Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
JAMA Netw Open. 2023 Mar 1;6(3):e232328. doi: 10.1001/jamanetworkopen.2023.2328.
Clinical manifestations of SARS-CoV-2 variants have not been systematically compared in children.
To compare symptoms, emergency department (ED) chest radiography, treatments, and outcomes among children with different SARS-CoV-2 variants.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study was performed at 14 Canadian pediatric EDs. Participants included children and adolescents younger than 18 years (hereinafter referred to as children) tested for SARS-CoV-2 infection in an ED between August 4, 2020, and February 22, 2022, with 14 days of follow-up.
EXPOSURE(S): SARS-CoV-2 variants detected on a specimen collected from the nasopharynx, nares, or throat.
The primary outcome was presence and number of presenting symptoms. The secondary outcomes were presence of core COVID-19 symptoms, chest radiography findings, treatments, and 14-day outcomes.
Among 7272 participants presenting to an ED, 1440 (19.8%) had test results positive for SARS-CoV-2 infection. Of these, 801 (55.6%) were boys, with a median age of 2.0 (IQR, 0.6-7.0) years. Children with the Alpha variant reported the fewest core COVID-19 symptoms (195 of 237 [82.3%]), which were most often reported by participants with Omicron variant infection (434 of 468 [92.7%]; difference, 10.5% [95% CI, 5.1%-15.9%]). In a multivariable model with the original type as the referent, the Omicron and Delta variants were associated with fever (odds ratios [ORs], 2.00 [95% CI, 1.43-2.80] and 1.93 [95% CI, 1.33-2.78], respectively) and cough (ORs, 1.42 [95% CI, 1.06-1.91] and 1.57 [95% CI, 1.13-2.17], respectively). Upper respiratory tract symptoms were associated with Delta infection (OR, 1.96 [95% CI, 1.38-2.79]); lower respiratory tract and systemic symptoms were associated with Omicron variant infection (ORs, 1.42 [95% CI, 1.04-1.92] and 1.77 [95% CI, 1.24-2.52], respectively). Children with Omicron infection most often had chest radiography performed and received treatments; compared with those who had Delta infection, they were more likely to have chest radiography performed (difference, 9.7% [95% CI, 4.7%-14.8%]), to receive intravenous fluids (difference, 5.6% [95% CI, 1.0%-10.2%]) and corticosteroids (difference, 7.9% [95% CI, 3.2%-12.7%]), and to have an ED revisit (difference, 8.8% [95% CI, 3.5%-14.1%]). The proportions of children admitted to the hospital and intensive care unit did not differ between variants.
The findings of this cohort study of SARS-CoV-2 variants suggest that the Omicron and Delta variants were more strongly associated with fever and cough than the original-type virus and the Alpha variant. Children with Omicron variant infection were more likely to report lower respiratory tract symptoms and systemic manifestations, undergo chest radiography, and receive interventions. No differences were found in undesirable outcomes (ie, hospitalization, intensive care unit admission) across variants.
SARS-CoV-2 变体的临床表现尚未在儿童中进行系统比较。
比较不同 SARS-CoV-2 变体患儿的症状、急诊（ED）胸部 X 线、治疗和结局。
设计、地点和参与者：这是一项多中心队列研究，在加拿大 14 家儿科 ED 进行。参与者包括 2020 年 8 月 4 日至 2022 年 2 月 22 日在 ED 检测到 SARS-CoV-2 感染的年龄在 18 岁以下的儿童和青少年（以下简称儿童），并进行了 14 天的随访。
从鼻咽、鼻腔或喉咙采集的标本中检测到的 SARS-CoV-2 变体。
主要结果是存在和出现的症状数量。次要结果是存在核心 COVID-19 症状、胸部 X 线检查结果、治疗和 14 天结局。
在 7272 名出现 ED 的参与者中，有 1440 名（19.8%）的 SARS-CoV-2 感染检测结果为阳性。其中，801 名（55.6%）为男孩，中位年龄为 2.0（IQR，0.6-7.0）岁。报告核心 COVID-19 症状最少的是 Alpha 变体患儿（237 例中的 195 例[82.3%]），而感染 Omicron 变体的患儿报告的最多（468 例中的 434 例[92.7%]；差异，10.5%[95%CI，5.1%-15.9%]）。在以原始类型为参照的多变量模型中，Omicron 和 Delta 变体与发热（比值比[ORs]，2.00[95%CI，1.43-2.80]和 1.93[95%CI，1.33-2.78]）和咳嗽（ORs，1.42[95%CI，1.06-1.91]和 1.57[95%CI，1.13-2.17]）相关。上呼吸道症状与 Delta 感染相关（OR，1.96[95%CI，1.38-2.79]）；下呼吸道和全身症状与 Omicron 变体感染相关（ORs，1.42[95%CI，1.04-1.92]和 1.77[95%CI，1.24-2.52]）。感染 Omicron 的患儿最常进行胸部 X 线检查和接受治疗；与 Delta 感染患儿相比，他们更有可能进行胸部 X 线检查（差异，9.7%[95%CI，4.7%-14.8%]）、接受静脉输液（差异，5.6%[95%CI，1.0%-10.2%]）和皮质类固醇（差异，7.9%[95%CI，3.2%-12.7%]），以及 ED 复诊（差异，8.8%[95%CI，3.5%-14.1%]）。不同变体患儿住院和入住 ICU 的比例无差异。
这项 SARS-CoV-2 变体队列研究的结果表明，Omicron 和 Delta 变体与发热和咳嗽的相关性强于原始病毒和 Alpha 变体。感染 Omicron 变体的患儿更有可能报告下呼吸道症状和全身表现，进行胸部 X 线检查，并接受干预。不同变体之间在不良结局（即住院、入住 ICU）方面没有差异。
