EPIDEMIOLOGY OF ACUTE COVID 19 IN CHILDREN AND ADOLESCENTS IN EUROPE: INSIGHTS FROM THE FIRST WAVE OF THE PANDEMIC
Background In the middle of the first wave of the COVID-19 pandemic, researchers from the Paediatric Tuberculosis Network European Trials Group (ptbnet) conducted the first multinational study in Europe to capture critical data on children with acute SARS-CoV-2.
Methods In April 2020, a multicentre study was conducted, involving 82 healthcare institutions across 25 European countries, at the initial peak of the European COVID-19 pandemic. Inclusion criteria comprised: age ≤18 years and SARS-CoV-2 detected at any anatomical site.
Findings A total of 582 PCR-confirmed cases were included [median age:5·0 years (IQR:0·5-12·0); male to female ratio 1·15:1]. One-hundred forty-five (24·9%) had significant pre-existing medical conditions. The majority (n=363;62·4%) were admitted to hospital. Forty-eight (8·2%) required intensive care unit (ICU) support, 25 (4·3%) mechanical ventilation (median duration:7 days; range:1-34 days), 19 (3·3%) inotropic support, and one (0·1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU support in multivariate analyses were age <1 month, male gender, pre-existing medical condition, and presence of lower respiratory tract infection symptoms at presentation. The most frequently used drug with antiviral activity was hydroxychloroquine, followed by remdesivir. Immunomodulatory medication used included corticosteroids, intravenous immunoglobulin, tocilizumab, anakinra, and siltuximab. Four children died (case fatality rate:0·69%; 95%CI:0·20-1·82%); the remaining 578 survived without apparent sequelae.
Interpretation During the first of the pandemic, acute COVID-19 caused mostly mild disease in children. However, a small proportion developed severe disease requiring ICU support and prolonged ventilation, although fatal outcomes were rare. The data reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed.