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A new study adds more evidence that COVID-19 tends to have a milder course of disease in children. Asymptomatic cases are also common in the pediatric population.
Information on COVID-19 in children has been slowly coming out over the past few months. For the first several weeks, no case was found in a child aged younger than 15 years. A recent review of 72,314 cases by the Chinese Center for Disease Control and Prevention found that less than 1% of the cases had occurred in children aged younger than 10 years. A new review of cases in the New England Journal of Medicine offers more evidence that pediatric cases tend to fall into the mild category.1
The investigators looked at children who had been infected with SARS-CoV-2, the coronavirus that causes COVID-19, and had been treated at Wuhan Children’s Hospital, which was the only place in Wuhan that children aged younger than 16 years could be treated for the disease. Asymptomatic children who had contact with people who had suspected or confirmed SARS-CoV-2 and symptomatic children were included. Nasopharyngeal or throat swabs were used to obtain specimens for testing using established methods.
From January 28, 2020, to February 26, 2020, 1391 children were tested and 171 were found to have a SARS-CoV-2 infection. The median age of children with infection was 6.7 years. Common symptoms seen in the ill children included cough and pharyngeal erythema as well as fever at any point during the course of infection, which was seen in 41.5% of cases. In the cohort of ill children, 27 had no radiologic features of pneumonia nor any symptom of infection, and 12 had radiologic features of pneumonia but no infection symptoms.
Among the children who required hospitalization for the illness, 3 required intensive care support and mechanical ventilation. All 3 children had coexisting health conditions: hydronephrosis, leukemia (for which the patient was receiving maintenance chemotherapy), and intussusception. Six patients had lymphopenia. Bilateral ground glass opacity was the most common radiologic finding. One child aged 10 months who had intussusception underwent multiorgan failure and died 4 weeks after being admitted to the hospital. Twenty-one children were in stable condition in the general wards of the hospital and 149 had been discharged.
The researchers concluded that infection in children continues to have a milder course than that seen in adults. Asymptomatic cases are also fairly common in the pediatric population, and the researchers urged further examination of the transmission potential in these cases.
1. Lu X, Zhang L, Du H, et al; Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 infection in children. N Engl J Med. 2020;382(17):1663-1665.