Severe Acute Respiratory Syndrome Among Children

Abstract

ABSTRACT. Objective. To study the epidemiologic, clinical, laboratory, and radiologic features, prognostic indicators, and short-term to medium-term outcomes for children with severe acute respiratory syndrome (SARS) and to validate the performance characteristics of a clinical case definition, calculated with respect to SARSassociated coronavirus (SARS-CoV) seroconversion.Methods. Children <18 years of age, from a singlesite outbreak, who satisfied a clinical case definition for SARS, with subsequent serologic confirmation, were treated according to a standard protocol and prospectively monitored.Results. Forty-four children were included. The median age was 12 years. Forty-two children (95.5%) demonstrated an epidemiologic link. Fever, cough, malaise, coryza, sputum production, headache, myalgia, lymphopenia, and elevated lactate dehydrogenase levels were common presenting features. Radiographic findings were nonspecific, but high-resolution computed tomography of the thorax was an early diagnostic aid. A specific reverse transcription-polymerase chain reaction assay for SARS-CoV yielded positive results for <50% of children. Of 9 children who developed hypoxemia, 8 were treated with methylprednisolone. Of 5 children who received intensive care, 3 required assisted ventilation. All children recovered, and serious adverse events in response to treatment were not observed. The outcomes at 3 to 6 months after disease onset, including exercise tolerance, pulmonary functions, and psychologic status, were favorable. An age of >12 years was associated with methylprednisolone therapy for severe illness. After exclusion of the only infant, an age of >12 years was associated with oxygen requirements. Sore throat, high neutrophil count at presentation, and peak neutrophilia were independent factors predicting severe illness. The clinical case definition demonstrated good sensitivity, specificity, and positive and negative predictive values (97.8%, 92.7%, 88%, and 98.7%, respectively) for diagnostic accuracy.Conclusions. 1 Although the majority were adults, 121 children (6.9%) Ͻ18 years of age were registered, yielding an age-specific attack rate of 8.9 cases per 100 000 persons Ͻ18 years of age and a case fatality rate of 0%. A total of 89 hospitalized children in Hong Kong demonstrated serologic evidence of infection by the SARS-associated coronavirus (SARS-CoV) (e-SARS database, Hospital Authority, Hong Kong Special Administrative Region, data on file).Published articles on pediatric SARS have focused on reporting the demographic, clinical, laboratory, and radiologic characteristics. Definitive virologic data, prognostic indicators, and short-term to medium-term follow-up information were lacking in those preliminary reports. [2][3][4] We prospectively monitored a cohort of 44 children with laboratory confirmation of SARS who were treated at a referral center for pediatric infectious diseases that admitted the largest number of pediatric patients with SARS in Hong Kong. Their epidemiologic links; clinical, laboratory,...

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“…For example, children < 12 years of age infected with SARS-CoV were reported to have milder disease compared with older children and adults [9,12,13]. Nose/throat swabs obtained during acute respiratory disease were tested, and the sensitivity of this specimen type for detecting MERS-CoV is currently unknown.…”

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“…Compared with adults, children are affected less frequently, have milder disease, and are less likely to transmit SARS-CoV. 135,[249][250][251] The overall case fatality rate is approximately 6%; underlying disease and advanced age increase the risk of mortality (see http://www.who.int/csr/sarsarchive/2003_05_07a/en/).…”

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“…Severe disease was limited in those 12 years of age and younger. 5 Symptoms are generally non-specific with fever, myalgia, and malaise among the most common. Laboratory derangements include lymphopenia, thrombocytopenia, elevated C-reactive protein, and elevated lactate dehydrogenase (LDH).…”