COVID ‐19 in New South Wales children during 2021: severity and clinical spectrum

Abstract

Objectives: To describe the severity and clinical spectrum of coronavirus disease 2019 (COVID‐19) in children during the 2021 New South Wales outbreak of the Delta variant of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Design, setting: Prospective cohort study in three metropolitan Sydney local health districts, 1 June – 31 October 2021. Participants: Children under 16 years of age with positive SARS‐CoV‐2 nucleic acid test results admitted to hospital or managed by the Sydney Children’s Hospital Network (SCHN) virtual care team. Main outcome measures: Age‐specific SARS‐CoV‐2 infection frequency, overall and separately for SCHN virtual and hospital patients; rates of medical and social reason admissions, intensive care admissions, and paediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2 per 100 SARS‐CoV‐2 infections; demographic and clinical factors that influenced likelihood of hospital admission. Results: A total of 17 474 SARS‐CoV‐2 infections in children under 16 were recorded in NSW, of whom 11 985 (68.6%) received SCHN‐coordinated care, including 459 admitted to SCHN hospitals: 165 for medical reasons (1.38 [95% CI, 1.17–1.59] per 100 infections), including 15 admitted to intensive care, and 294 (under 18 years of age) for social reasons (2.45 [95% CI, 2.18–2.73] per 100 infections). In an analysis that included all children admitted to hospital and a random sample of those managed by the virtual team, having another medical condition (adjusted odds ratio [aOR], 7.42; 95% CI, 3.08–19.3) was associated with increased likelihood of medical admission; in univariate analyses, non‐asthmatic chronic respiratory disease was associated with greater (OR, 9.21; 95% CI, 1.61–174) and asthma/viral induced wheeze with lower likelihood of admission (OR, 0.38; 95% CI, 0.18–0.78). The likelihood of admission for medical reasons declined from infancy to 5–11 years, but rose again for those aged 12–15 years. Sex and Indigenous status did not influence the likelihood of admission. Conclusion: Most SARS‐CoV‐2 infections (Delta variant) in children were asymptomatic or associated with mild disease. Hospitalisation was relatively infrequent, and most common for infants, adolescents, and children with other medical conditions. More children were hospitalised for social than for medical reasons.

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“…In a study from Thailand human bocavirus was the third most common pathogen detected, after rhinovirus and RSV, accounting for 12% of all cases ( 46 ). SARS-CoV-2, the cause of the COVID-19 pandemic, also infects children, but it rarely causes severe disease ( 47 ) and this risk is further reduced by vaccination ( 48 ). Four other coronaviruses are established human pathogens, but only cause mild cold like symptoms ( 49 ).…”

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“…Phoebe Williams and her colleagues 11 investigated COVID‐19 severity and outcomes in Sydney children during the Delta SARS‐CoV‐2 variant wave in 2021. Most infections were asymptomatic or mild.…”

“…Phoebe Williams and her colleagues 11 In the largest published post-marketing analysis of the safety of the Comirnaty and Vaxzevria vaccines, Lucy Deng and colleagues 13 analysed data from online AusVaxSafety surveys of more than three million people aged 16 years or more. The authors found that adverse events were more frequently reported by people with underlying medical conditions, including a history of anaphylaxis.…”

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“…The few Australian publications on COVID‐19 in children have reported its often mild nature, but have described only limited numbers of children (36 to 384 per article) infected during 2020 with the original SARS‐CoV‐2 strain or one of its early variants 3‐6 . In this issue of the MJA , Williams and colleagues provide welcome information about infections with the Delta SARS‐CoV‐2 variant during June–October 2021 in 17 474 New South Wales children under 16 years of age, including 11 985 managed by the Sydney Children’s Hospital Network virtual care team 7 . In a sample including all 165 children admitted to hospital for medical reasons (1.3% of confirmed infections) and a random selection of those who received virtual team care, 110 of 509 children (22%) were asymptomatic, and the others had mild symptoms.…”

“… 3 , 4 , 5 , 6 In this issue of the MJA , Williams and colleagues provide welcome information about infections with the Delta SARS‐CoV‐2 variant during June–October 2021 in 17 474 New South Wales children under 16 years of age, including 11 985 managed by the Sydney Children’s Hospital Network virtual care team. 7 In a sample including all 165 children admitted to hospital for medical reasons (1.3% of confirmed infections) and a random selection of those who received virtual team care, 110 of 509 children (22%) were asymptomatic, and the others had mild symptoms. Only fifteen NSW children with confirmed infections (0.09%) required intensive care, including seven with multisystem inflammatory syndrome in children (MIS‐C).…”