Coronavirus-19 and its Epidemiology in Children − An Ambispective Observational Study from Central India

Abstract

This ambispective observational study, was conducted at a tertiary care centre in Central India. Children aged <16 y who tested positive for SARS-CoV2 between 1st April 2020 to 30th April 2022 were included. The prevalence of coronavirus disease-19 (COVID-19) infection was 1.2%. Of 525 children, median age was 60 mo; 88 (16.7%) were infants. Comorbidities were noted in 89 (16.9%) children. About 59% (n=309) were asymptomatic. Among symptomatic (n=216) children, fever (57.9%) was the most common symptom followed by cough (37%), running nose (21.3%) and shortness of breath (13.9%). Forty-three (8.2%) children required pediatric intensive care unit (PICU) admission, among which 21 required invasive ventilation. Patients with comorbidities were independently associated with need for invasive mechanical ventilation. Among PICU admitted children, 20 patients died. In multivariate logistic regression, children presenting with fever, shortness of breath and vasoactive requirement were found to be significantly associated with mortality. As the number of waves progressed, number of admissions were less but severity, association with comorbidities, need of ICU, mechanical ventilation and death rate increased.

Introduction

Coronavirus disease-19 (COVID-19) pandemic, has caused so much panic, with its multivariant emerging strains both infective and non-infective, have created a havoc in the immune system by opening the pandora box of inflammation over the past three years. Primary objective of this study was to define the prevalence and epidemiology of pediatric COVID-19 cases, and the secondary objective was to explore the association between patient characteristics and treatments that may influence outcome in pediatric COVID-19 cases admitted in authors’ institute.

Material and Methods

It was an ambispective observational study, done from 1^st April, 2020, to 30^th April, 2022. All the patients enrolled by 31^st March 2022, were followed until hospital discharge. The patients were identified through daily screening and other relevant censuses as well as the review of hospital reports of SARS-CoV2 test results. There was no exclusion criteria and children aged <16 y old and tested positive for SARS-CoV2 (mode of testing: RT PCR /rapid antigen test or Truenat) were included in the study. Ethical clearance was obtained from Institutional Ethics Committee (AIIMSRPR/IEC/2020/649). Statistical Package for Social Sciences (SPSS) for Windows version 26.0 was used to conduct the analysis. Logistic regression analysis was done by using STATA version 64.

Results

A total of 525 out of 44851 children were admitted with COVID-19 hence, the prevalence was 1.2%, out of which 505 (96.1%) survived. The median age of presentation was 60 mo, (IQR 15-108); 88 (16.7%) were infants. Different comorbidities were noted in 88 (16.8%), the most common being malignancy seen in 24 (27.3%) children. The asymptomatic cases (59%) were more common. Among the symptomatic, fever was most common 125 (31.2%). The most common complication in non-survivors were pneumonia 15 (75%), followed by acute respiratory distress syndrome (ARDS) in 8 (40%), meningitis in 3 (15%), and acute liver dysfunction in 3 (15%) children. Forty-three (8.2%) children were admitted to PICU, among which 20 (46.5%) children died (Fig. 1). There were 438 (83.4%) children, admitted during the 1^st wave, 47 (10%) children during the 2^nd wave, and 40 (7.6%) children during the 3^rd wave. The need for mechanical ventilation, the vasoactive requirement and mortality was seen in 2.7%, 2.2% and 2.2% during the 1^st wave, 8.5%, 6.35% and 6.3% during the 2^nd wave, 12.5%, 17.5% and 17.5% during the 3^rd wave respectively (Fig. 1). In multivariate logistic regression, children presenting with fever [4.41 (CI = 1.411-13.793)], shortness of breath [12.087 (CI = 3.864-37.805)] and vasoactive requirement [6.92 (CI = 1.058-45.275)] were found to be significantly associated with mortality.

Fig. 1.

Percentage of ICU need, ventilation, inotropes, mortality among 3 waves

Discussion

The prevalence of pediatric COVID-19 is less (1.2%) when compared to adults (13.8%), and is in consonance with the existing literature owing to conclusion that children are seldom symptomatic [1, 2]. Predominant age group was 1-10 y (56.5%, median - 60 mo), males (55.6%) were predominantly admitted with a ratio of 1.25:1 which was similar to other studies [1, 3–5]. This may be due to increased predisposition of males to viral infection. The severity of illness and mortality was more in females (75%) with respect to outcome (p = 0.005); this can be attributable to increased immune reactivity found inherently in females. Associated comorbidities had been a predictor of mortality and morbidity, seen in 16.8% of total enrolled patients, similar to findings by Banerjee et al. (25%) [4]. The most common complication was pneumonia seen in 5.5% of children, ARDS in 1.5%, which was in contrast to Singh et al., where ARDS (18%), acute kidney injury (AKI) (16%) were common [3]. The authors could not reason any better as why this difference has occurred, whether the patients presented to the hospital earlier or their patients progressed faster, as the necessary data are deficient. There wasn’t much difference in the PICU admission and outcome; 43 (8.2%) were admitted to PICU which was similar to Tagarro et al. (10%) [6]. So, the incidence of critical and severe disease was less in children. Oxygen requirement was seen in 7.8%, non-invasive ventilation in 3.4%, invasive ventilation was used in 4%, vasoactive in 3.4%, antivirals in 3.6%, antibiotics in 28.6%, corticosteroids in 4.4% and mortality was seen in 3.8% children, which was similar to a multi-centric study done by Jat et al. (3.2%) [5]. In the study done by Parhad et al. in the same institute on adult patients with COVID-19, and mortality was 10% [7]. This difference in mortality suggests that children have less viral load, may be due to less ACE-2 receptors and lesser number of comorbidities when compared to adults. As the number of waves progressed, admissions decreased but severity, association with comorbidities, need of PICU, mechanical ventilation and mortality increased as the conception of disease improved.

Conclusions

The occurrence of COVID-19 pandemic has taken the public and medical system flabbergasted. In nutshell, the prevalence of the disease was 1.2%, males were more commonly infected, females showed severe reactions, comorbidities were independent risk factors, most common complication was pneumonia, and overall children show less manifestations and mortality than adults.

Authors’ Contributions

SVS: Study design, data collection and data analysis; AK: Data analysis, manuscript design and writing; AB: Microbiological testing, data analysis and manuscript review; AJ: Study design, data collection and analysis, manuscript editing and review. AJ will act as the guarantor for this manuscript.

Declarations

Conflict of Interest

None.