What children are infected with Omicron and are prone to serious illness?
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What children are infected with Omicron and are prone to serious illness?
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What children are infected with Omicron and are prone to serious illness?
In the past month, Taiwan has successively reported two tragedies in which young children were diagnosed with the COVID-19 and died.
One of the cases occurred on May 14. The young child was only 2 years old and had a fever of 42.4°C. After being sent to the hospital, he was suspected of having viral encephalitis and was advised to be transferred to a hospital for treatment as soon as possible.
Doctors and family members asked 5 hospitals in one night, and it took 6 hours to finally find a hospital for treatment. The next day, the child passed away.
Earlier, another 2-year-old boy became unwell the day after the infection. After being sent to the hospital, the boy died of serious illness after 6 days of rescue.
The main epidemic strain in this round of epidemics in Taiwan is the Omicron subline BA.2. Yih-Giun Cherng, director of the local Shuangho Hospital, said in an interview that Omicron infection progressed very quickly, rare and serious in the above-mentioned sick children. “This has not happened when treating children in the past.”
“For children, Omi Kron is not a clever tiger, but an auntie tiger. The epidemic has just begun in children, and the acute and critical illness has already turned on the red light. I can’t imagine the situation when the peak comes.” Recently, Taiwanese media quoted Taiwan National Taiwan University. Li Jianzhang, a clinical professor of the hospital’s emergency medicine department, said in a Facebook article that Omicron was particularly ferocious towards children.
Infections in children develop into severe disease: Is there a “high-risk sign”?
A series of laboratory and real-world data suggest that Omicron is less toxic than Delta.
On November 24, 2021, South Africa first reported the discovery of Omicron to the World Health Organization (WHO) .
Two months later, the country’s study showed that the proportion of people hospitalized and in need of oxygen-assisted treatment had dropped from 74 percent in Delta to 17.6 percent in Omicron.
But Omicron is very transmissible, which will lead to a rapid increase in the number of patients.
Data from many countries show that children and young children with less infection and mild illness in the past have become the hardest hit areas that cannot be ignored in the Omicron wave.
The U.S. Centers for Disease Control and Prevention (CDC) found that the rate of hospitalizations for children infected with Omicron is higher than that of adults.
At the peak of the infection in Omicron, about 15 out of every 100,000 children under the age of 5 were hospitalized with the infection. This is 5 times the peak delta spread.
Among infants 6 months of age and younger, the hospitalization rate for infection with Omicron was 68 per 100,000. During the delta transmission period, the associated hospitalization rate was 11 per 100,000 population.
Weekly hospitalizations for COVID-19 among Americans aged 0-17 from July 3, 2021 to January 22, 2022. By age group, it is calculated according to the actual number of occurrences per 100,000 people. /CDC
According to CDC analysis, when Omicron becomes the main epidemic strain, about 20% of children aged 5-11 admitted to hospital will develop severe disease and need to be transferred to the intensive care unit (19%) .
Qiu Zhengxun, deputy director of Chang Gung Memorial Hospital in Linkou, Taiwan, pointed out: “This (severe disease) is likely to occur in younger children, or in children with autoimmune diseases or chronic diseases.”
According to the “Consensus Statement on Early Identification of Children with COVID-19 Severe Patients” (hereinafter referred to as the “Statement”) issued by the Taiwan Children’s Emergency Medicine Association in late April, children infected with the following symptoms in the early stage tend to have a higher risk of severe illness, and it is recommended to seek medical treatment as soon as possible. . Including: fever of 39°C; change of consciousness; shallow and rapid breathing, combined with gastrointestinal symptoms such as vomiting and diarrhea.
The “statement” also stated that convulsions, unconsciousness, difficulty breathing / sunken chest, white / purple lips, cold limbs, sluggish eyes / involuntary eye movements, etc., are symptoms of late organ failure, indicating that the child is extremely dangerous. “Early signs, rather than late signs, are recommended as the basis for emergency medical attention or referral. The literature supports better outcomes in children treated early.”
The “statement” reminds parents that there is no need to panic. Only 3% of infected children will develop more serious complications such as pneumonia, myocarditis, encephalitis or sepsis, and the final fatality rate is 0.1%. This is very low relative to adults .
Which children are more likely to be seriously ill?
So, which children are at higher risk for severe illness?
From March 2020 to February 2022, the CDC conducted a study on children aged 0-4 infected with the virus in the country. The results showed that among the 0-4 year olds, the top 8 risk factors were preterm birth, neurological disease, congenital heart disease, chronic lung disease or asthma, immunocompromised, chronic lung disease in premature infants, chronic metabolic disease. Disease, tracheal abnormalities.
At the same time, for children aged 5-11 infected with the virus, if they have “diabetes”, “obesity”, “congenital genetic diseases”, “asthma”, etc., the risk of developing severe disease is higher.
Whether the younger the age is, the greater the risk of severe illness, or vice versa, the scientific community does not have a unified understanding.
“Children under the age of 4 have weak language skills and need to be alerted by primary caregivers.” Li Jianzhang reminded.
A study published earlier this year by the JAMA sub-journal analyzed a total of 3,221 infected children under the age of 18. The results show that the initial symptoms of people in this age group are “lack of specificity” and “similar to a cold” after being infected. Mainly manifested as: cough, runny nose, nasal congestion, phlegm, headache, fever, chest pain, sore throat, muscle pain, joint pain, lethargy, loss of appetite, vomiting, diarrhea, abdominal pain.
Based on this, if you find that your child has “abnormal body temperature” and “respiratory symptoms such as cough and runny nose”, you should think more about whether it is a COVID-19 infection.
East and West children are infected with Omicron: The effects seem to be different
“Doctors have observed that the performance of Omicron in children is significantly different from that of Delta.” Li Jianzhang wrote that the impact of Omicron on children in the East and the West seems to be different.
Huang Limin, director of the National Taiwan University Children’s Hospital in Taiwan, analyzed that recent reports from Hong Kong, China showed that children infected with the virus suddenly developed encephalitis; but this is not the case in Europe and the United States.
Japanese data support this phenomenon. According to data released by the National Academy of Pediatrics, under the Omicron epidemic, the risk of heat cramps in children aged 1-4 years old was three times higher than during the Delta epidemic. The incidence of heat cramps also rose from 0% to 3.5% in diagnosed children aged 5-11 years. Based on this, Japanese pediatricians worry that this may have an impact on children’s brains.
Two 2-year-old dead sick children in Taiwan were also found to have encephalitis.
In addition, infected children aged 5-11 years are at high risk of developing multisystem inflammatory syndrome in children (MIS-C) .
According to the CDC, if children and adolescents have been diagnosed with the COVID-19 in the past 6 weeks, or have had close contact with the confirmed person, once they have persistent fever and one of the following 6 symptoms, it is likely to indicate MIS-C. The six symptoms include stomach pain, diarrhea, vomiting, rash, bloodshot eyes, and dizziness.
Image courtesy of CDC
“The most important thing is prevention, and vaccination has become very important.” Huang Limin pointed out.
April data from the US CDC shows that vaccines have strong protection against hospitalization and severe illness.
During the first few months when the Omicron strain predominated in transmission, 87% of hospitalized children aged 5-11 were unvaccinated.
For the period from December 19, 2021, to February 28, 2022, the hospitalization rate of unvaccinated children aged 5-11 was twice that of vaccinated children of the same age.
At the same time, the rate of use of oxygen support also lower than that of non-vaccinated patients.
On May 17, local time, the U.S. Food and Drug Administration approved Pfizer/BioNTech’s mRNA COVID-19 vaccine booster for children 5-11 years old.
According to a number of people familiar with the matter, the external vaccine experts of the CDC Advisory Committee will hold a meeting on May 19, local time, to decide whether to follow up and approve it.
Clinical trials have shown that compared with the second dose, the level of neutralizing antibodies to the original strain of children in this age group can be increased by 6 times after one month of vaccination with the booster dose.
In many countries in Europe and the United States, there is currently no vaccine approved for use in infants under the age of 5.
This reminds children of the necessity of wearing masks. In addition, everyone around infants and young children must be vaccinated to form a protective wall.
source:
[1] Most children hospitalized with COVID-19 during omicron wave were unvaccinated: CDC study. AAP
[2] Hospitalizations of Children and Adolescents with Laboratory-Confirmed COVID-19—COVID-NET, 14 States, July 2021–January 2022.MMWR Morb Mortal Wkly Rep.2022;71:271–278.doi.org/10.15585/mmwr .mm7107e4
[3]Study:COVID hospitalization for young children 5 times higher during omicron than delta.AAP
Hospitalization of Infants and Children Aged 0–4 Years with Laboratory-Confirmed COVID-19—COVID-NET,14 States,March 2020–February 2022.MMWR Morb Mortal Wkly Rep.2022;71:429–436.doi.org/10.15585 /mmwr.mm7111e2
[4] Hospitalizations of Children Aged 5–11 Years with Laboratory-Confirmed COVID-19—COVID-NET, 14 States, March 2020–February 2022.MMWR Morb Mortal Wkly Rep.2022;71:574-581.doi.org/ 10.15585/mmwr.mm7116e1
[5] Outcomes of SARS-CoV-2–Positive Youths Tested in Emergency Departments.JAMA Netw Open.2022 Jan;5(1):e2142322.doi:10.1001/jamanetworkopen.2021.42322
[6] Taiwan Children’s Emergency Medicine Association Consensus Statement on Early Identification of Children with Severe COVID Patients. Taiwan Children’s Emergency Medicine Association, China
What children are infected with Omicron and are prone to serious illness?
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