Coronavirus Infections in Children Including COVID-19

Abstract

Coronaviruses (CoVs) are a large family of enveloped, singlestranded, zoonotic RNA viruses. Four CoVs commonly circulate among humans: HCoV2-229E, -HKU1, -NL63 and -OC43. However, CoVs can rapidly mutate and recombine leading to novel CoVs that can spread from animals to humans. The novel CoVs severe acute respiratory syndrome coronavirus (SARS-CoV) emerged in 2002 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012. The 2019 novel coronavirus (SARS-CoV-2) is currently causing a severe outbreak of disease (termed COVID-19) in China and multiple other countries, threatening to cause a global pandemic. In humans, CoVs mostly cause respiratory and gastrointestinal symptoms. Clinical manifestations range from a common cold to more severe disease such as bronchitis, pneumonia, severe acute respiratory distress syndrome, multiorgan failure and even death. SARS-CoV, MERS-CoV and SARS-CoV-2 seem to less commonly affect children and to cause fewer symptoms and less severe disease in this age group compared with adults, and are associated with much lower case-fatality rates. Preliminary evidence suggests children are just as likely as adults to become infected with SARS-CoV-2 but are less likely to be symptomatic or develop severe symptoms. However, the importance of children in transmitting the virus remains uncertain. Children more often have gastrointestinal symptoms compared with adults. Most children with SARS-CoV present with fever, but this is not the case for the other novel CoVs. Many children affected by MERS-CoV are asymptomatic. The majority of children infected by novel CoVs have a documented household contact, often showing symptoms before them. In contrast, adults more often have a nosocomial exposure. In this review, we summarize epidemiologic, clinical and diagnostic findings, as well as treatment and prevention options for common circulating and novel CoVs infections in humans with a focus on infections in children.

Integrated analyses of single-cell atlases reveal age, gender, and smoking status associations with cell type-specific expression of mediators of SARS-CoV-2 viral entry and highlights inflammatory programs in putative target cells

“…The age associations highlighted particularly low expression in samples from very young children (newborn to 3 years old). As reports suggest that most infants and young children cases do not display severe disease 11,74 , we inspected the subsets of studies of human development and pediatric samples from our integrated analysis (Supplementary Table 2). These included cells from 12 first trimester samples (8 donors) of fetal lung (8.5 weeks post conception; wpc), 29 fetal lung samples (26 donors) from the second trimester (13-24 weeks) 68 , 13 lung samples (10 donors) spanning from third trimester premature births (n=4), full term newborns (n=1), ~3-month old (n=4), 3-year-old (n=3), and 10-year-old (n=1) children.…”

COVID-19 bei hospitalisierten Kindern und Jugendlichen

“…Nach derzeitigen Erkenntnissen infizieren sich Kinder und Jugendliche nicht seltener als Erwachsene mit SARS-CoV-2, ihre Infektion scheint aber oft asymptomatisch oder oligosymptomatisch abzulaufen [22]. Die hier vorgestellten Fallserien bestätigen die früheren Beobachtungen, dass auch symptomatische Infektionen bei hospitalisierten Kindern generell weniger schwer und mit einer besseren Prognose als bei Erwachsenen verlaufen [11,22,26,31,36]. Typische Kennzeichen einer COVID-19-Infektion bei hospitalisierten Kindern waren Fieber und eine Infektionserkrankung der oberen Atemwege mit Rhinitis, Pharyngitis und Hus-tenoderderunterenAtemwege mitPneumonie und/oder Bronchitis.…”

“…Auffällig bei COVID-19-Patienten war in dieser Studie auch eine Erhöhung der myokardialen Enzyme (31 % vs. 11 %) [26]. Gegenüber anderen epidemisch auftretenden Coronaviren wie SARS-CoV und MERS-CoV scheint eine Infektion mit SARS-CoV-2 in der Regel deutlich weniger schwer zu verlaufen [26,36].…”

“…Insgesamt scheint das Erkrankungsbild von COVID-19 bei Kindern einen überwiegend leichten Verlauf zu zeigen [3,22,36], auch wenn vereinzelt Komplikationen besonders bei Patienten mit Risikofaktoren, wie z. B. kardialen, pulmonalen und immunologischen Grunderkrankungen, sowie bei Säuglingen berichtet wurden.…”

COVID-19 in Children: Clinical Approach and Management

“…Treatment consists of mainly supportive care; while role of antiviral agents is being evaluated. Prevention is the key and home isolation of exposed individuals, management of symptomatic cases in healthcare facilities, and strict infection control measures at hospitals may help break the chain of transmission [12].…”