The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a significant impact on global health, claiming millions of lives worldwide. Initial studies suggested that children were at a lower risk of severe infection compared to adults. However, a recent nationwide, multicenter, and observational cohort study conducted in Germany has shed light on the risk factors associated with severe COVID-19 in children and adolescents.
In this article, we will explore the findings of the study and identify the factors that increase the risk of severe COVID-19 in children. Understanding these risk factors is crucial for developing effective preventive measures and guidelines to protect children and adolescents from the virus.
The German Study
The German Society for Pediatric Infectious Diseases (DGPI) launched a nationwide survey to collect data on children and adolescents hospitalized due to severe SARS-CoV-2 infection. The study recruited pediatric patients between the ages of one and 17 with confirmed SARS-CoV-2 infection requiring hospitalization.
The study collected important information linked to the patients, including initial symptoms, exposures, comorbidities, disease course during hospitalization, medical treatment, and outcomes. Various comorbidities were evaluated as potential risk factors for severe SARS-CoV-2 infection, including psychiatric, respiratory, hematological, cardiovascular, neurological/neuromuscular, gastrointestinal, renal, hepatic, autoimmune, syndromic diseases, cancer, primary immunodeficiency (PID), and obesity.
Risk Factors for Severe COVID-19 in Children
The study identified several risk factors associated with severe COVID-19 in children and adolescents. Let’s explore these risk factors in detail:
1. Obesity
Obesity was found to be a significant risk factor for severe COVID-19 in children. Children with obesity have a higher likelihood of developing severe symptoms and requiring hospitalization. This finding emphasizes the importance of addressing childhood obesity as a preventive measure against severe COVID-19.
2. Trisomy 21 and Other Genetic Conditions
Children with Trisomy 21, also known as Down syndrome, and other genetic conditions were found to be at an increased risk of severe COVID-19. These individuals may have underlying health issues that make them more vulnerable to the virus.
3. Age
The study revealed that children between the ages of five and 11 had a higher risk of developing severe COVID-19 compared to younger children. This age group may have different immune responses to the virus, contributing to the increased risk.
4. Neurological/Neuromuscular Diseases
Children with pre-existing neurological or neuromuscular diseases, such as epilepsy or psychomotor retardation, were found to be at a greater risk of severe COVID-19. These conditions may weaken the immune system or affect respiratory function, making them more susceptible to complications from the virus.
5. Coinfections
Coinfections, where children have both SARS-CoV-2 infection and another concurrent infection, were also identified as a risk factor for severe COVID-19. Coinfections may exacerbate symptoms and increase the risk of complications.
Impact of SARS-CoV-2 Variants
The study also examined the impact of different SARS-CoV-2 variants on hospitalization and ICU admission rates. During the study period, six phases were identified, each associated with different dominant SARS-CoV-2 variants of concern (VOC).
The emergence of the Omicron variant led to a shift in the pattern of hospitalization and ICU admission rates. For the pediatric population, overall hospitalization and ICU admission rates decreased during the Omicron circulation. This may be attributed to the reduced virulence of the Omicron variant compared to the Delta variant. Additionally, higher vaccination coverage and infection-acquired immunity contributed to the reduced severity of Omicron infections.
Interestingly, the study found that infant hospitalization rates increased during the Omicron period, while teenage hospitalization rates decreased. This finding aligns with previous studies conducted in the United States, emphasizing the need for age-specific preventive measures.
Conclusion
The German study provides valuable insights into the risk factors associated with severe COVID-19 in children and adolescents. Obesity, Trisomy 21, age, neurological/neuromuscular diseases, and coinfections were identified as significant risk factors for severe infection. Understanding these risk factors is crucial for formulating effective preventive measures, developing vaccination strategies, and providing appropriate medical care for children and adolescents.
It is important to note that while the study provides valuable insights, further research is needed to validate these findings and understand the underlying mechanisms that contribute to the increased risk of severe COVID-19 in children. By addressing these risk factors and implementing targeted interventions, we can better protect the younger population and mitigate the impact of the ongoing pandemic.
References
Footnotes
- Doenhardt, M., Hufnagel, M., Diffloth, N., et al. (2024) Epidemiology of 7375 children and adolescents hospitalized with COVID-19 in Germany, reported via a prospective, nationwide surveillance study in 2020–2022. Scientific Reports 14(1); 1-15. doi:10.1038/s41598-023-49210-1