Reduced inflammatory responses to SARS-CoV-2 infection in children presenting to hospital with COVID-19 in China

• Published in: EClinicalMedicine 2021-04, Vol.34, p.100831-100831, Article 100831
• Main Authors: Qian, Guoqing, Zhang, Yong, Xu, Yang, Hu, Weihua, Hall, Ian P., Yue, Jiang, Lu, Hongyun, Ruan, Liemin, Ye, Maoqing, Mei, Jin
• Format: Article
• Language: English
• Subjects: Research Paper
• ISSN: 2589-5370; 2589-5370
• DOI: 10.1016/j.eclinm.2021.100831

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children is associated with better outcomes than in adults. The inflammatory response to COVID-19 infection in children remains poorly characterised. We retrospectively analysed the medical records of 127 laboratory-confirmed COVID-19 patients aged 1 month to 16 years from Wuhan and Jingzhou of Hubei Province. Patients presented between January 25th and March 24th 2020. Information on clinical features, laboratory results, plasma cytokines/chemokines and lymphocyte subsets were analysed. Children admitted to hospital with COVID-19 were more likely to be male (67.7%) and the median age was 7.3 [IQR 4.9] years. All but one patient with severe disease was aged under 2 and the majority (5/7) had significant co-morbidities. Despite 53% having viral pneumonia on computed tomography (CT) scanning only 2 patients had low lymphocyte counts and no differences were observed in the levels of plasma proinflammatory cytokines, including interleukin (IL)-2, IL-4, IL-6, tumour necrosis factor (TNF)-α, and interferon (IFN)-γ between patients with mild, moderate or severe disease. We observed that the immune responses of children to COVID-19 infection is significantly different from that seen in adults. Our evidence suggests that SARS-CoV-2 does not trigger a robust inflammatory response or ‘cytokine storm’ in children with COVID-19, and this may underlie the generally better outcomes seen in children with this disease.