Comparison of Severe Viral Pneumonia Caused by SARS-CoV-2 and Other Respiratory Viruses Among Malaysian Children During the COVID-19 Pandemic

Ng, David Chun‐Ern; Tan, Kah Kee; TING, Grace Sieng Sing; Chin, Ling; Fadzilah, Nur Fadzreena Binti; TAN, Shir Fong; Subramaniam, Thayasheri; Zailanalhuddin, Nur Emylia Binti; LIM, Hui Yi; Baharuddin, Suhaila Binti; LEE, Yee Lean; Nor, Airena Mohamad; Khoo, Erwin Jiayuan

doi:10.3389/fped.2022.865099

Cited by 8 publications

(11 citation statements)

References 27 publications

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“…However, our ratio of males to females was almost similar to published studies regionally 23,24 . The predominance of Malays in our patient cohort was consistent with the demographic distribution of COVID‐19 in our earlier publications 21,25,26 . The majority of patients in our study demonstrated seropositivity for SARS‐CoV‐2 antibodies, as opposed to direct detection of the virus through RT‐PCR, suggesting MIS‐C as a post‐infectious phenomenon 27 …”

Section: Discussionsupporting

confidence: 90%

“…23,24 The predominance of Malays in our patient cohort was consistent with the demographic distribution of COVID-19 in our earlier publications. 21,25,26 The majority of patients in our study demonstrated seropositivity for SARS-CoV-2 antibodies, as opposed to direct detection of the virus through RT-PCR, suggesting MIS-C as a post-infectious phenomenon. 27 The clinical presentation of MIS-C was diverse, characterized by fever and multi-system involvement, particularly the gastrointestinal, mucocutaneous, and cardiovascular systems.…”

Section: Discussionmentioning

confidence: 67%

“…This differed from many Western countries, where widespread immunity through vaccination or prior Delta variant exposure, was established by the time Omicron emerged. However, our country's effective containment strategies during the Delta wave resulted in a milder outbreak, 21 leaving many children without pre‐existing immunity when the Omicron wave began. As the Omicron wave progressed, we observed a decline in MIS‐C cases, with no new cases reported in the first half of 2023.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology, clinical characteristics and outcomes of multisystem inflammatory syndrome in children

Chun‐Ern Ng,

Liew,

Tan

et al. 2023

Pediatrics International

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BackgroundWe describe the epidemiology, clinical characteristics, and outcomes of multisystem inflammatory syndrome in children (MIS‐C) among children from Negeri Sembilan, Malaysia.MethodsA retrospective, multicentre, observational study was performed among children ≤15 years old who were hospitalized for MIS‐C between January 18, 2021 and June 30, 2023. The incidence of MIS‐C was estimated using reported SARS‐CoV‐2 cases and census population data. Descriptive analyses were used to summarize the clinical presentation and outcomes.ResultsThe study included 53 patients with a median age of 5.7 years (IQR 1.8–8.7 years); 75.5% were males. The overall incidence of MIS‐C was approximately 5.9 cases per 1,000,000 person‐months. Pediatric intensive care unit (PICU) admission was required for 22 (41.5%) patients. No mortalities were recorded. Children aged 6–12 years were more likely to present with cardiac dysfunction/shock (odds ratio [OR] 5.43, 95% confidence interval [CI] 1.67–17.66), whereas children below 6 years were more likely to present with a Kawasaki disease phenotype (OR 5.50, 95% CI 1.33–22.75). Twenty patients (37.7%) presented with involvement of at least four organ systems, but four patients (7.5%) demonstrated single‐organ system involvement.ConclusionAn age‐based variation in the clinical presentation of MIS‐C was demonstrated. Our findings suggest MIS‐C could manifest in a spectrum, including single‐organ involvement. Despite the high requirement for PICU admission, the prognosis of MIS‐C was favorable, with no recorded mortalities.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Epidemiology, clinical characteristics and outcomes of multisystem inflammatory syndrome in children

Chun‐Ern Ng,

Liew,

Tan

et al. 2023

Pediatrics International

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“…Hence, other viral or bacterial co‐infection causing serious disease could have been missed. However, the negative blood cultures for all patients who were started on iv antibiotics and the low co‐detection rates of other respiratory viruses, as demonstrated in our previous study, 23 suggest that the severity of the disease was caused by SARS‐CoV‐2 alone. Fourth, genomic sequencing for SARS‐Cov‐2 variants was not performed in this study.…”

Section: Discussionsupporting

confidence: 48%

Clinical characteristics of COVID‐19 in hospitalized young infants and risk factors for disease severity

Tan

Liew³

et al. 2023

Pediatrics International

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BackgroundThis study aimed to describe the clinical characteristics and severity of young infants hospitalized with COVID‐19 and study the relationship between breastfeeding and maternal COVID‐19 vaccination on the severity of COVID‐19.MethodsA retrospective, observational study was performed among infants aged 6 months and below hospitalized for COVID‐19 in a tertiary state hospital in Malaysia between February 1 and April 30, 2022. The primary outcome was “serious disease,” defined as pneumonia requiring respiratory support or dehydration with warning signs. Multivariate logistic regression was used to determine independent predictors for serious disease.ResultsA total of 102 infants were included in the study; 53.9% were males with a median age of 11 weeks (interquartile range: 5–20 weeks). Sixteen patients (15.7%) had pre‐existing comorbidities, including preterm birth. Fever was the most common presenting symptom (82.4%), followed by cough (53.9%), and rhinorrhea (31.4%). Forty‐one infants (40.2%) presented with serious disease, warranting either respiratory support or intravenous fluid therapy for dehydration. Recent maternal COVID‐19 vaccination was associated with a reduced risk of serious disease on univariate analysis but was not significant after multivariate adjustment (adjusted odds ratio [aOR] 0.39; 95% CI: 0.14–1.11; p = 0.08). Exclusive breastfeeding was protective against serious COVID‐19 in young infants, independent of other confounding factors (aOR 0.21, 95% CI: 0.06–0.71; p = 0.01).ConclusionCOVID‐19 is a serious disease with non‐specific clinical manifestations in young infants. Exclusive breastfeeding could play an important protective role.

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“…Duration of illness was calculated from the first symptom onset. A potential source of infection with an adult or child was specified based on the age and nature of contact, as defined previously 10 . When multiple family members were symptomatic, the first family member who became symptomatic was regarded as the sick contact.…”

Section: Methodsmentioning

confidence: 99%

Clinical comparison of HMPV and RSV infections in hospitalised Malaysian children: A propensity score matched study

Ng,

Liew,

Tan

et al. 2024

Clinical Respiratory J

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IntroductionHuman metapneumovirus (hMPV) and respiratory syncytial virus (RSV) are significant contributors to the burden of acute respiratory infections in children, but data on hMPV from Southeast Asia are limited despite its potential for serious disease. This study aimed to compare the clinical presentation, resource utilisation and outcomes between hMPV and RSV infections in hospitalised Malaysian children.MethodsThis retrospective, observational study included children aged ≤12 years old hospitalised with hMPV or RSV, confirmed via direct fluorescent antibody (DFA) methods, between 1 July to 30 October 2022 at Hospital Tuanku Ja'afar Seremban, Malaysia. Demographic, clinical presentation, resource utilisation and outcome data were analysed. Propensity score matching was used to balance cohorts based on key demographic and clinical characteristics.ResultsThis study included 192 patients, comprising 112 with hMPV and 80 with RSV. hMPV patients were older (median age 20.5 vs. 9.4 months, p < 0.001) and had a higher incidence of comorbidities (24.1% vs. 7.5%, p = 0.003). Fever was more common in the hMPV group (97.3% vs. 73.8%, p < 0.001), but the other clinical manifestations were similar. Postmatching analysis showed higher corticosteroid use in the hMPV group (p = 0.01). No significant differences were observed in the use of other resources, PICU admissions, duration of hospitalisation or mortality rates between both groups.ConclusionhMPV and RSV infections in children share similar clinical manifestations and outcomes, with hMPV affecting older children and showing higher corticosteroid usage. These findings emphasise the need for equal clinical vigilance for both hMPV and RSV in paediatric respiratory infections.

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Comparison of Severe Viral Pneumonia Caused by SARS-CoV-2 and Other Respiratory Viruses Among Malaysian Children During the COVID-19 Pandemic

Cited by 8 publications

References 27 publications

Epidemiology, clinical characteristics and outcomes of multisystem inflammatory syndrome in children

Epidemiology, clinical characteristics and outcomes of multisystem inflammatory syndrome in children

Clinical characteristics of COVID‐19 in hospitalized young infants and risk factors for disease severity

Clinical comparison of HMPV and RSV infections in hospitalised Malaysian children: A propensity score matched study

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