed in intensive care, which is a rate similar to that seen in adults. About 6% required mechanical ventilation, compared with about 19% of adults. About 4 of 10 had underlying medical conditions, including obesity and chronic lung disease. In children younger than 2 years of age, prematurity was also considered an underlying condition.
As described in the August 14, 2020 MMWR, some aspects of these data are limited by the fact that they represent a review of a convenience sample of patient charts.
Between the beginning of March and mid-July 2020, the CDC received reports of 570 patients less than 21 years of age with multi-inflammatory syndrome in children (MIS-C), according to an August 14, 2020 MMWR. In 86% of these patients, four or more organ systems were affected. Most often the affected systems included the gastrointestinal tract (91%), cardiovascular system (86%), and dermatologic or mucocutaneous system (71%).
The most common symptoms included:
Common severe complications included:
Of patients diagnosed with MIS-C, 10 died. As with infection rates, certain groups are at higher risk for developing MIS-C:
Statistical modeling, known as latent class analysis (LCA), defined three types of MIS-C-related cases:
To read more about MIS-C and coronavirus infections in children, access the August 14, 2020 MMWR article.
As SARS-CoV-2 infections tend to be less severe in young people, the number of deaths is also lower. But they still occur. Check out the “In the Journals” section for a review of data presented in the Sept. 15, 2020 MMWR.
Current phase III trials are not being conducted in those younger than 18 years of age. As such, it is not likely that early COVID-19 vaccines will be available for children. We respond to this and other questions related to COVID-19 vaccines on our dedicated page, www.COVIDVaccineAnswers.org.
Contributed by: Charlotte A. Moser, MS, Paul A. Offit, MD
Categories: Vaccine Update September 2020, News and Views About Vaccines
Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.
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