TY - JOUR
T1 - COVID-19 in children and adolescents in Europe
T2 - a multinational, multicentre cohort study
AU - Buonsenso D
AU - Götzinger, Florian
AU - Santiago-García, Begoña
AU - Noguera-Julián, Antoni
AU - Lanaspa, Miguel
AU - Lancella, Laura
AU - Calò Carducci, Francesca I.
AU - Gabrovska, Natalia
AU - Velizarova, Svetlana
AU - Prunk, Petra
AU - Osterman, Veronika
AU - Krivec, Uros
AU - Lo Vecchio, Andrea
AU - Shingadia, Delane
AU - Soriano-Arandes, Antoni
AU - Melendo, Susana
AU - Lanari, Marcello
AU - Pierantoni, Luca
AU - Wagner, Noémie
AU - L'Huillier, Arnaud G.
AU - Heininger, Ulrich
AU - Ritz, Nicole
AU - Bandi, Srini
AU - Krajcar, Nina
AU - Roglić, Srđan
AU - Santos, Mar
AU - Christiaens, Christelle
AU - Creuven, Marine
AU - Buonsenso, Danilo
AU - Welch, Steven B.
AU - Bogyi, Matthias
AU - Brinkmann, Folke
AU - Tebruegge, Marc
AU - Pfefferle, Jasmin
AU - Zacharasiewicz, Angela
AU - Berger, Angelika
AU - Berger, Roland
AU - Strenger, Volker
AU - Kohlfürst, Daniela S.
AU - Zschocke, Anna
AU - Bernar, Benoît
AU - Simma, Burkhard
AU - Haberlandt, Edda
AU - Thir, Christina
AU - Biebl, Ariane
AU - Vanden Driessche, Koen
AU - Boiy, Tine
AU - Van Brusselen, Daan
AU - Bael, An
AU - Debulpaep, Sara
AU - Valentini, Piero
N1 - Funding Information:
We express our gratitude to all colleagues and research personnel involved in the data collection for this study, as well as the members of the human research ethics committees and institutional review boards that have kindly fast-tracked this study. We are also grateful for the kind support of the Clinical Microbiology & Infectious Diseases Department and the COVID-19 Group at Hospital General Universitario Gregorio Marañón, Madrid, Spain. This project did not receive specific funding. ptbnet is supported by the Deutsche Gesellschaft für Internationale Zusammenarbeit. BS-G is funded by the Spanish Ministry of Health—Instituto de Salud Carlos III and co-funded by the European Union (FEDER; Contrato Juan Rodés, Grant JR16/00036). AN-J was supported by “Subvencions per a la Intensificacio de Facultatius Especialistes”—Departament de Salut de la Generalitat de Catalunya, Programa PERIS 2016–2020 (SLT008/18/00193).
Funding Information:
We express our gratitude to all colleagues and research personnel involved in the data collection for this study, as well as the members of the human research ethics committees and institutional review boards that have kindly fast-tracked this study. We are also grateful for the kind support of the Clinical Microbiology & Infectious Diseases Department and the COVID-19 Group at Hospital General Universitario Gregorio Mara??n, Madrid, Spain. This project did not receive specific funding. ptbnet is supported by the Deutsche Gesellschaft f?r Internationale Zusammenarbeit. BS-G is funded by the Spanish Ministry of Health?Instituto de Salud Carlos III and co-funded by the European Union (FEDER; Contrato Juan Rod?s, Grant JR16/00036). AN-J was supported by ?Subvencions per a la Intensificacio de Facultatius Especialistes??Departament de Salut de la Generalitat de Catalunya, Programa PERIS 2016?2020 (SLT008/18/00193). Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.
Funding Information:
FG has received funding from Gilead for research related to hepatitis E. BS-G and MT have received assays free of charge from Cepheid for tuberculosis diagnostics projects. MT has received assays at reduced pricing or free of charge from Cellestis/Qiagen for tuberculosis diagnostics projects, has received support for conference attendance from Cepheid, and is currently receiving funding from bioMérieux as an investigator of an ongoing tuberculosis diagnostics study. UH reports personal fees from CEPI for being a member of the SPEAC-CEPI Meta-Data safety monitoring board for COVID-19 vaccine trials, outside of the submitted work. The other authors declare no competing interests.
Publisher Copyright:
© 2020 Elsevier Ltd
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/9
Y1 - 2020/9
N2 - Background: To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. Methods: This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network—the Paediatric Tuberculosis Network European Trials Group (ptbnet)—that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission. Findings: 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5–12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2–11, range 1–34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5·06, 95% CI 1·72–14·87; p=0·0035), male sex (2·12, 1·06–4·21; p=0·033), pre-existing medical conditions (3·27, 1·67–6·42; p=0·0015), and presence of lower respiratory tract infection signs or symptoms at presentation (10·46, 5·16–21·23; p<0·0001). The most frequently used drug with antiviral activity was hydroxychloroquine (40 [7%] patients), followed by remdesivir (17 [3%] patients), lopinavir–ritonavir (six [1%] patients), and oseltamivir (three [1%] patients). Immunomodulatory medication used included corticosteroids (22 [4%] patients), intravenous immunoglobulin (seven [1%] patients), tocilizumab (four [1%] patients), anakinra (three [1%] patients), and siltuximab (one [<1%] patient). Four children died (case-fatality rate 0·69%, 95% CI 0·20–1·82); at study end, the remaining 578 were alive and only 25 (4%) were still symptomatic or requiring respiratory support. Interpretation: COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed. Funding: ptbnet is supported by Deutsche Gesellschaft für Internationale Zusammenarbeit.
AB - Background: To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. Methods: This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network—the Paediatric Tuberculosis Network European Trials Group (ptbnet)—that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission. Findings: 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5–12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2–11, range 1–34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5·06, 95% CI 1·72–14·87; p=0·0035), male sex (2·12, 1·06–4·21; p=0·033), pre-existing medical conditions (3·27, 1·67–6·42; p=0·0015), and presence of lower respiratory tract infection signs or symptoms at presentation (10·46, 5·16–21·23; p<0·0001). The most frequently used drug with antiviral activity was hydroxychloroquine (40 [7%] patients), followed by remdesivir (17 [3%] patients), lopinavir–ritonavir (six [1%] patients), and oseltamivir (three [1%] patients). Immunomodulatory medication used included corticosteroids (22 [4%] patients), intravenous immunoglobulin (seven [1%] patients), tocilizumab (four [1%] patients), anakinra (three [1%] patients), and siltuximab (one [<1%] patient). Four children died (case-fatality rate 0·69%, 95% CI 0·20–1·82); at study end, the remaining 578 were alive and only 25 (4%) were still symptomatic or requiring respiratory support. Interpretation: COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed. Funding: ptbnet is supported by Deutsche Gesellschaft für Internationale Zusammenarbeit.
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U2 - 10.1016/S2352-4642(20)30177-2
DO - 10.1016/S2352-4642(20)30177-2
M3 - Article
C2 - 32593339
AN - SCOPUS:85087362754
VL - 4
SP - 653
EP - 661
JO - The Lancet Child and Adolescent Health
JF - The Lancet Child and Adolescent Health
SN - 2352-4642
IS - 9
ER -