Institute of Social Paediatrics and Adolescent Medicine, Division of Paediatric Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany.
University Children's Hospital, Eberhard Karls University, Tuebingen, Germany.
Eur J Pediatr. 2022 Oct;181(10):3635-3643. doi: 10.1007/s00431-022-04587-5. Epub 2022 Aug 13.
Although children and adolescents have a lower burden of SARS-CoV-2-associated disease compared to adults, assessing the risk for severe outcomes among SARS-CoV-2-infected children remains difficult due to a high rate of undetected cases. We combine data from three data sources - a national seroprevalence study (the SARS-CoV-2 KIDS study), the nationwide, state-based reporting system for PCR-confirmed SARS-CoV-2 infections in Germany, and a nationwide registry on children and adolescents hospitalized with either SARS-CoV-2 or pediatric inflammatory multisystem syndrome (PIMS-TS, also known as MIS-C) - in order to provide estimates on the risk of hospitalization for COVID-19-related treatment, intensive care admission, and death due to COVID-19 and PIMS-TS in children. The rate of hospitalization for COVID-19-related treatment among all SARS-CoV-2 seropositive children was 7.13 per 10,000, ICU admission 2.21 per 10,000, and case fatality was 0.09 per 10,000. In children without comorbidities, the corresponding rates for severe or fatal disease courses were substantially lower. The lowest risk for the need of COVID-19-specific treatment was observed in children aged 5-11 without comorbidities. In this group, the ICU admission rate was 0.37 per 10,000, and case fatality could not be calculated due to the absence of cases. The overall PIMS-TS rate was 2.47 per 10,000 SARS-CoV-2 infections, the majority being children without comorbidities.
Overall, the SARS-CoV-2-associated burden of a severe disease course or death in children and adolescents is low. This seems particularly the case for 5-11-year-old children without comorbidities. By contrast, PIMS-TS plays a major role in the overall disease burden among all pediatric age groups.
• SARS-CoV-2-associated burden of disease in children is considered to be low, but accurate risk estimates accounting for clinically undiagnosed infections are lacking. • Asymptomatic SARS-CoV-2 infections are common in children.
• We provide risk estimates for hospitalization for COVID-19-related treatment, ICU admission, death from COVID-19, and PIMS-TS for children with SARS-CoV-2 infections by pooling different data sources. • The risk for PIMS-TS exceeds the risk for severe COVID-19 in all age groups; the risk for severe COVID-19 is the lowest in 5-11 years old.
描述儿童 SARS-CoV-2 感染的严重结局，尤其是合并症对风险的影响。
我们结合了三个数据源的数据——一项全国性血清流行率研究（SARS-CoV-2 KIDS 研究）、德国全国范围内基于 PCR 确诊 SARS-CoV-2 感染的州级报告系统，以及一项关于因 SARS-CoV-2 或儿童炎症性多系统综合征（PIMS-TS，也称为 MIS-C）住院的儿童和青少年的全国性登记处——以提供有关儿童 COVID-19 相关治疗、重症监护入院和 COVID-19 和 PIMS-TS 死亡风险的估计。所有 SARS-CoV-2 血清阳性儿童中 COVID-19 相关治疗住院率为每 10000 人 7.13 例，重症监护入院率为每 10000 人 2.21 例，病死率为每 10000 人 0.09 例。在没有合并症的儿童中，严重或致命疾病的发生率要低得多。在没有合并症的 5-11 岁儿童中，COVID-19 特异性治疗的需求风险最低。在该组中，重症监护入院率为每 10000 人 0.37 例，由于没有病例，无法计算病死率。总体 PIMS-TS 发生率为每 10000 例 SARS-CoV-2 感染 2.47 例，大多数是没有合并症的儿童。
总体而言，儿童和青少年中严重疾病或死亡的 SARS-CoV-2 相关负担较低。对于没有合并症的 5-11 岁儿童尤其如此。相比之下，PIMS-TS 在所有儿科年龄组的整体疾病负担中起主要作用。
儿童 SARS-CoV-2 相关疾病负担被认为较低，但缺乏准确的风险估计，这些估计考虑了未临床诊断的感染。
儿童中无症状 SARS-CoV-2 感染很常见。
我们通过合并不同的数据源，为 SARS-CoV-2 感染儿童的 COVID-19 相关治疗、重症监护入院、COVID-19 死亡和 PIMS-TS 住院风险提供了风险估计。
在所有年龄组中，PIMS-TS 的风险超过了严重 COVID-19 的风险；在 5-11 岁儿童中，严重 COVID-19 的风险最低。
