key: cord-0735211-yvj1ou6n
authors: Rao, Sunil Kumar; Kumar, Ashutosh; Prasad, Rajniti; Gupta, Vineeta; Mishra, Om Prakash
title: Clinical Profile and Outcome of COVID-19 Among Immunocompromised Children
date: 2021-08-05
journal: Indian Pediatr
DOI: 10.1007/s13312-021-2267-6
sha: 9253abc42283ed7df9d026354b60aa238b6c837e
doc_id: 735211
cord_uid: yvj1ou6n

This retrospective study describes the clinical profile, risk of infection and outcome of coronavirus disease-19 in immunocompromised children. It was found that children on immunosuppressant medication has 2.89 times increased risk of infection (P=0.01). Disease manifestation was asymptomatic (P=0.01) or mild with predominant gastrointestinal symptoms (P=0.02) without alteration in immunosuppressive treatment regime.

Data of 409 children were extracted during the study period; 162 (396%) of these were immunocompromised. Of the 409 children, 26 (6.3%) were diagnosed with SARS-CoV-2. Data of one child was incomplete and he was excluded from the analysis. The proportion of SARS-CoV-2 positivity in immunocompromised and immunocompetent children was 16 (9.9%) and 9 (3.6%), respectively [OR (95% CI) 2.89 (1.24-6.73); P=0.01]. Comorbidities were present in 184 (44.9%) children, mainly malignancy in 78 (18.9%) and nephrotic syndrome (NS) in 67 (16.3%). The clinical profile and outcome of children with COVID-19 is shown in Table I . All children with severe COVID-19 disease had features of sepsis and shock; however, 3 children had acute respiratory distress syndrome (ARDS). Only 12 children with COVID-19 underwent blood biochemistry, and reports revealed anemia (n=6), leucopenia (n=5), neutrophil-lymphocyte ratio>3 (n=5) and thrombocytopenia in 3 children. High resolution computed tomography of chest showed ground glass opacities in two and air-bronchogram in three children. One child presented with severe abdominal pain and computed tomography of abdomen was suggestive of pancreatitis, he also had elevated amylase (217µ/L) and lipase (365µ/L).

Immunocompromised children had a significantly higher risk of SARS CoV-2 infection which may be due to the need of frequent hospital visits for their medications (chemotherapy), which exposed them to get infection. However, they had a lower hospitalization rate [8 (50%) vs 9 (100%), P=0.01] as compared to immunocompetent children possibly because of day care This retrospective study describes the clinical profile, risk of infection and outcome of coronavirus disease-19 in immunocompromised children. It was found that children on immunosuppressant medication has 2.89 times increased risk of infection (P=0.01). Disease manifestation was asymptomatic (P=0.01) or mild with predominant gastrointestinal symptoms (P=0.02) without alteration in immunosuppressive treatment regime.

Children with COVID-19 Immuno-

Comorbidity a 5 1 6 [8] and in a systematic review of 16 articles (100 adults, 10 children) by Minotti, et al. [5] , which concluded that these children had asymptomatic or mild disease, and had a favorable outcome. Severe disease manifestations and require-ment of intensive care, respiratory support, and inotropes were comparable between the two groups. Overall mortality was 16% and this might be a reflection of high incidence of non-COVID sepsis and associated complications in these patients. In a study on 113 children with kidney diseases receiving immunosuppressive medications from 30 countries; authors found that only 9.7% had severe grade of disease [3] . Features of relapse, or new organ involvement (pancreas) or new onset glomerulonephritis have been seen in children with nephrotic syndrome in present study and this might be like other viruses, SARS Co-V-2 infection may also precipitate relapses or infect new organ [9, 10] .

The present study has few limitations, one being retrospective analysis and small sample size, and short term followup. Additionally, admitting policy kept on changing during the study period depending on government guidelines. We conclude that children with immunosuppressant medication are at an increased risk of SARS Co-V-2 infection, and disease manifestations may be asymptomatic or mild with predominantly gastrointestinal symptoms.

Contributors: SKR, RP, VG, OPM: concept, design, drafting of the manuscript, critical analysis; AK: acquisition of data, analysis and interpretation. All authors approved the final version of manuscript, and are accountable for all aspects related to the study. 

Clinical features and outcome of SARS-CoV-2 infection in children: A systematic review and metaanalysis

The severity of COVID-19 in children on immunosuppressive medication

COVID-19 in children treated with immunosuppressive medication for kidney disease

Clinical course of COVID-19 among immunocompromised children: A clinical case series

How is immunosuppressive status affecting children and adults in SARS-CoV-2 infection? A systematic review

Managing children with renal diseases during the COVID-19 pandemic

Ministry of Health and Family Welfare Guidelines on clinical management of COVID-19. Directorate General of Health Services (EMR Division)

Flash survey on severe acute respiratory syndrome coronavirus-2 infections in paediatric patients on anticancer treatment

COVID-19 associated with onset nephrotic syndrome in a pediatric patient: Coincidence or related conditions?

Relapse rate of nephrotic syndrome in the time of COVID-19

A comparison of post-vaccination hepatitis B surface antibody level on the large and appropriate for gestational age infants (Clin Exp Vaccine Res. 2021; 10:47-51) Hepatitis B infection is the most common cause of chronic hepatitis leading to cirrhosis and carcinoma. Perinatally acquired hepatitis B infection has the highest rates of progression from acute to chronic disease compared to an infection at later age. Hepatitis B vaccination is important in reducing the global burden of the disease. The researchers enrolled 132 infants aged 7 months, one month after the last CLIPPINGS (4th) dose of recombinant DNA hepatitis B vaccine containing pentavalent vaccine. All infants were negative for hepatitis B surface antigen and hepatitis B core antibody. On the basis of birthweight, participants were divided into group 1: weighing between 2-4 kg (n=63), appropriate for gestational age, and group 2: weighing >4kg (n=69), large for gestational age. Anti-Hbs antibody titers ≥10 IU/L were taken as adequate. Mean birthweight of the groups was 2.98 (0.53) and 4.19 (0.19) kg, respectively. The mean (SD) anti-HBs antibody titer in group 1 and 2 was 13701.0 (11744.4) and 8997.1 (2827.2), respectively (95% CI of difference, -7607.4 to -1800.2; P=0.002), even though the titers were in protective range in both the groups.

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