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. 2022 Oct 25;11(10):440-447.
doi: 10.1093/jpids/piac068.

Severity of Illness Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Variants of Concern in Children: A Single-Center Retrospective Cohort Study

Priya R Edward  1 , Ramon Lorenzo-Redondo  2   3 , Megan E Reyna  1 , Lacy M Simons  2   3 , Judd F Hultquist  2   3 , Ami B Patel  1   2 , Egon A Ozer  2   3 , William J Muller  1   2 , Taylor Heald-Sargent  1   2 , Matthew McHugh  1 , Taylor Dean  2   3 , Raj M Dalal  2 , Jordan John  2 , Shannon C Manz  2 , Larry K Kociolek  1   2
Affiliations

Severity of Illness Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Variants of Concern in Children: A Single-Center Retrospective Cohort Study

Priya R Edward et al. J Pediatric Infect Dis Soc. .

Abstract

Background: Recent COVID-19 surges are attributed to emergence of more transmissible SARS-CoV-2 variants of concern (VOCs). The relative severity of VOCs in children is unknown.

Methods: We performed a single-center retrospective cohort study of children ≤18 years old diagnosed with COVID-19 from October 2020-February 2022 and whose SARS-CoV-2 isolate underwent Illumina sequencing. We measured the frequency of five markers of COVID-19 severity. Logistic regression models were fitted to estimate the odds of each severity marker with each VOC.

Results: Among 714 children, 471 (66.0%) were infected with a VOC: 96 (13.4%) alpha, 38 (5.3%) gamma, 119 (16.7%) delta, and 215 (30.1%) omicron. High-risk medical conditions and increasing age were independently associated with COVID-19 severity. After adjusting for age, race, ethnicity, high-risk medical conditions, and COVID-19 community incidence, neither alpha, delta, nor omicron was associated with severe COVID-19. Gamma was independently associated with hospitalization (OR 6.7, 95% CI 2.0-22.1); pharmacologic treatment (OR 5.7, 95% CI 1.2-26.8); respiratory support (OR 11.9, 95% CI 2.7-62.4); and severe disease per the WHO Clinical Progression Scale (OR 11.7, 95% CI 2.1-90.5). Upon subgroup analyses, omicron was independently associated with ICU admission and severe disease per the WHO Clinical Progression Scale in children without SARS-CoV-2 immunization or prior COVID-19 infection.

Conclusions: Compared to non-VOC COVID-19, the gamma VOC was independently associated with increased COVID-19 severity, as was omicron in children without SARS-CoV-2 immunization or prior COVID-19 infection. SARS-CoV-2 vaccination and prior COVID-19 prevented severe outcomes during the omicron surge.

Keywords: COVID-19; SARS-CoV-2; children; outcomes; severity.

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Figures

Figure 1.
Figure 1.
SARS-CoV-2 molecular epidemiology. proportions (A) and frequencies (B) of lineages of SARS-CoV-2 identified in pediatric patients during 16-month study period (October 2020–February 2022). Lineages are listed in the legend in chronological order of their emergence/classification.
Figure 2.
Figure 2.
Predictor effect displays for the multivariable logistic regressions fitted for various COVID-19 severity markers in a pediatric cohort. The effect plots illustrate the adjusted probabilities of each marker for the VOC variable. Compared with Non-VOC COVID-19 infections, infections caused by the gamma VOC were significantly more likely to be associated with hospitalization for COVID-19, COVID-19 pharmacologic treatment, respiratory support, and WHO Clinical Progression Scale score ≥6 (Odds ratios listed in Table 2). Alpha, delta, and omicron infections did not significantly differ from non-VOC infections for any severity marker.
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References

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