Review

. 2022 Jan;58(1):46-53.

doi: 10.1111/jpc.15811. Epub 2021 Oct 25.

COVID-19 in children. II: Pathogenesis, disease spectrum and management

Annaleise R Howard-Jones^{1

2}, David P Burgner^{3

4

5}, Nigel W Crawford^{4

5

6}, Emma Goeman⁷, Paul E Gray^{8

9}, Peter Hsu^{1

10}, Stephanie Kuek¹¹, Brendan J McMullan^{8

9}, Shidan Tosif^{4

5

6}, Danielle Wurzel^{4

11

12}, Asha C Bowen^{13

14}, Margie Danchin^{4

5

6}, Archana Koirala^{1

15

16}, Ketaki Sharma^{1

15}, Daniel K Yeoh^{13

17}, Philip N Britton^{1

18}

Affiliations

¹ Discipline of Child and Adolescent Health, University of Sydney, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
² NSW Health Pathology-Nepean, Nepean Hospital, Sydney, New South Wales, Australia.
³ Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.
⁴ Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
⁵ Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
⁶ Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.
⁷ Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
⁸ Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.
⁹ School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
¹⁰ Department of Immunology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
¹¹ Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.
¹² School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
¹³ Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.
¹⁴ Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
¹⁵ National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
¹⁶ Department of Infectious Diseases, Nepean Hospital, Penrith, New South Wales, Australia.
¹⁷ Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁸ Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.

PMID: 34694037
PMCID: PMC8662268
DOI: 10.1111/jpc.15811

Review

COVID-19 in children. II: Pathogenesis, disease spectrum and management

Annaleise R Howard-Jones et al. J Paediatr Child Health. 2022 Jan.

. 2022 Jan;58(1):46-53.

doi: 10.1111/jpc.15811. Epub 2021 Oct 25.

Authors

Affiliations

¹ Discipline of Child and Adolescent Health, University of Sydney, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
² NSW Health Pathology-Nepean, Nepean Hospital, Sydney, New South Wales, Australia.
³ Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.
⁴ Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
⁵ Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
⁶ Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.
⁷ Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
⁸ Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.
⁹ School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
¹⁰ Department of Immunology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
¹¹ Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.
¹² School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
¹³ Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.
¹⁴ Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
¹⁵ National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
¹⁶ Department of Infectious Diseases, Nepean Hospital, Penrith, New South Wales, Australia.
¹⁷ Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁸ Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.

PMID: 34694037
PMCID: PMC8662268
DOI: 10.1111/jpc.15811

Abstract

The global disruption of the COVID-19 pandemic has impacted the life of every child either directly or indirectly. This review explores the pathophysiology, immune response, clinical presentation and treatment of COVID-19 in children, summarising the most up-to-date data including recent developments regarding variants of concern. The acute infection with SARS-CoV-2 is generally mild in children, whilst the post-infectious manifestations, including paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and 'long COVID' in children, are more complex. Given that most research on COVID-19 has focused on adult cohorts and that clinical manifestations, treatment availability and impacts differ markedly in children, research that specifically examines COVID-19 in children needs to be prioritised.

Keywords: COVID-19; PIMS-TS; SARS-CoV-2; management; virology.

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Figures

**Fig 1**
Overall severity of COVID‐19 disease in children., , , The left‐hand panel depicts outcomes from acute COVID‐19 infection; the right‐hand panel represents outcomes from PIMS‐TS in children. Estimates of the proportion hospitalised and those requiring intensive care shown here are higher than are being observed in Australia in 2021 (Hospitalised ~1% for medical reasons and ICU admitted ~0.1% of symptomatic cases; unpublished data, PN Britton).

**Fig 2**
Pharmaceutical agents available for use in severe COVID‐19 disease and important considerations for use in children, based on the principles of Grading of Recommendations, Assessment, Development and Evaluations (GRADE). These considerations are reflective of advice current on 5 October 2021, which is updated regularly. The reader is directed to the most up‐to‐date recommendations at (), Recommended; (), conditional recommendation; (), conditional recommendation *against*; (), not recommended.

formula image — **Fig 2**
Pharmaceutical agents available for use in severe COVID‐19 disease and important considerations for use in children, based on the principles of Grading of Recommendations, Assessment, Development and Evaluations (GRADE). These considerations are reflective of advice current on 5 October 2021, which is updated regularly. The reader is directed to the most up‐to‐date recommendations at (), Recommended; (), conditional recommendation; (), conditional recommendation *against*; (), not recommended.

See this image and copyright information in PMC

References

1. World Health Organization . Weekly Epidemiological Update on COVID‐19: Edition 50. Geneva: WHO; 2021.
1. Wu F, Zhao S, Yu B et al. A new coronavirus associated with human respiratory disease in China. Nature 2020; 579: 265–9. - PMC - PubMed
1. Sharma K, Koirala A, Nicolopoulos K, Chiu C, Wood N, Britton PN. Vaccines for COVID‐19: Where do we stand in 2021? Paediatr. Respir. Rev. 2021; 39: 22–31. - PMC - PubMed
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COVID-19 in children. II: Pathogenesis, disease spectrum and management

Affiliations

COVID-19 in children. II: Pathogenesis, disease spectrum and management

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Supplementary concepts

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous