304 - Spectrum of Disease in Children Infected with SARS-CoV-2

Poster Number: 304
Publication Number: 304.215

Bazak Sharon, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States

Background: The COVID-19 pandemic has been a tragedy, affecting children worldwide. Although pediatric infections are usually mild, children are at risk for complicated disease. It imperative to expand our understanding of the epidemiology and pathophysiology of this disease, starting by describing key demographic and clinical data of children infected with SARS-CoV-2.

Objective: To describe the demographic and pathology in children, infected with SARS-CoV-2.

Design/Methods: Pediatric Covid care at the University of Minnesota has been coordinated through a multidisciplinary workgroup that also contribute to a national registry for children infected with SARS-CoV-2 (PIDTRAN-6_Covid-19). Utilizing these mechanisms, we have identified children infected with SARS-CoV-2 including those who presented to our hospital and clinics with acute illnesses, to create a Covid cohort. Inclusion criterion was confirmed SARS-CoV-2 infection and exclusion criterion was opt-out of research on general consent form. Following IRB approved protocol, we collected demographic data and clinical information on those with symptomatic disease following SARS-CoV-2 infection.

Results: As of December 12/31/2021 we reported 7404 children with SARS-CoV-2 (confirmed by PCR) to the national registry. Separately, we identified a cohort of 152 children with new onset disease or exacerbation of existing illness in association or following their Covid-19 diagnosis [Table 1]. The majority (105) experienced mild-to-moderate acute Covid-19 within days of exposure, but 10 had severe Covid-19 pneumonia. Multisystem inflammatory syndrome in children (MIS-C) was diagnosed and successfully treated in 33 children [Figure 2]. A variety of inflammatory diseases and invasive infections developed in 40 children. Some had probable association to Covid, other more obscure[Table 1]. Long Covid was diagnosed in 39 children with lingering symptoms affecting daily function at least 3 months following infection.Conclusion(s): SARS-CoV-2 infection can cause disease to children of all ages. This cohort includes children from across clinical settings, and although it was not generated by systemic review it can be regard as a comprehensive representation of Covid related illness. Of those with symptomatic illness acute disease is most common, usually mild-to-moderate with 8% developing severe Covid-19 pneumonia. Long Covid syndrome is the most common pediatric illness caused by the virus. More than 20% of children infected with the virus present with inflammatory and immune mediated illnesses suggesting the role of SARS-CoV-2 in triggering immune dysregulation pathologies.
Figure 1: Age and Gender Distribution of Children with Covid Infection and DiseaseChildren with SARS-CoV-2 infection (Registry, Nf7404) are in green and children with illness following their infection (Cohort, Nf152) are in brown. Bars represent the percentage each age group has within its own larger group and total numbers are specified for each bar by [N]. Distribution of clinical entities in those with disease are specified for each age group (“Acute”: Mild-to-moderate acute Covid-19; “PNA”: Severe Covid-19 pneumonia; “MISC”: Multisystem inflammatory syndrome in children; “Long”: Long Covid; “Other”: Other illnesses following SARS-CoV-2 infection).
Figure 2: Spectrum of disease in 152 children with symptomatic SARS-CoV-2 infectionClinical presentation in children with symptomatic disease following SARS-CoV-2 infection (Nf152). Gray arrows from “Acute mild-to-moderate Covid-19” to other clinical entities represent children who had both acute symptoms and later developed additional illness.