From the South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences.
Department of Paediatrics and Child Health.
Pediatr Infect Dis J. 2021 Sep 1;40(9):e323-e332. doi: 10.1097/INF.0000000000003227.
Globally, very few childhood deaths have been attributed to coronavirus disease 2019 (COVID-19). We evaluated clinical, microbiologic and postmortem histopathologic findings in childhood deaths in whom severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified antemortem or postmortem.
Surveillance of childhood deaths was ongoing during the initial COVID-19 outbreak in South Africa from April 14, 2020, to August 31, 2020. All children hospitalized during this time had a SARS-CoV-2 test done as part of standard of care. Postmortem sampling included minimally invasive tissue sampling (MITS) of lung, liver and heart tissue; blood and lung samples for bacterial culture and molecular detection of viruses (including SARS-CoV-2) and bacteria. The cause of death attribution was undertaken by a multidisciplinary team and reported using World Health Organization framework for cause of death attribution.
SARS-CoV-2 was identified on antemortem and/or postmortem sampling in 11.7% (20/171) of deceased children, including 13.2% (12/91) in whom MITS was done. Eighteen (90%) of 20 deaths with SARS-CoV-2 infection were <12 months age. COVID-19 was attributed in the causal pathway to death in 91.7% (11/12) and 87.5% (7/8) cases with and without MITS, respectively. Lung histopathologic features in COVID-19-related deaths included diffuse alveolar damage (n = 6, 54.5%), type 2 pneumocyte proliferation (n = 6, 54.5%) and hyaline membrane formation (n = 5, 36.4%). Culture-confirmed invasive bacterial disease was evident in 54.5% (6/11) of COVID-19 attributed deaths investigated with MITS.
COVID-19 was in the causal pathway of 10.5% (18/171) of all childhood deaths under surveillance. The postmortem histopathologic features in fatal COVID-19 cases in children were consistent with reports on COVID-19 deaths in adults; although there was a high prevalence of invasive bacterial disease in the children.
在全球范围内，仅有极少数儿童死亡归因于 2019 年冠状病毒病（COVID-19）。我们评估了在生前或死后被确定为严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）的儿童死亡病例的临床、微生物学和死后组织病理学发现。
从 2020 年 4 月 14 日至 8 月 31 日，南非在 COVID-19 疫情初期持续监测儿童死亡情况。在此期间，所有住院的儿童均按照标准护理进行了 SARS-CoV-2 检测。死后采样包括肺、肝和心脏组织的微创组织采样（MITS）；血液和肺样本进行细菌培养和病毒（包括 SARS-CoV-2）和细菌的分子检测。死因归因由一个多学科小组进行，并根据世界卫生组织死因归因框架进行报告。
在 171 名死亡儿童中，有 11.7%（20/171）在生前和/或死后样本中检测到 SARS-CoV-2，其中 MITS 组为 13.2%（12/91）。20 例 SARS-CoV-2 感染死亡中，18 例（90%）年龄<12 个月。COVID-19 在有和没有 MITS 的情况下分别导致 91.7%（11/12）和 87.5%（7/8）的病例死亡。COVID-19 相关死亡的肺组织病理学特征包括弥漫性肺泡损伤（n=6，54.5%）、Ⅱ型肺泡细胞增生（n=6，54.5%）和透明膜形成（n=5，36.4%）。对 11 例进行 MITS 调查的 COVID-19 归因死亡病例中，有 54.5%（6/11）经培养证实存在侵袭性细菌病。
在监测的所有儿童死亡中，COVID-19 是 10.5%（18/171）的死因。儿童致死性 COVID-19 病例的死后组织病理学特征与成人 COVID-19 死亡报告一致；尽管儿童中侵袭性细菌病的患病率很高。
