Risk Factors for Severe COVID-19 Among Children and Adolescents Enrolled in Acute Respiratory Infection Sentinel Surveillance in South Africa, 2020–2022

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Abstract

Background: Identifying children at risk for severe COVID-19 disease from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may guide future mitigation interventions. Using sentinel surveillance data, we aimed to identify risk factors for SARS-CoV-2–associated hospitalisation among patients aged ≤ 18 years with respiratory illness. Methods: From April 2020 to March 2022, patients meeting study case definitions were enrolled at four outpatient influenza-like illness (ILI) and five inpatient severe respiratory infection (SRI) surveillance sites and tested for SARS-CoV-2 infection using polymerase chain reaction (PCR). Each ILI clinic shared a catchment area with its corresponding SRI hospital. Potential risk factors for SARS-CoV-2–associated hospitalisation were analysed using multivariable logistic regression by comparing inpatient versus outpatient SARS-CoV-2 cases. Results: Of 4688 participants aged ≤ 18 years, 4556 (97%) with complete PCR and HIV data were included in the analysis. Among patients with ILI and SRI, 92/1145 (8%) and 154/3411 (5%) tested SARS-CoV-2 positive, respectively. Compared to outpatients, hospitalised SARS-CoV-2 cases were associated with age < 6 months ([adjusted odds ratio (aOR) 8.0, 95% confidence interval (CI) 2.7–24.0] versus 1–4 years); underlying medical condition other than HIV [aOR 5.8, 95% CI 2.3–14.6]; laboratory-confirmed Omicron BA.1/BA.2 or Delta variant ([aOR 4.9, 95% CI 1.7–14.2] or [aOR 2.8, 95% CI 1.1–7.3] compared to ancestral SARS-CoV-2); and respiratory syncytial virus coinfection [aOR 6.2, 95% CI 1.0–38.5]. Conclusion: Aligning with previous research, we identified age < 6 months or having an underlying condition as risk factors for SARS-CoV-2–associated SRI hospitalisation and demonstrated the potential of sentinel surveillance to monitor COVID-19 in children.

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APA

Bishop, K., Meiring, S., Tempia, S., von Gottberg, A., Wolter, N., Kleynhans, J., … Walaza, S. (2024). Risk Factors for Severe COVID-19 Among Children and Adolescents Enrolled in Acute Respiratory Infection Sentinel Surveillance in South Africa, 2020–2022. Influenza and Other Respiratory Viruses, 18(5). https://doi.org/10.1111/irv.13300

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