Wilde, Harrison;
Tomlinson, Christopher;
Mateen, Bilal A;
Selby, David;
Kanthimathinathan, Hari Krishnan;
Denaxas, Spiros;
Flaxman, Seth;
... CVD-COVID-UK/COVID-IMPACT Consortium; + view all
(2024)
Trends in Pediatric Hospital Admissions Caused or Contributed by SARS-CoV-2 Infection in England.
The Journal of Pediatrics
, Article 114370. 10.1016/j.jpeds.2024.114370.
(In press).
Preview |
Text
Pagel_1-s2.0-S0022347624004736-main.pdf Download (1MB) | Preview |
Abstract
Objective: To investigate the changing characteristics of SARS-CoV-2 related pediatric hospital admissions over time. // Study design: A national, observational cohort study from 1, July 2020, to August 31, 2023, using English population-linked electronic health records. We identified 45,203 children under 18 years old in whom SARS-CoV-2 either caused or contributed to hospitalization, excluding those admitted with “incidental” infection. Studied outcomes were types of hospitalization and severe hospitalizations involving either critical care or PIMS-TS. // Results: There were 45,920 SARS-CoV-2 related hospitalizations in children: 34,870 (75.9%) due to COVID-19; 1,845 (4.0%) due to pediatric inflammatory multisystem syndrome – temporally associated with SARS-CoV-2 (PIMS-TS); 8,330 (18.1%) with SARS-CoV-2 as contributor to admission; and 875 (1.9%) acquired nosocomial SARS-CoV-2 infection. The most notable changes between the first three waves (March 2020 through November 2021) and the omicron era (December 2021 onwards) were: a fall in PIMS-TS from 1,575 of 14,020 (11.2%) to 270 of 31,905 (0.8%); a reduction in critical care use from 1,175 of 14,020 (8.4%) to 1,390 of 31,905 (4.4%); a fall in mortality rate among those hospitalized from 521 per 100,000 to 249 per 100,000; and a drop in the median age of hospitalized children from 4.7 (IQR 0.6,12.3) to 1.1 (IQR 0.3,6.4) years. Of children hospitalized, infants, 10.2% of whom had a recorded underlying health condition, comprised 4,225 of 14,020 (30.1%) admissions 2020 through 2021 and 15,555 of 31,900 (48.8%) since 2022. (p<0.001 for all comparisons). // Conclusions: Infants are now the most affected age group by SARS-CoV2, at least partially related to having the least immunity to the virus, and are most vulnerable to respiratory illnesses. Among 11.9 million children and adolescents resident in England,1 we previously studied hospital admissions related to SARS-CoV-2 infection, between July 2020 when the testing program had been set up and February 2022;2 finding that this infection was causal or a contributory factor in the hospitalization of 21,000 individuals.2 Since February 2022, children’s SARS-CoV-2 exposure histories,3 relevant SARS-CoV-2 testing and health protection policies,4 and variant dominance5 have evolved. In England, over 90% of school age children had detectable SARS-CoV-2 antibodies in March 2022.6 This was largely due to infection, especially in younger children; by October 2023, at least one dose of COVID-19 vaccine had been received in only 9% of 5-11 year-olds; 42% of 12-15 year-olds and 61% of 16 to 17 year-olds.7 For children in England under 5 years old, only those with significant underlying health conditions have ever been eligible for COVID-19 vaccination. Since 2023, only children with significant underlying health conditions are eligible for any SARS-CoV-2 vaccines across all age groups.8 Increased SARS-CoV-2 immunity from previous infection or vaccination may be responsible for the noted drop in incidence of pediatric inflammatory multisystem syndrome in children temporally associated with COVID-19(PIMS-TS) (also known as multisystem inflammatory syndrome in children in some countries, MIS-C) ,9 however, the wider impacts of evolving complex inter-related factors upon changes in the phenotypes of pediatric SARS-CoV-2 related hospital admissions are unclear. We used population-based electronic healthcare record (EHR) data to describe trends in hospital admissions caused or contributed to by SARS-CoV-2 infection among children and adolescents resident in England. Our study objectives were to explore any changes over time in the characteristics of hospital admissions caused or contributed to by SARS-CoV-2, including severe admissions involving critical care10 and in the demographics of affected children.
Archive Staff Only
 |
View Item |
