. 2020 Dec;9(1):2588-2596.

doi: 10.1080/22221751.2020.1846462.

COVID-19 in children across three Asian cosmopolitan regions

Gilbert T Chua¹, Xiaoli Xiong², Eun Hwa Choi³, Mi Seon Han⁴, Sung Hee Chang⁵, Byoung Lo Jin⁶, Eun Joo Lee⁷, Baek Nam Kim⁸, Min Kyoung Kim⁹, Kihyun Doo¹⁰, Ju Hee Seo¹¹, Yae Jean Kim¹², Yeo Jin Kim¹³, Ji Young Park¹⁴, Sun Bok Suh¹⁵, Hyunju Lee¹⁶, Eun Young Cho¹⁷, Dong Hyun Kim¹⁸, Jong Min Kim¹⁹, Hye Young Kim²⁰, Su Eun Park²¹, Joon Kee Lee²², Dae Sun Jo²³, Seung Man Cho²⁴, Jae Hong Choi²⁵, Kyo Jin Jo²¹, Young June Choe²⁶, Ki Hwan Kim²⁷, Shuiqing Chi²⁸, Shao-Tao Tang²⁸, Huan Qin²⁹, Li Shan Zhou², Peng Chen³⁰, Joshua Sung Chih Wong³¹, Kate Ching Ching Chan³², Felix Yat Sun Yau³³, Shu Yan Lam³⁴, Calvin Chit Kwong Chow³⁵, Tak Wai Wong³⁶, Victor Chi-Man Chan³⁷, Grace Wing Kit Poon^{1

38}, Chun Bong Chow^{1

30}, Wilfred H S Wong¹, Yu Lung Lau¹, Godfrey Chi Fung Chan¹, Celine S L Chui^{1

39}, Xue Li^{39

40}, Marco Hok Kung Ho¹, Ian C K Wong^{39

41}, Paul Kwong Hang Tam^{42

43}, Kelvin K W To⁴⁴, Jong Hyun Kim⁴⁵, Patrick Ip¹, Mike Yat Wah Kwan³⁰

Affiliations

¹ Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, People's Republic of China.
² Department of Integrated Chinese and Western Medicine, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
³ Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
⁴ Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
⁵ Department of Pediatrics, Seoul Medical Center, Seoul, Korea.
⁶ Department of Pediatrics, Hongseong Medical Center, Hongseong, Korea.
⁷ Department of Pediatrics, Seongnam Citizens Medical Center, Seongnam, Korea.
⁸ Department of Pediatrics, Gyeonggi Provincial Medical Center Ansung Hospital, Ansung, Korea.
⁹ Department of Pediatrics, Seonam Hospital, Seoul, Korea.
¹⁰ Department of Pediatrics, Gyeonggi Provincial Medical Center Icheon Hospital, Icheon, Korea.
¹¹ Department of Pediatrics, Dankook University Hospital, Cheonan, Korea.
¹² Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
¹³ Department of Pediatrics, Masan Medical Center, Changwon, Korea.
¹⁴ Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea.
¹⁵ Department of Pediatrics, Busan Medical Center, Busan, Korea.
¹⁶ Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
¹⁷ Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea.
¹⁸ Department of Pediatrics, Inha University Hospital, Incheon, Korea.
¹⁹ Department of Pediatrics, Myongji Hospital, Goyang, Korea.
²⁰ Department of Pediatrics, Pusan National University Hospital, Busan, Korea.
²¹ Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea.
²² Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Korea.
²³ Department of Pediatrics, Jeonbuk National University Medical School, Jeonju, Korea.
²⁴ Department of Pediatrics, Dongguk University College of Medicine, Gyeongju, Korea.
²⁵ Department of Pediatrics, Jeju National University Hospital, Jeju, Korea.
²⁶ Department of Social and Preventive Medicine, Hallym University College of Medicine, Chuncheon, Korea.
²⁷ Department of Pediatrics, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea.
²⁸ Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
²⁹ Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
³⁰ Department of Respiratory Medicine, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
³¹ Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, People's Republic of China.
³² Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
³³ Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, People's Republic of China.
³⁴ Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong, People's Republic of China.
³⁵ Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong, People's Republic of China.
³⁶ Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, People's Republic of China.
³⁷ Department of Paediatrics and Adolescent Medicine, Pamela Youle Nethersole Eastern Hospital, Hong Kong, People's Republic of China.
³⁸ Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong, People's Republic of China.
³⁹ Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, People's Republic of China.
⁴⁰ Department of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China.
⁴¹ Research Department of Practice and Policy, UCL School of Pharmacy, University College, London, UK.
⁴² Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Hong Kong, People's Republic of China.
⁴³ Dr. Li Dak Sum Research Centre, The University of Hong Kong-Karolinska, Institute Collaboration in Regenerative Medicine, The University of Hong Kong, Hong Kong, People's Republic of China.
⁴⁴ Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China.
⁴⁵ Department of Pediatrics, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.

PMID: 33138739
PMCID: PMC7723019
DOI: 10.1080/22221751.2020.1846462

COVID-19 in children across three Asian cosmopolitan regions

Gilbert T Chua et al. Emerg Microbes Infect. 2020 Dec.

. 2020 Dec;9(1):2588-2596.

doi: 10.1080/22221751.2020.1846462.

Authors

Affiliations

¹ Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, People's Republic of China.
² Department of Integrated Chinese and Western Medicine, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
³ Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
⁴ Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
⁵ Department of Pediatrics, Seoul Medical Center, Seoul, Korea.
⁶ Department of Pediatrics, Hongseong Medical Center, Hongseong, Korea.
⁷ Department of Pediatrics, Seongnam Citizens Medical Center, Seongnam, Korea.
⁸ Department of Pediatrics, Gyeonggi Provincial Medical Center Ansung Hospital, Ansung, Korea.
⁹ Department of Pediatrics, Seonam Hospital, Seoul, Korea.
¹⁰ Department of Pediatrics, Gyeonggi Provincial Medical Center Icheon Hospital, Icheon, Korea.
¹¹ Department of Pediatrics, Dankook University Hospital, Cheonan, Korea.
¹² Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
¹³ Department of Pediatrics, Masan Medical Center, Changwon, Korea.
¹⁴ Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea.
¹⁵ Department of Pediatrics, Busan Medical Center, Busan, Korea.
¹⁶ Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
¹⁷ Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea.
¹⁸ Department of Pediatrics, Inha University Hospital, Incheon, Korea.
¹⁹ Department of Pediatrics, Myongji Hospital, Goyang, Korea.
²⁰ Department of Pediatrics, Pusan National University Hospital, Busan, Korea.
²¹ Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea.
²² Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Korea.
²³ Department of Pediatrics, Jeonbuk National University Medical School, Jeonju, Korea.
²⁴ Department of Pediatrics, Dongguk University College of Medicine, Gyeongju, Korea.
²⁵ Department of Pediatrics, Jeju National University Hospital, Jeju, Korea.
²⁶ Department of Social and Preventive Medicine, Hallym University College of Medicine, Chuncheon, Korea.
²⁷ Department of Pediatrics, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea.
²⁸ Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
²⁹ Institute of Maternal and Child Health, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
³⁰ Department of Respiratory Medicine, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
³¹ Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, People's Republic of China.
³² Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
³³ Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, People's Republic of China.
³⁴ Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong, People's Republic of China.
³⁵ Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong, People's Republic of China.
³⁶ Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, People's Republic of China.
³⁷ Department of Paediatrics and Adolescent Medicine, Pamela Youle Nethersole Eastern Hospital, Hong Kong, People's Republic of China.
³⁸ Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong, People's Republic of China.
³⁹ Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, People's Republic of China.
⁴⁰ Department of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China.
⁴¹ Research Department of Practice and Policy, UCL School of Pharmacy, University College, London, UK.
⁴² Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Hong Kong, People's Republic of China.
⁴³ Dr. Li Dak Sum Research Centre, The University of Hong Kong-Karolinska, Institute Collaboration in Regenerative Medicine, The University of Hong Kong, Hong Kong, People's Republic of China.
⁴⁴ Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China.
⁴⁵ Department of Pediatrics, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.

PMID: 33138739
PMCID: PMC7723019
DOI: 10.1080/22221751.2020.1846462

Abstract

ABSTRACT As another wave of COVID-19 outbreak has approached in July 2020, a larger scale COVID-19 pediatric Asian cohort summarizing the clinical observations is warranted. Children confirmed with COVID-19 infection from the Republic of Korea, the Hong Kong Special Administrative Region (HKSAR) and Wuhan, China, during their first waves of local outbreaks were included. Their clinical characteristics and the temporal sequences of the first waves of local paediatric outbreaks were compared. Four hundred and twenty three children with COVID-19 were analyzed. Wuhan had the earliest peak, followed by Korea and HKSAR. Compared with Korea and Wuhan, patients in HKSAR were significantly older (mean age: 12.9 vs. 10.8 vs. 6.6 years, p < 0.001, respectively) and had more imported cases (87.5% vs. 16.5% vs. 0%, p < 0.001, respectively). The imported cases were also older (13.4 vs. 7.6 years, p < 0.001). More cases in HKSAR were asymptomatic compared to Korea and Wuhan (45.5% vs. 22.0% vs. 20.9%, p < 0.001, respectively), and significantly more patients from Wuhan developed fever (40.6% vs. 29.7% vs. 21.6%, p=0.003, respectively). There were significantly less imported cases than domestic cases developing fever after adjusting for age and region of origin (p = 0.046). 5.4% to 10.8% of patients reported anosmia and ageusia. None developed pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PMIS-TS). In general, adolescents were more likely to be asymptomatic and less likely to develop fever, but required longer hospital stays. In conclusion, majority patients in this pediatric Asian cohort had a mild disease. None developed PIMS-TS. Their clinical characteristics were influenced by travel history and age.

Keywords: Asia; COVID-19; age-stratified; children; travel history.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

**Figure 1.**
Distribution of the admission in domestic and imported pediatric COVID-19 cases in the Republic of Korea, and Hong Kong SAR and Wuhan during the first wave of COVID-19.

See this image and copyright information in PMC

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COVID-19 in children across three Asian cosmopolitan regions

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COVID-19 in children across three Asian cosmopolitan regions

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