For most of the pandemic, COVID-19 has been mild in children. Has this been true for children with underlying health conditions, in particular cancer?
Although the delta variant has changed how COVID-19 impacts populations of all ages, SARS- CoV-2 rarely caused serious illness in healthy children . For children and teenagers with cancer, however, severe illness is more likely when caused by respiratory viruses, such as COVID-19. A recent investigation sought to find the clinical course and outcomes of COVID-19 in children and teenagers who have cancer.1
The investigators used data from 131 institutions in 45 countries to create the Global Registry of COVID-19 in Childhood Cancer to included de-identified data related to laboratory-confirmed infection of COVID-19 in children and adolescents aged <19 years who had either cancer or had received a hematopoietic stem-cell transplantation. Data for oncological diagnosis, clinical course, cancer therapy details, and demographics were collected.
There were a total of 1500 patients included in the study, of which 1319 had complete 30 days of follow-up. A severe or critical infection occurred in 259 patients and 50 died from a cause that is attributable to the COVID-19 infection. Alterations in cancer-directed therapy were made for 609 patients who were receiving active oncological treatment. Several factors were linked to severe or critical illness, following a multivariable analysis, included absolute lymphocyte count of 300 or less cells per mm3 (odds ratio (OR) 2.5 [95% CI, 1.8–3.4]; p<0.0001), absolute neutrophil count of 500 or less cells per mm3 (OR 1.8 [95% CI, 1.3–2.4]; p=0.0001), and intensive treatment (OR 1.8 [95% CI, 1.3–2.3]; World Bank low-income or lower-middle-income (OR 5.8 [95% CI 3.8–8.8]; p<0.0001) and upper-middle-income (OR 1.6 [95% CI, 1.2–2.2]; p=0.0024) country status; and age 15–18 years (OR 1.6 [95% CI, 1.1–2.2]; p=0.013). A primary diagnosis of other hematological malignancies (OR 0.5 [95% CI, 0.3–0.8]; p=0.0088), at least 1 COVID-19 symptom at the time of presentation (OR 1.8 [95% CI, 1.3–2.4]; p=0.0002), the presence of at least 1 comorbidity (OR 1.6 [95% CI, 1.1–2.3]; p=0.020), and upper-middle-income country status (OR 0.5 [95% CI, 0.3–0.7]; p=0.0004).
The investigators concluded that among pediatric patients with cancer and COVID-19, severe and critical illness happened in 1 in 5 patients. Deaths occurred at a higher rate than had been reported in the general pediatric population. The data from the study could help with the creation of clinical guidelines for COVID-19 in children.
For more on the American Cancer Society, click here.
Reference
1. Mukkada S, Bhakta N, Chantada G, et al. Global characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with cancer (GRCCC): a cohort study. The Lancet Oncology. August 26, 2021. Epub ahead of print. doi:10.1016/S1470-2045(21)00454-X
Recent reports of measles in multiple states
January 25th 2024Tina Tan, MD, FAAP, FIDSA, FPIDS, tells Contemporary Pediatrics, “This is not new and demonstrates what is known, in that if vaccination rates do not stay at a level that is protective, outbreaks of vaccine preventable diseases will occur.”