Read on Twitter
Ok a few things have been moving in the world of paediatric #COVIDー19 literature
Time for an updated #tweetorial on SARS-CoV-2 infection in children!
#FOAMped #FOAMed #PedsICU #PedsID #IDtwitter
1/12
Time for an updated #tweetorial on SARS-CoV-2 infection in children!
#FOAMped #FOAMed #PedsICU #PedsID #IDtwitter
1/12
So there are fewer cases in children. How much fewer?
Children consistently make up <2% of confirmed COVID-19 cases. These are usually ascertained by testing sick people in hospital
US: http://dx.doi.org/10.15585/mmwr.mm6914e4
Italy: https://jamanetwork.com/journals/jama/fullarticle/2763401
Madrid: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2764394
2/12
Children consistently make up <2% of confirmed COVID-19 cases. These are usually ascertained by testing sick people in hospital
US: http://dx.doi.org/10.15585/mmwr.mm6914e4
Italy: https://jamanetwork.com/journals/jama/fullarticle/2763401
Madrid: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2764394
2/12
COVID-19 is less severe in children, but often is it severe?
From a Chinese cohort 0.6% needed PICU but lots of community testing involved
https://pediatrics.aappublications.org/content/early/2020/03/16/peds.2020-0702
US CDC data has 2% of admissions in PICU (limited data)
http://dx.doi.org/10.15585/mmwr.mm6914e4
3/12
From a Chinese cohort 0.6% needed PICU but lots of community testing involved
https://pediatrics.aappublications.org/content/early/2020/03/16/peds.2020-0702
US CDC data has 2% of admissions in PICU (limited data)
http://dx.doi.org/10.15585/mmwr.mm6914e4
3/12
So why aren't we seeing kids with COVID-19? Is it because they're not getting it, or just not sick enough to go to hospital?
Iceland tested 6% of their whole population. In community testing (random), 0/848 of children <10yrs were positive
https://www.nejm.org/doi/full/10.1056/NEJMoa2006100
4/12
Iceland tested 6% of their whole population. In community testing (random), 0/848 of children <10yrs were positive
https://www.nejm.org/doi/full/10.1056/NEJMoa2006100
4/12
Also in Italy, where a town screened 70% of its residents. Of the general population, 2.6% were positive. Of children <10yrs, 0%.
https://doi.org/10.1101/2020.04.17.20053157
Japanese contact tracing data found lower attack rate in kids
https://www.medrxiv.org/content/10.1101/2020.03.09.20033142v1
Seems they catch it less
5/12
https://doi.org/10.1101/2020.04.17.20053157
Japanese contact tracing data found lower attack rate in kids
https://www.medrxiv.org/content/10.1101/2020.03.09.20033142v1
Seems they catch it less
5/12
So are they not the super spreaders we thought?
Household transmission is now the most common mode, and children appear to rarely be the index case (5-10%)
https://www.medrxiv.org/content/10.1101/2020.03.26.20044826v1
https://www.medrxiv.org/content/10.1101/2020.04.11.20056010v1
6/12
Household transmission is now the most common mode, and children appear to rarely be the index case (5-10%)
https://www.medrxiv.org/content/10.1101/2020.03.26.20044826v1
https://www.medrxiv.org/content/10.1101/2020.04.11.20056010v1
6/12
OK but when they DO get symptoms, what does it look like?
Cough and fever much less frequent than in adults (both ~50% of cases) with about 10% having GI symptoms
No reports of anosmia or rashes as yet...
7/12
Cough and fever much less frequent than in adults (both ~50% of cases) with about 10% having GI symptoms
No reports of anosmia or rashes as yet...
7/12
Neonates - can't trust 'em right? What about with COVID-19?
Essentially all reported cases in newborns so far very mild disease needed limited support!
https://erj.ersjournals.com/content/early/2020/04/01/13993003.00697-2020
8/12
Essentially all reported cases in newborns so far very mild disease needed limited support!
https://erj.ersjournals.com/content/early/2020/04/01/13993003.00697-2020
8/12
How about vertical/intrauterine transmission? This is complicated
ALL swabs of placenta/amniotic fluid/vaginal fluid negative so far
But some babies have been IgM +ve positive at birth. IgM doesn't cross the placenta so implies infection
https://jamanetwork.com/journals/jama/fullarticle/2763854
9/12
ALL swabs of placenta/amniotic fluid/vaginal fluid negative so far
But some babies have been IgM +ve positive at birth. IgM doesn't cross the placenta so implies infection
https://jamanetwork.com/journals/jama/fullarticle/2763854
9/12
Now we know SARS-CoV-2 serology is not great so far, and IgM has high cross-reactivity, so remains to be seen whether this will be born out in future research.
So what about kids with comorbidities/immunosuppression?
10/12
So what about kids with comorbidities/immunosuppression?
10/12
Numbers are small, but all reported cases mild so far in children with IBD
https://journals.lww.com/jpgn/Abstract/publishahead/COVID_19_and_Paediatric_Inflammatory_Bowel.96116.aspx
And cancer
https://ssrn.com/abstract=3559560
But higher rates of resp/cardiac comorbidity in admitted children in US (23%)
http://dx.doi.org/10.15585/mmwr.mm6914e4
11/12
https://journals.lww.com/jpgn/Abstract/publishahead/COVID_19_and_Paediatric_Inflammatory_Bowel.96116.aspx
And cancer
https://ssrn.com/abstract=3559560
But higher rates of resp/cardiac comorbidity in admitted children in US (23%)
http://dx.doi.org/10.15585/mmwr.mm6914e4
11/12
That's all, thanks for reading!
For a comprehensive review of the literature, check out the @DFTBubbles rapid review page here
https://dontforgetthebubbles.com/evidence-summary-paediatric-covid-19-literature/
12/12
For a comprehensive review of the literature, check out the @DFTBubbles rapid review page here
https://dontforgetthebubbles.com/evidence-summary-paediatric-covid-19-literature/
12/12
