BREAKING! U.S. Researchers Find That Acute Upper Airway Infection Rates In Children Have Increased Exponentially During Omicron Variant Surge
: Researchers from University of Colorado School of Medicine-USA, Northwestern University Feinberg School of Medicine-USA and Stony Brook University-USA have in a new retrospective cohort study discovered that pediatric acute upper airway infection cases have increased exponentially during Omicron variant surge in the United States. Physicians elsewhere around the globe that are experiencing the Omicron surge are also reporting of the same occurrences among children and it is important that both parents and teachers are aware of this.
Numerous reports of SARS-CoV-2 causing laryngotracheobronchitis (commonly known as croup) have been limited to small number of documented case series.
Preliminary published reports suggest the Omicron (B.1.1.529) strain of SARS-CoV-2 (the dominant circulating US strain since the week of 12/25/2021) replicates more efficiently in the conducting airways. This may increase the risk of a croup phenotype in children as they have smaller airway calibers.
The study team analyzed incidences and changes over time, and characteristics of children with SARS-CoV-2 and upper airway infection (UAI) diagnoses within the National COVID Cohort Collaborative (N3C) before and during the rise of the Omicron variant.
team compared the demographics, comorbidities, and clinical outcomes of hospitalized SARS-CoV-2 positive children with and without UAI.
The study findings showed that SARS-CoV-2 positive UAI cases increased to the highest number per month (N = 170) in December 2021 as the Omicron variant became dominant. Of 15,806 hospitalized children with SARS-CoV-2, 1.5% (234/15,806) had an UAI diagnosis. Those with UAI were more likely to be male, younger, white, have asthma and develop severe disease as compared to those without UAI.
The study findings lead to the conclusion that pediatric acute UAI cases have increased during the Omicron variant surge with many developing severe disease. Improved understanding of this emerging clinical phenotype could aid in therapeutic decision-making and healthcare resource planning.
The study findings were published on a preprint server and are currently being peer reviewed. https://www.medrxiv.org/content/10.1101/2022.01.27.22269865v1
The SARS-CoV-2 coronavirus can cause severe disease in children, including acute coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C).
The Omicron strain of SARS-CoV-2 has been the predominant circulating strain in the US since the last week of December 2021.
Studies suggested that the Omicron variant causes less severe disease than the Delta variant, with the hypothesis that Omicron replicates less effectively in lung parenchymal cells and more effectively in the bronchial airways. https://www.medrxiv.org/content/10.1101/2021.12.24.21268382v2
However due to small and collapsible airways, young children are more vulnerable to acute upper airway infection (UAI), resulting in decreased airflow. Hence, in the pediatric population, the Omicron strain of SARS-CoV-2 may increase the risk of laryngotracheobronchitis, commonly known as croup.
The study team used data from the National COVID Cohort Collaborative (N3C) collated before and during the surge of the Omicron variant and transferred to the pediatric COVID-19 dashboard. Among the data of all children in N3C, only data of children less than 19 years of age with positive SARS-CoV-2 results and a diagnosis of croup or tracheitis was collected. Demographic features, clinical outcomes, and comorbidities of SARS-CoV-2 positive hospitalized children with and without UAI were compared using a suitable statistical method.
The study team demonstrated that the highest number of pediatric SARS-CoV-2-positive hospitalized (N=32) and non-hospitalized (N=138) UAI cases in the US were observed during December 2021. During this period, 2.5% of total hospitalized cases had UAI. From the released data of 15,806 SARS-CoV-2-positive hospitalized children, 1.5% had a diagnosis of UAI.
It was found that children with UAI were mostly male (59.8% versus 50.4%), white (54.7% versus 43.3%), younger (2.4 versus 10.1 years), and asthmatics (15% versus 10%). SARS-CoV-2-positive children with UAI developed severe disease with the need of vasopressors, invasive ventilation, extracorporeal membrane oxygenation (ECMO), and had even high mortality as compared to children without UAI (31.6% versus 13.5%).
Alarmingly during the surge of Omicron variant in December 2021 in the US, there was an increase in overall pediatric acute UAI cases, with nearly a third of affected children developing severe disease. Children with UAI with severe croup and tracheitis are at risk of cardiac arrest due to rapidly developed upper airway obstruction requiring intensive care.
The study findings could help an enhanced understanding of this new clinical phenotype and could also help therapeutic decision-making and planning healthcare resources, especially when there is a severe strain on the healthcare system.
The study limitations include diagnostic codes being present only for completed hospitalizations in N3C. Also, children who were still hospitalized were not included in the study.
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