Coronavirus disease 2019 in children

Abstract

Despite the global spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, there are limited data emerging in children. This review provides an update on clinical features, diagnosis, epidemiology, management and prevention of coronavirus disease 2019 (COVID-19) in children. Specific characteristics noted in children and their implications in disease management as well as transmission control are highlighted. Besides respiratory symptoms, gastrointestinal and atypical features such as chilblains, neurological symptoms and multisystem inflammation are also reported. Younger infants and those with comorbidity were found to be at risk of severe illness. Infected pregnant women and neonates were reported to have good prognosis. It is possible to manage the children with mild disease at home, with strict infection prevention control measures; severely affected require respiratory support and intensive care management. There are anecdotal reports of using antiviral and immunomodulatory drugs, benefit of which needs to be confirmed in clinical trials. A significant percentage of asymptomatic infection in children has epidemiological implication as these may act as links in transmission chain in the community. There is a need for systematic data on extra-pulmonary manifestations and atypical features, risk factors of severity, role of imaging and biomarkers, testing and management strategies and trials with antivirals and immunomodulatory drugs in children. The psychosocial effects of quarantine, closure of schools, lack of play activities and impact of lockdown need to be addressed. Understanding the biological basis for the profound age-dependent differential outcome of COVID-19 infection is important. Elucidating the protective mechanisms in children may aid in developing novel treatment strategies.

COVID-19 Management in the Pediatric Age: Consensus Document of the COVID-19 Working Group in Paediatrics of the Emilia-Romagna Region (RE-CO-Ped), Italy

“…Anosmia, hyposmia, ageusia and dysgeusia have been reported less frequently in the pediatric population than in adults. More frequently, however, highly polymorphic skin lesions such as livedo reticularis, purpuric lesions, measles lesions, multiform-like erythema lesions, extremity cyanosis and vesicular lesions have been detected [25]. Rare, but still possible, are heart complications with chest pain and hypoperfusion related to heart failure, arrhythmia, myocarditis and shock, kidney complications up to kidney failure with the need for hemodialysis and systemic complications such as sepsis and MIS-C [26].…”

SARS-CoV-2 Seroprevalence Structure of the Russian Population during the COVID-19 Pandemic

“…Such detection makes it possible to assess not only pathogen contact, or response levels to the introduction of specific vaccines, but also to assess a person’s degree of protection from development of the disease [ 12 ]. In addition, such assessment is indispensable for retrospective identification of asymptomatic cases, as well as for identifying people who have recovered from COVID-19, whose antibodies can be used for plasma therapy for critically ill patients [ 13 ].…”

Epidemiological and clinical profile of COVID-positive children without comorbidities: Observations from a dedicated COVID hospital in East India

“…Till then, children should be taught to inculcate universal hygienic practices in their routine life, such as social distancing, frequent hand wash, and use of masks (as far as practical) to break the chain of transmission of the virus. the previous studies [3,4,6,9], a majority of symptomatic patients (95.6%) had mild disease and none of them were critically ill, reinforcing the fact that COVID-19 in children is indeed a mild disease. The exact reason for the same is not clearly understood till now, although several hypotheses have been proposed [10,11].…”