Thread by @apsmunro, Ok a few things have been moving in the world of paediatric [...]

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

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://dx.doi.org/10.15585/... https://jamanetwork.com/journals/jama/fullarticle/2763401
Madrid:">https://jamanetwork.com/journals/... https://jamanetwork.com/journals/jamapediatrics/fullarticle/2764394

2/12">https://jamanetwork.com/journals/...

Screening and Severity of COVID-19 in Children in Madrid, Spain

This case series describes the testing for and treatment of children with coronavirus disease 2019 (COVID-19) in Madrid, Spain.

http://dx.doi.org/10.15585/mmwr.mm6914e4

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">https://pediatrics.aappublications.org/content/e... CDC data has 2% of admissions in PICU (limited data)
http://dx.doi.org/10.15585/mmwr.mm6914e4

3/12">https://dx.doi.org/10.15585/...

So why aren& #39;t we seeing kids with COVID-19? Is it because they& #39;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">https://www.nejm.org/doi/full/...

Spread of SARS-CoV-2 in the Icelandic Population | NEJM

Original Article from The New England Journal of Medicine — Spread of SARS-CoV-2 in the Icelandic Population

https://www.nejm.org/doi/full/10.1056/NEJMoa2006100

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">https://doi.org/10.1101/2... contact tracing data found lower attack rate in kids

https://www.medrxiv.org/content/10.1101/2020.03.09.20033142v1

Seems">https://www.medrxiv.org/content/1... they catch it less

5/12

Age specificity of cases and attack rate of novel coronavirus disease (COVID-19)

Age distribution of the cases with novel coronavirus disease (COVID-19) is rather different from that of influenza. We examined the age distribution of COVID-19 cases in Japan from January to March,...

https://doi.org/10.1101/2020.04.17.20053157

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/1... href=" https://www.medrxiv.org/content/10.1101/2020.04.11.20056010v1

6/12">https://www.medrxiv.org/content/1...

https://www.medrxiv.org/content/1..." title="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/1... href=" https://www.medrxiv.org/content/10.1101/2020.04.11.20056010v16/12">https://www.medrxiv.org/content/1..." class="img-responsive" style="max-width:100%;"/>

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

Neonates - can& #39;t trust & #39;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">https://erj.ersjournals.com/content/e...

Novel Coronavirus Infection in Newborn Babies Under 28 Days in China

Previous studies described the clinical features of Covid-19 in adults and infants under 1 year of age. Little is known about features, outcomes and intrauterine transmission potential in newborn...

https://erj.ersjournals.com/content/early/2020/04/01/13993003.00697-2020

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& #39;t cross the placenta so implies infection

https://jamanetwork.com/journals/jama/fullarticle/2763854

9/12">https://jamanetwork.com/journals/...

Antibodies in Infants Born to Mothers With COVID-19

This study measured antibodies from infant throat swabs and sera samples.

https://jamanetwork.com/journals/jama/fullarticle/2763854

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

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">https://journals.lww.com/jpgn/Abst... cancer
https://ssrn.com/abstract=3559560

But">https://ssrn.com/abstract=... higher rates of resp/cardiac comorbidity in admitted children in US (23%)
http://dx.doi.org/10.15585/mmwr.mm6914e4

11/12">https://dx.doi.org/10.15585/...

Coronavirus Disease 2019 in Children — United States, February 12 ...

In this preliminary description of pediatric U.S. COVID-19 cases, relatively few children with COVID-19 are hospitalized, and fewer children than adults experience fever, cough, or shortness of ...

https://journals.lww.com/jpgn/Abstract/publishahead/COVID_19_and_Paediatric_Inflammatory_Bowel.96116.aspx

That& #39;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">https://dontforgetthebubbles.com/evidence-...

An evidence summary of Paediatric COVID-19 literature

A rapid review of the published original research of COVID-19 in children ....

https://dontforgetthebubbles.com/evidence-summary-paediatric-covid-19-literature/

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