Comparing SARS-CoV-2 variants among children and adolescents in Germany: relative risk of COVID-19-related hospitalization, ICU admission and mortality.
Adolescents
Burden of disease
COVID-19
Children
Pandemic
SARS-CoV-2
Seroprevalence
Variants of concern
Journal
Infection
ISSN: 1439-0973
Titre abrégé: Infection
Pays: Germany
ID NLM: 0365307
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
30
12
2022
accepted:
31
01
2023
medline:
23
10
2023
pubmed:
15
2
2023
entrez:
14
2
2023
Statut:
ppublish
Résumé
SARS-CoV-2 infections cause COVID-19 and have a wide spectrum of morbidity. Severe disease courses among children are rare. To date, data on the variability of morbidity in relation to variant of concern (VOC) in children has been sparse and inconclusive. We compare the clinical severity of SARS-CoV-2 infection among children and adolescents in Germany during the Wildtype and Alpha combined, Delta and Omicron phases of the COVID-19 pandemic. Comparing risk of COVID-19-related hospitalization, intensive care unit (ICU) admission and death due to COVID-19 in children and adolescents, we used: (1) a multi-center seroprevalence study (SARS-CoV-2-KIDS study); (2) a nationwide registry of pediatric patients hospitalized with SARS-CoV-2 infections; and (3) compulsory national reporting for RT-PCR-confirmed SARS-CoV-2 infections in Germany. During the Delta predominant phase, risk of COVID-19-related hospitalization among all SARS-CoV-2 seropositive children was 3.35, ICU admission 1.19 and fatality 0.09 per 10,000; hence about halved for hospitalization and ICU admission and unchanged for deaths as compared to the Wildtype- and Alpha-dominant period. The relative risk for COVID-19-related hospitalization and ICU admission compared to the alpha period decreased during Delta [0.60 (95% CI 0.54; 0.67) and 0.51 (95% CI 0.42; 0.61)] and Omicron [0.27 (95% CI 0.24; 0.30) and 0.06 (95% CI 0.05; 0.08)] period except for the < 5-year-olds. The rate of case fatalities decreased slightly during Delta, and substantially during Omicron phase. Morbidity caused by SARS-CoV-2 infections among children and adolescents in Germany decreased over the course of the COVID-19 pandemic, as different VOCs) emerged.
Identifiants
pubmed: 36787015
doi: 10.1007/s15010-023-01996-y
pii: 10.1007/s15010-023-01996-y
pmc: PMC9925936
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1357-1367Informations de copyright
© 2023. The Author(s).
Références
Viner RM, Mytton OT, Bonell C, Melendez-Torres GJ, Ward J, Hudson L, et al. Susceptibility to SARS-CoV-2 infection among children and adolescents compared with adults: a systematic review and meta-analysis. JAMA Pediatr. 2021;175:143–56.
doi: 10.1001/jamapediatrics.2020.4573
pubmed: 32975552
Gudbjartsson DF, Helgason A, Jonsson H, Magnusson OT, Melsted P, Norddahl GL, et al. Spread of SARS-CoV-2 in the icelandic population. N Engl J Med. 2020;382:2302–15.
doi: 10.1056/NEJMoa2006100
pubmed: 32289214
Brodin P. SARS-CoV-2 infections in children: understanding diverse outcomes. Immunity. 2022;55:201–9.
doi: 10.1016/j.immuni.2022.01.014
pubmed: 35093190
pmcid: 8769938
Sorg AL, Schönfeld V, Siedler A, Hufnagel M, Doenhardt M, Diffloth N, et al. SARS-CoV-2 variants and the risk of pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 among children in Germany. Infection. 2022. https://doi.org/10.1007/s15010-022-01908-6 .
doi: 10.1007/s15010-022-01908-6
pubmed: 36048361
pmcid: 9435410
Sorg A-L, Hufnagel M, Doenhardt M, Diffloth N, Schroten H, von Kries R, et al. Risk for severe outcomes of COVID-19 and PIMS-TS in children with SARS-CoV-2 infection in Germany. Eur J Pediatr. 2022;181:3635–43.
doi: 10.1007/s00431-022-04587-5
pubmed: 35962242
pmcid: 9374569
RKI. Coronavirus Disease 2019 (COVID-19) Daily Situation Report of the Robert Koch Institute [Internet]. 26.12.20220. https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/Dez_2020/2020-12-26-en.pdf?__blob=publicationFile .
RKI - Coronavirus SARS-CoV-2 - Anzahl und Anteile von VOC und VOI in Deutschland (Tabelle wird donnerstags aktualisiert) [Internet]. [cited 2022 Nov 15]. https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Daten/VOC_VOI_Tabelle.html .
Ong SWX, Chiew CJ, Ang LW, Mak TM, Cui L, Toh MPHS, et al. Clinical and virological features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern: a retrospective cohort study comparing B.1.1.7 (Alpha), B.1.351 (Beta), and B.1.617.2 (Delta). Clin Infect Dis. 2022;75:e1128–36.
doi: 10.1093/cid/ciab721
pubmed: 34423834
Twohig KA, Nyberg T, Zaidi A, Thelwall S, Sinnathamby MA, Aliabadi S, et al. Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study. Lancet Infect Dis. 2022;22:35–42.
doi: 10.1016/S1473-3099(21)00475-8
pubmed: 34461056
pmcid: 8397301
Fisman DN, Tuite AR. Evaluation of the relative virulence of novel SARS-CoV-2 variants: a retrospective cohort study in Ontario, Canada. CMAJ Can Med Assoc J. 2021;193:E1619–25.
doi: 10.1503/cmaj.211248
Whittaker R, Greve-Isdahl M, Bøås H, Suren P, Buanes EA, Veneti L. COVID-19 hospitalization among children <18 years by variant wave in Norway. Pediatrics. 2022;150: e2022057564.
doi: 10.1542/peds.2022-057564
pubmed: 35916036
Martin B, DeWitt PE, Russell S, Anand A, Bradwell KR, Bremer C, et al. Characteristics, outcomes, and severity risk factors associated with SARS-CoV-2 infection among children in the US national COVID cohort collaborative. JAMA Netw Open. 2022;5: e2143151.
doi: 10.1001/jamanetworkopen.2021.43151
pubmed: 35133437
pmcid: 8826172
Shoji K, Akiyama T, Tsuzuki S, Matsunaga N, Asai Y, Suzuki S, et al. Comparison of the clinical characteristics and outcomes of COVID-19 in children before and after the emergence of Delta variant of concern in Japan. J Infect Chemother. 2022;28:591–4.
doi: 10.1016/j.jiac.2022.01.009
pubmed: 35074258
pmcid: 8769918
Yılmaz Çelebi M, Kıymet E, Böncüoğlu E, Şahinkaya Ş, Cem E, Düzgöl M, et al. Evaluation of childhood hospitalization rates and degree of severity of SARS-CoV-2 variants, including B.1.1.7 (Alpha), B.1.315/P.1 (Beta/Gamma), and B.1.617.2 (Delta). J Med Virol. 2022;94:2050–4.
doi: 10.1002/jmv.27587
pubmed: 35018660
pmcid: 9015582
Doenhardt M, Gano C, Sorg A-L, Diffloth N, Tenenbaum T, von Kries R, et al. Burden of pediatric SARS-CoV-2 hospitalizations during the omicron wave in Germany. Viruses. 2022;14:2102.
doi: 10.3390/v14102102
pubmed: 36298657
pmcid: 9607436
Sorg A-L, Bergfeld L, Jank M, Corman V, Semmler I, Goertz A, et al. Cross-sectional seroprevalence surveys of SARS-CoV-2 antibodies in children in Germany, June 2020 to May 2021. Nat Commun. 2022;13:3128.
doi: 10.1038/s41467-022-30482-6
pubmed: 35668073
pmcid: 9170697
Bevölkerung nach Altersgruppen (ab 2011) [Internet]. Stat. Bundesamt. [cited 2022 Nov 15]. https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Bevoelkerung/Bevoelkerungsstand/Tabellen/liste-altersgruppen.html .
RKI - Empfehlungen der STIKO - Mitteilung der STIKO zur Aktualisierung der COVID-19-Impfempfehlung für Kinder und Jugendliche (16.8.2021) [Internet]. [cited 2022 Dec 10]. https://www.rki.de/DE/Content/Kommissionen/STIKO/Empfehlungen/PM_2021-08-16.html .
RKI - Empfehlungen der STIKO - Pressemitteilung der STIKO zur COVID-19-Impfempfehlung für Kinder von 5–11 Jahren und für Personen mit durchgemachter SARS-CoV-2-Infektion und bisher unvollständiger Immunisierung (20. Aktualisierung) [Internet]. [cited 2022 Dec 10]. https://www.rki.de/DE/Content/Kommissionen/STIKO/Empfehlungen/PM_2022-05-24.html .
Koch-Institut R. Epidemiologisches Bulletin 1/2022. 2022.
Madhi SA, Kwatra G, Myers JE, Jassat W, Dhar N, Mukendi CK, et al. Population immunity and Covid-19 severity with omicron variant in South Africa. N Engl J Med. 2022;386:1314–26.
doi: 10.1056/NEJMoa2119658
pubmed: 35196424
Wang L, Berger NA, Kaelber DC, Davis PB, Volkow ND, Xu R. Incidence rates and clinical outcomes of SARS-CoV-2 infection with the omicron and delta variants in children younger than 5 years in the US. JAMA Pediatr. 2022;176:811–3.
doi: 10.1001/jamapediatrics.2022.0945
pubmed: 35363246
pmcid: 8976262
Hoch M, Vogel S, Kolberg L, Dick E, Fingerle V, Eberle U, et al. Weekly SARS-CoV-2 Sentinel Surveillance in Primary Schools, Kindergartens, and Nurseries, Germany, June‒November 2020 - Volume 27, Number 8—August 2021 - Emerging Infectious Diseases journal - CDC. [cited 2022 Dec 10]; https://wwwnc.cdc.gov/eid/article/27/8/20-4859_article .
Vogel S, von Both U, Nowak E, Ludwig J, Köhler A, Lee N, et al. SARS-CoV-2 saliva mass screening in primary schools: a 10-week sentinel surveillance study in Munich, Germany. Diagnostics. 2022;12:162.
doi: 10.3390/diagnostics12010162
pubmed: 35054329
pmcid: 8774979
Oeser C, Whitaker H, Linley E, Borrow R, Tonge S, Brown CS, et al. Large increases in SARS-CoV-2 seropositivity in children in England: effects of the delta wave and vaccination. J Infect. 2022;84:418–67.
doi: 10.1016/j.jinf.2021.11.019
pubmed: 34861351
Kläser K, Molteni E, Graham M, Canas LS, Österdahl MF, Antonelli M, et al. COVID-19 due to the B.1.617.2 (Delta) variant compared to B.1.1.7 (Alpha) variant of SARS-CoV-2: a prospective observational cohort study. Sci Rep. 2022;12:10904.
doi: 10.1038/s41598-022-14016-0
pubmed: 35764879
pmcid: 9240087
Chadeau-Hyam M, Wang H, Eales O, Haw D, Bodinier B, Whitaker M, et al. SARS-CoV-2 infection and vaccine effectiveness in England (REACT-1): a series of cross-sectional random community surveys. Lancet Respir Med. 2022;10:355–66.
doi: 10.1016/S2213-2600(21)00542-7
pubmed: 35085490
pmcid: 8786320
Vöhringer HS, Sanderson T, Sinnott M, De Maio N, Nguyen T, Goater R, et al. Genomic reconstruction of the SARS-CoV-2 epidemic in England. Nature. 2021;600:506–11.
doi: 10.1038/s41586-021-04069-y
pubmed: 34649268
pmcid: 8674138
Molteni E, Sudre CH, Canas LDS, Bhopal SS, Hughes RC, Chen L, et al. Illness characteristics of COVID-19 in children infected with the SARS-CoV-2 delta variant. Child Basel Switz. 2022;9:652.
Sheikh A, McMenamin J, Taylor B, Robertson C, Public Health Scotland and the EAVE II Collaborators. SARS-CoV-2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness. Lancet. 2021;397:2461–2.
doi: 10.1016/S0140-6736(21)01358-1
pubmed: 34139198
pmcid: 8201647
Angepasste Teststrategie [Internet]. [cited 2023 Jan 18]. https://www.bundesgesundheitsministerium.de/coronavirus/nationale-teststrategie/coronavirus-testverordnung.html .
Butt AA, Dargham SR, Loka S, Shaik RM, Chemaitelly H, Tang P, et al. Coronavirus disease 2019 disease severity in children infected with the omicron variant. Clin Infect Dis. 2022;75:e361–7.
doi: 10.1093/cid/ciac275
pubmed: 35404391
Marks KJ, Whitaker M, Anglin O, Milucky J, Patel K, Pham H, et al. Hospitalizations of children and adolescents with laboratory-confirmed COVID-19—COVID-NET, 14 states, July 2021–January 2022. Morb Mortal Wkly Rep. 2022;71:271–8.
doi: 10.15585/mmwr.mm7107e4
Hyams C, Challen R, Marlow R, Nguyen J, Begier E, Southern J, et al. Severity of Omicron (B.1.1.529) and Delta (B.1.617.2) SARS-CoV-2 infection among hospitalised adults: A prospective cohort study in Bristol, United Kingdom. Lancet Reg Health – Eur [Internet]. Elsevier; 2023 [cited 2023 Jan 15];25. https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(22)00252-6/fulltext .
Lauring AS, Tenforde MW, Chappell JD, Gaglani M, Ginde AA, McNeal T, et al. Clinical severity of, and effectiveness of mRNA vaccines against, covid-19 from omicron, delta, and alpha SARS-CoV-2 variants in the United States: prospective observational study. BMJ. 2022;376:e069761.
doi: 10.1136/bmj-2021-069761
pubmed: 35264324
Nyberg T, Ferguson NM, Nash SG, Webster HH, Flaxman S, Andrews N, et al. Comparative analysis of the risks of hospitalisation and death associated with SARS-CoV-2 omicron (B.1.1.529) and delta (B.1.617.2) variants in England: a cohort study. Lancet. 2022;399:1303–12.
doi: 10.1016/S0140-6736(22)00462-7
pubmed: 35305296
pmcid: 8926413
Bager P, Wohlfahrt J, Bhatt S, Stegger M, Legarth R, Møller CH, et al. Risk of hospitalisation associated with infection with SARS-CoV-2 omicron variant versus delta variant in Denmark: an observational cohort study. Lancet Infect Dis. 2022;22:967–76.
doi: 10.1016/S1473-3099(22)00154-2
pubmed: 35468331
pmcid: 9033212
Miron VD, Gunșahin D, Filimon C, Bar G, Craiu M. Pediatric emergencies and hospital admissions in the first six months of the COVID-19 pandemic in a tertiary children’s hospital in Romania. Child Basel Switz. 2022;9:513.
Bögli J, Güsewell S, Strässle R, Kahlert CR, Albrich WC. Pediatric hospital admissions, case severity, and length of hospital stay during the first 18 months of the COVID-19 pandemic in a tertiary children’s hospital in Switzerland. Infection [Internet]. 2022 [cited 2023 Jan 13]; https://doi.org/10.1007/s15010-022-01911-x .
Methi F, Størdal K, Telle K, Larsen VB, Magnusson K. Hospital admissions for respiratory tract infections in children aged 0–5 years for 2017/2023.
COVID-19-Klinik-Diagnostik-Therapie-Stellungnahme-2022–02_Final2.pdf [Internet]. [cited 2023 Jan 12]. https://dgpi.de/wp-content/uploads/2022/02/COVID-19-Klinik-Diagnostik-Therapie-Stellungnahme-2022-02_Final2.pdf .
Dorabawila V, Hoefer D, Bauer UE, Bassett MT, Lutterloh E, Rosenberg ES. Risk of infection and hospitalization among vaccinated and unvaccinated children and adolescents in New York after the emergence of the omicron variant. JAMA. 2022;327:2242–4.
doi: 10.1001/jama.2022.7319
pubmed: 35559959
pmcid: 9107062
Shi DS, Whitaker M, Marks KJ, Anglin O, Milucky J, Patel K, et al. Hospitalizations of children aged 5–11 years with laboratory-confirmed COVID-19 - COVID-NET, 14 States, March 2020-February 2022. MMWR Morb Mortal Wkly Rep. 2022;71:574–81.
doi: 10.15585/mmwr.mm7116e1
pubmed: 35446827
pmcid: 9042359
Cohen-Stavi CJ, Magen O, Barda N, Yaron S, Peretz A, Netzer D, et al. BNT162b2 vaccine effectiveness against omicron in children 5 to 11 years of age. N Engl J Med. 2022;387:227–36.
doi: 10.1056/NEJMoa2205011
pubmed: 35767475
Hui KPY, Ho JCW, Cheung M, Ng K, Ching RHH, Lai K, et al. SARS-CoV-2 Omicron variant replication in human bronchus and lung ex vivo. Nature. 2022;603:715–20.
doi: 10.1038/s41586-022-04479-6
pubmed: 35104836
Meng B, Abdullahi A, Ferreira IATM, Goonawardane N, Saito A, Kimura I, et al. Altered TMPRSS2 usage by SARS-CoV-2 Omicron impacts infectivity and fusogenicity. Nature. 2022;603:706–14.
doi: 10.1038/s41586-022-04474-x
pubmed: 35104837
pmcid: 8942856
Di Chiara C, Cantarutti A, Costenaro P, Donà D, Bonfante F, Cosma C, et al. Long-term immune response to SARS-CoV-2 infection among children and adults after mild infection. JAMA Netw Open. 2022;5: e2221616.
doi: 10.1001/jamanetworkopen.2022.21616
pubmed: 35816313
pmcid: 9280400
Stich M, Benning L, Speer C, Garbade SF, Bartenschlager M, Kim H, et al. Waning immunity 14 months after SARS-CoV-2 infection. Pediatrics. 2022;150: e2022057151.
doi: 10.1542/peds.2022-057151
pubmed: 35953884