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Meta-Analysis
. 2023 Aug 25:14:1159269.
doi: 10.3389/fimmu.2023.1159269. eCollection 2023.

The impact of immunocompromise on outcomes of COVID-19 in children and young people-a systematic review and meta-analysis

James Greenan-Barrett  1 , Samuel Aston  2 , Claire T Deakin  3   4   5 , Coziana Ciurtin  3   6
Affiliations
Meta-Analysis

The impact of immunocompromise on outcomes of COVID-19 in children and young people-a systematic review and meta-analysis

James Greenan-Barrett et al. Front Immunol. .

Abstract

Background: Despite children and young people (CYP) having a low risk for severe coronavirus disease 2019 (COVID-19) outcomes, there is still a degree of uncertainty related to their risk in the context of immunodeficiency or immunosuppression, primarily due to significant reporting bias in most studies, as CYP characteristically experience milder or asymptomatic COVID-19 infection and the severe outcomes tend to be overestimated.

Methods: A comprehensive systematic review to identify globally relevant studies in immunosuppressed CYP and CYP in general population (defined as younger than 25 years of age) up to 31 October 2021 (to exclude vaccinated populations) was performed. Studies were included if they reported the two primary outcomes of our study, admission to intensive therapy unit (ITU) and mortality, while data on other outcomes, such as hospitalization and need for mechanical ventilation were also collected. A meta-analysis estimated the pooled proportion for each severe COVID-19 outcome, using the inverse variance method. Random effects models were used to account for interstudy heterogeneity.

Findings: The systematic review identified 30 eligible studies for each of the two populations investigated: immunosuppressed CYP (n = 793) and CYP in general population (n = 102,022). Our meta-analysis found higher estimated prevalence for hospitalization (46% vs. 16%), ITU admission (12% vs. 2%), mechanical ventilation (8% vs. 1%), and increased mortality due to severe COVID-19 infection (6.5% vs. 0.2%) in immunocompromised CYP compared with CYP in general population. This shows an overall trend for more severe outcomes of COVID-19 infection in immunocompromised CYP, similar to adult studies.

Interpretation: This is the only up-to-date meta-analysis in immunocompromised CYP with high global relevance, which excluded reports from hospitalized cohorts alone and included 35% studies from low- and middle-income countries. Future research is required to characterize individual subgroups of immunocompromised patients, as well as impact of vaccination on severe COVID-19 outcomes.

Systematic review registration: PROSPERO identifier, CRD42021278598.

Keywords: COVID - 19; ITU - (intensive therapy unit); children; death; hospitalization; immunosuppression; young people.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow charts for all studies in the systematic analysis. (A) studies of immunocompromised CYP (B) general population studies of CYP. CYP, children and young people; ITU, Intensive Therapy Unit.
Figure 2
Figure 2
Estimated proportions of COVID–19 outcomes of interest in immunocompromised CYP (random effects model, 95% CI), (A) Hospitalization (B) Admission to ITU (C) Mechanical ventilation (D) Death. CI, confidence interval; CYP, children young people; ITU, intensice therapy unit.
Figure 3
Figure 3
Estimated proportions of Covid–19 outcomes of interest inCYP in the general population (random effects model, 95% CI) (A) Hospitalization (B) Admission to ITU (C) Mechanical ventilation (D) Death. CI, confidence interval; CYP, children and young people; ITU, intensive therapy unit.
See this image and copyright information in PMC

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