Clinical Experience With Severe Acute Respiratory Syndrome Coronavirus 2–Related Illness in Children: Hospital Experience in Cape Town, South Africa. (10th November 2020)

• Record Type: Journal Article
• Authors: van der Zalm, Marieke M; Lishman, Juanita; Verhagen, Lilly M; Redfern, Andrew; Smit, Liezl; Barday, Mikhail; Ruttens, Dries; da Costa, A'ishah; van Jaarsveld, Sandra; Itana, Justina; Schrueder, Neshaad; Van Schalkwyk, Marije; Parker, Noor; Appel, Ilse; Fourie, Barend; Claassen, Mathilda; Workman, Jessica J; Goussard, Pierre; Van Zyl, Gert; Rabie, Helena
• Is Part Of: Clinical infectious diseases. Volume 72:Number 12(2021)
• Page Start: e938
• Page End: e944
• Publication Date: 2020-11-10
• Subjects: COVID-19 -- children -- respiratory virus infections -- MIS-C -- sub-Saharan Africa; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa1666
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Children seem relatively protected from serious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related disease, but little is known about children living in settings with high tuberculosis and human immunodeficiency virus (HIV) burden. This study reflects clinical data on South African children with SARS-CoV-2. Methods: We collected clinical data of children aged <13 years with laboratory-confirmed SARS-CoV-2 presenting to Tygerberg Hospital, Cape Town, between 17 April and 24 July 2020. Results: One hundred fifty-nine children (median age, 48.0 months [interquartile range {IQR}, 12.0–106.0 months]) were included. Hospitalized children (n = 62), with a median age of 13.5 months (IQR, 1.8–43.5 months) were younger than children not admitted (n = 97; median age, 81.0 months [IQR, 34.5–120.5 months]; P < .01.). Thirty-three of 159 (20.8%) children had preexisting medical conditions. Fifty-one of 62 (82.3%) hospitalized children were symptomatic; lower respiratory tract infection was diagnosed in 21 of 51 (41.2%) children, and in 11 of 16 (68.8%) children <3 months of age. Respiratory support was required in 25 of 51 (49.0%) children; 13 of these (52.0%) were <3 months of age. One child was HIV infected and 11 of 51 (21.2%) were HIV exposed but uninfected, and 7 of 51 (13.7%) children had a recent or new diagnosis of tuberculosis. Conclusions: Children <1 year of age hospitalized with SARS-CoV-2 in Cape Town frequently required respiratory support. Access to oxygen may be limited in some low- and middle-income countries, which could potentially drive morbidity and mortality. HIV infection was uncommon but a relationship between HIV exposure, tuberculosis, and SARS-CoV-2 should be explored. Abstract : South African children hospitalized with COVID-19 respiratory tract infection were young and required respiratory support. This underscores the need for widespread implementation of oxygen and noninvasive respiratory support strategies in resource-limited settings to limit mortality due to COVID-19.