Fatal SARS-CoV-2 Infection among Children, Japan, January-September 20221

Abstract

To determine the characteristics of pediatric patients 0-19 years of age who died after onset of SARS-CoV-2 infection in Japan during January 1-September 30, 2022, we reviewed multiple sources. We identified 62 cases, collected detailed information from medical records and death certificates, and conducted interviews, resulting in 53 patients with detailed information for our study. Among 46 patients with internal causes of death (i.e., not external causes such as trauma), 15% were <1 year of age, 59% had no underlying disease, and 88% eligible for vaccination were unvaccinated. Nonrespiratory symptoms were more common than respiratory symptoms. Out-of-hospital cardiac arrest affected 46% of patients, and time from symptom onset to death was <7 days for 77%. Main suspected causes of death were central nervous system abnormalities (35%) and cardiac abnormalities (20%). We recommend careful follow-up of pediatric patients after SARS-CoV-2 infection during the first week after symptom onset, regardless of underlying diseases.

Keywords: 2019 novel coronavirus disease; COVID-19; Japan; SARS-CoV-2; children; coronavirus disease; death; encephalopathy; myocarditis; pediatrics; respiratory infections; severe acute respiratory syndrome coronavirus 2; underlying disease; viruses; zoonoses.

Figure 1

Number of reported fatal cases after COVID-19 among 61 children 0–19 years of age, by week of symptom onset or diagnosis, Japan, January–September 2022, and number of reported COVID-19 cases among patients of all ages. Excludes 1 patient for whom date of symptom onset and date of diagnosis of COVID-19 were unknown. Date of symptom onset for the 61 pediatric patients was January 1, 2022 (epidemiologic week 52, 2021) through September 30, 2022 (epidemiologic week 39, 2022). Bars denote the number of reported fatal pediatric cases (left axis); line denotes the numbers of COVID-19 patients of all ages reported by the Ministry of Health, Labour and Welfare (right axis). Scales for the y-axes differ substantially to underscore patterns but do not permit direct comparisons.

Figure 2

Patient selection in study of fatal SARS-CoV-2 infection among children, Japan, January–September 2022. CNS, central nervous system.

Figure 3

Distribution of symptoms before admission or death in outpatient settings in study of fatal SARS-CoV-2 infection among children, Japan, January–September 2022 (n = 46). Data account for multiple symptoms in some patients.