Systematic review of COVID ‐ 19 in children shows milder cases and a better prognosis than adults
A systematic literature review was conducted to identify articles on COVID ‐ 19, using the MEDLINE and Embase databases between January 1 and March 18, 2020. The search identified 45 relevant articles.
Children, who represent 1-5% of diagnosed cases of COVID-19, have milder symptoms than adults, and deaths have been extremely rare. Diagnostic findings are similar in adults, with a prevalence of fever and respiratory symptoms, but fewer children have developed severe pneumonia.
Elevated inflammatory markers are less common in children, and lymphocytopenia appears rare. Infants have developed symptomatic COVID-19, but evidence of vertical intrauterine transmission is still scarce.
- Suggested treatment includes oxygen supply, inhalations, nutritional support, and maintenance of fluid and electrolyte balances.
- February 24, 2020. JAMA.
- Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention.
The article from the Chinese Center for Disease Control and Prevention reports that out of 72,314 cases, less than 1% concern children under the age of 10 and another 1% between 10 and 19 years old.
The description of the clinical features of the confirmed cases has so far been based on a few hundred children and adolescents under the age of 18: 35% were asymptomatic or had only an upper respiratory infection, the remaining 65% were diagnosed with pneumonia.
However, since these are mostly hospital cases or in any case of subjects in close contact with symptomatic family cases, it is presumed that asymptomatic and mild infections were – and are also in our reality – many more.
This is important because children may be or have been more likely to be vehicles of infection than adults, particularly for older people (grandparents).
As for the symptoms, as in the adult there is fever, but in the child it is not high, often <38 ° C, respiratory symptoms (nasal congestion, cough, shortness of breath but the latter infrequent) and – perhaps more characteristic of children – gastrointestinal symptoms such as vomiting and diarrhea. After all, COVID-19 has also been found in feces and children, due to their lifestyle, could more easily become infected even via the fecal-oral route.
- Children’s multisystem inflammatory syndrome (MIS-C) is a severe postinfectious hyperinflammatory condition, typically occurring 2-6 weeks after a typically mild or asymptomatic SARS-CoV-2 infection.
- Recent evidence suggests that COVID-19 vaccination is associated with a lower incidence of MIS-C among adolescents; however, the real-world efficacy of the Pfizer-BioNTech 2-dose regimen against MIS-C has not been evaluated.
Patients with MIS-C and two hospitalized control groups matched to case-patients were evaluated: negative test controls had at least one symptom similar to COVID-19 and negative RT-PCR or antigen test results and negative controls for syndrome were hospitalized patients without COVID-19-like disease.
Among 102 MIS-C patients and 181 hospitalized controls, the estimated efficacy of 2 doses of Pfizer-BioNTech vaccine against MIS-C was 91% (95% CI = 78% -97%). All 38 MIS-C patients who required life support were not vaccinated. Administration of 2 doses of the Pfizer-BioNTech vaccine is associated with a high level of protection against MIS-C in people aged 12 to 18, highlighting the importance of vaccination among all eligible children.
Treatment of multisystem inflammatory syndrome in children
June 16. Nejm. Treatment of Multisystem Inflammatory Syndrome in Children
An observational cohort study evaluated immunomodulatory therapy of multisystem inflammatory syndrome in children by comparing intravenous immunoglobulin (IVIG), IVIG plus glucocorticoids or glucocorticoids alone. The researchers found no evidence of the superiority of any of the three therapies, although significant differences may emerge as more data accumulate.