Prospective characterisation of SARS-CoV-2 infections among children presenting to tertiary paediatric hospitals across Australia in 2020: a national cohort study

doi:10.1136/bmjopen-2021-054510

Multicenter Study

. 2021 Nov 8;11(11):e054510.

doi: 10.1136/bmjopen-2021-054510.

Prospective characterisation of SARS-CoV-2 infections among children presenting to tertiary paediatric hospitals across Australia in 2020: a national cohort study

Danielle Wurzel^{1

2

3}, Alissa McMinn⁴, Monsurul Hoq⁵, Christopher C Blyth^{6

7

8}, David Burgner^{4

9

10}, Shidan Tosif^{4

9

11}, Jim Buttery^{4

9}, Jeremy Carr^{12

13}, Julia E Clark¹⁴, Allen C Cheng^{15

16}, Nicole Dinsmore¹⁷, Joshua Reginald Francis^{18

19}, Anne Kynaston²⁰, Ryan Lucas²¹, Helen Marshall^{22

23}, Brendan McMullan^{24

25

26}, Davinder Singh-Grewal^{25

27

28}, Nicholas Wood^{29

30}, Kristine Macartney^{28

29

31}, Phil N Britton^{31

32}, Nigel W Crawford^{4

9

11}

Affiliations

¹ Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia danielle.wurzel@unimelb.edu.au.
² Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
³ Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
⁴ Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
⁵ Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
⁶ Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
⁷ Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.
⁸ Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia.
⁹ Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁰ Department of Infectious Diseases, The Royal Children's Hospital, Parkville, Victoria, Australia.
¹¹ General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
¹² Department of Infection and Immunity, Monash Children's Hospital, Clayton, Victoria, Australia.
¹³ Department of Paediatrics, University of Oxford, Oxford, UK.
¹⁴ Infectious Diseases, Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia.
¹⁵ Infectious Disease Epidemiology Unit - School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
¹⁶ Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia.
¹⁷ National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Westmead, New South Wales, Australia.
¹⁸ Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia.
¹⁹ Department of Paediatrics, Royal Darwin Hospital, Casuarina, Northern Territory, Australia.
²⁰ Queensland Children's Hospital, South Brisbane, Queensland, Australia.
²¹ General Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
²² Discipline of Paediatrics, Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
²³ Vaccinology and Immunology Research Trials Unit, The Women's and Children's Health Network, Adelaide, South Australia, Australia.
²⁴ Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.
²⁵ School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
²⁶ National Centre for Infections in Cancer, University of Melbourne, Melbourne, Victoria, Australia.
²⁷ Department of Rheumatology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.
²⁸ Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.
²⁹ National Centre for Immunisation Research and Surveillance, The Children's Hospital, Westmead, New South Wales, Australia.
³⁰ The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
³¹ Department Infectious Diseases and Microbiology, Children's Hospital Westmead, Sydney, New South Wales, Australia.
³² Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.

PMID: 34750151
PMCID: PMC8576200
DOI: 10.1136/bmjopen-2021-054510

Multicenter Study

Prospective characterisation of SARS-CoV-2 infections among children presenting to tertiary paediatric hospitals across Australia in 2020: a national cohort study

Danielle Wurzel et al. BMJ Open. 2021.

. 2021 Nov 8;11(11):e054510.

doi: 10.1136/bmjopen-2021-054510.

Authors

Affiliations

¹ Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia danielle.wurzel@unimelb.edu.au.
² Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
³ Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
⁴ Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
⁵ Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
⁶ Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
⁷ Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.
⁸ Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia.
⁹ Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁰ Department of Infectious Diseases, The Royal Children's Hospital, Parkville, Victoria, Australia.
¹¹ General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
¹² Department of Infection and Immunity, Monash Children's Hospital, Clayton, Victoria, Australia.
¹³ Department of Paediatrics, University of Oxford, Oxford, UK.
¹⁴ Infectious Diseases, Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia.
¹⁵ Infectious Disease Epidemiology Unit - School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
¹⁶ Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia.
¹⁷ National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Westmead, New South Wales, Australia.
¹⁸ Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia.
¹⁹ Department of Paediatrics, Royal Darwin Hospital, Casuarina, Northern Territory, Australia.
²⁰ Queensland Children's Hospital, South Brisbane, Queensland, Australia.
²¹ General Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
²² Discipline of Paediatrics, Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
²³ Vaccinology and Immunology Research Trials Unit, The Women's and Children's Health Network, Adelaide, South Australia, Australia.
²⁴ Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.
²⁵ School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
²⁶ National Centre for Infections in Cancer, University of Melbourne, Melbourne, Victoria, Australia.
²⁷ Department of Rheumatology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.
²⁸ Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.
²⁹ National Centre for Immunisation Research and Surveillance, The Children's Hospital, Westmead, New South Wales, Australia.
³⁰ The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
³¹ Department Infectious Diseases and Microbiology, Children's Hospital Westmead, Sydney, New South Wales, Australia.
³² Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.

PMID: 34750151
PMCID: PMC8576200
DOI: 10.1136/bmjopen-2021-054510

Abstract

Objective: To present Australia-wide data on paediatric COVID-19 and multisystem inflammatory syndromes to inform health service provision and vaccination prioritisation.

Design: Prospective, multicentre cohort study.

Setting: Eight tertiary paediatric hospitals across six Australian states and territories in an established research surveillance network-Paediatric Active Enhanced Disease (PAEDS).

Participants: All children aged <19 years with SARS-CoV-2 infection including COVID-19, Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS) and Kawasaki-like disease TS infection (KD-TS) treated at a PAEDS site from 24 March 2020 to 31 December 2020.

Intervention: Laboratory-confirmed SARS-CoV-2 infection.

Main outcome: Incidence of severe disease among children with COVID-19, PIMS-TS and KD-TS. We also compared KD epidemiology before and during the COVID-19 pandemic.

Results: Among 386 children with SARS-CoV-2 infection, 381 (98.7%) had COVID-19 (median 6.3 years (IQR 2.1-12.8),53.3% male) and 5 (1.3%) had multisystem inflammatory syndromes (PIMS-TS, n=4; KD-TS, n=1) (median 7.9 years (IQR 7.8-9.8)). Most children with COVID-19 (n=278; 73%) were Australian-born from jurisdictions with highest community transmission. Comorbidities were present in 72 (18.9%); cardiac and respiratory comorbidities were most common (n=32/72;44%). 37 (9.7%) children with COVID-19 were hospitalised, and two (0.5%) required intensive care. Postinfective inflammatory syndromes (PIMS-TS/KD-TS) were uncommon (n=5; 1.3%), all were hospitalised and three (3/5; 60%) required intensive care management. All children recovered and there were no deaths. KD incidence remained stable during the pandemic compared with prepandemic.

Conclusions: Most children with COVID-19 had mild disease. Severe disease was less frequent than reported in high prevalence settings. Preventative strategies, such as vaccination, including children and adolescents, could reduce both the acute and postinfective manifestations of the disease.

Keywords: COVID-19; epidemiology; paediatric infectious disease & immunisation; paediatrics; public health; virology.

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Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Comorbidities among children (n=72 of 381) with COVID-19.

**Figure 2**
Heatmap showing tetrachoric correlation coefficient between two symptoms (n=187) demonstrating clustering of symptoms such as anosmia and muscle pain among the symptoms with minimum 10 patients.

**Figure 3**
Epidemiology of Kawasaki disease (KD) prior to and during the COVID-19 pandemic with absolute numbers of COVID-19 (orange bars), (KD, grey bars), PIMS-TS (blue bars) and KD-TS (red bars) cases and 3 months moving average illustrating KD cases remained stable during 2020 in comparison to 2019. PIMS-TS, Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 infection.

See this image and copyright information in PMC

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References

1. World Health organization (who): coronavirus (COVID-19) Dashboard, 2021. Available: https://covid19.who.int/ [Accessed 7 Sep 2021].
1. Australia Government Department of Health . Coronaviruses (COVID-19) resources for the general public, 2021. Available: https://www.health.gov.au/resources/collections/novel-coronavirus-2019-n... [Accessed 27 Mar 2021].
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1. Paediatric active enhanced disease surveillance: an NCIRS led collaboration. Available: https://www.paeds.org.au/

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[1] World Health organization (who): coronavirus (COVID-19) Dashboard, 2021. Available: https://covid19.who.int/ [Accessed 7 Sep 2021].

[2] World Health organization (who): coronavirus (COVID-19) Dashboard, 2021. Available: https://covid19.who.int/ [Accessed 7 Sep 2021].

[3] Australia Government Department of Health . Coronaviruses (COVID-19) resources for the general public, 2021. Available: https://www.health.gov.au/resources/collections/novel-coronavirus-2019-n... [Accessed 27 Mar 2021].

[4] Australia Government Department of Health . Coronaviruses (COVID-19) resources for the general public, 2021. Available: https://www.health.gov.au/resources/collections/novel-coronavirus-2019-n... [Accessed 27 Mar 2021].

[5] Victoria state government, department of health and human services. Available: https://www.dhhs.vic.gov.au/wastewater-testing-covid-19#wastewater-testi...

[6] Victoria state government, department of health and human services. Available: https://www.dhhs.vic.gov.au/wastewater-testing-covid-19#wastewater-testi...

[7] Australian Government Department of Health . National notifiable diseases surveillance system. notifications of COVID-19 2020, 2021. Available: http://www9.health.gov.au/cda/source/rpt_5.cfm

[8] Australian Government Department of Health . National notifiable diseases surveillance system. notifications of COVID-19 2020, 2021. Available: http://www9.health.gov.au/cda/source/rpt_5.cfm

[9] Paediatric active enhanced disease surveillance: an NCIRS led collaboration. Available: https://www.paeds.org.au/

[10] Paediatric active enhanced disease surveillance: an NCIRS led collaboration. Available: https://www.paeds.org.au/

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Prospective characterisation of SARS-CoV-2 infections among children presenting to tertiary paediatric hospitals across Australia in 2020: a national cohort study

Affiliations

Prospective characterisation of SARS-CoV-2 infections among children presenting to tertiary paediatric hospitals across Australia in 2020: a national cohort study

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Conflict of interest statement

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