Severity of Illness Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Variants of Concern in Children: A Single-Center Retrospective Cohort Study

• Published in: Journal of the Pediatric Infectious Diseases Society 2022-10, Vol.11 (10), p.440-447
• Main Authors: Edward, Priya R, Lorenzo-Redondo, Ramon, Reyna, Megan E, Simons, Lacy M, Hultquist, Judd F, Patel, Ami B, Ozer, Egon A, Muller, William J, Heald-Sargent, Taylor, McHugh, Matthew, Dean, Taylor, Dalal, Raj M, John, Jordan, Manz, Shannon C, Kociolek, Larry K
• Format: Article
• Language: English
• Subjects: Adolescent; Child; COVID-19; COVID-19 Vaccines; Humans; Original; Patient Acuity; Retrospective Studies; SARS-CoV-2
• ISSN: 2048-7207; 2048-7193; 2048-7207
• DOI: 10.1093/jpids/piac068

Recent COVID-19 surges are attributed to emergence of more transmissible SARS-CoV-2 variants of concern (VOCs). The relative severity of VOCs in children is unknown. We performed a single-center retrospective cohort study of children ≤18 years old diagnosed with COVID-19 from October 2020-February 2022 and whose SARS-CoV-2 isolate underwent Illumina sequencing. We measured the frequency of five markers of COVID-19 severity. Logistic regression models were fitted to estimate the odds of each severity marker with each VOC. Among 714 children, 471 (66.0%) were infected with a VOC: 96 (13.4%) alpha, 38 (5.3%) gamma, 119 (16.7%) delta, and 215 (30.1%) omicron. High-risk medical conditions and increasing age were independently associated with COVID-19 severity. After adjusting for age, race, ethnicity, high-risk medical conditions, and COVID-19 community incidence, neither alpha, delta, nor omicron was associated with severe COVID-19. Gamma was independently associated with hospitalization (OR 6.7, 95% CI 2.0-22.1); pharmacologic treatment (OR 5.7, 95% CI 1.2-26.8); respiratory support (OR 11.9, 95% CI 2.7-62.4); and severe disease per the WHO Clinical Progression Scale (OR 11.7, 95% CI 2.1-90.5). Upon subgroup analyses, omicron was independently associated with ICU admission and severe disease per the WHO Clinical Progression Scale in children without SARS-CoV-2 immunization or prior COVID-19 infection. Compared to non-VOC COVID-19, the gamma VOC was independently associated with increased COVID-19 severity, as was omicron in children without SARS-CoV-2 immunization or prior COVID-19 infection. SARS-CoV-2 vaccination and prior COVID-19 prevented severe outcomes during the omicron surge.