ABSTRACT
Background. Texas Children's Hospital is the largest pediatric solid organ transplant (SOT) program in the US, performing heart, kidney, liver, and lung transplants. Limited data exist about SARS-CoV-2 infection (COVID-19) in the pediatric SOT population. We evaluated the impact of different SARS-CoV-2 variants in a cohort of PCR positive SOT recipients. Methods. SOT recipients with a positive SARS-CoV-2 PCR test from 3/1/2020 to 2/28/2022 were included in the cohort. The study period was divided into 3 eras based on the predominant circulating variant of SARS-CoV-2: 3/20-6/21 original strain/ Alpha, 7/21-11/21 Delta, and 12/21-2/22 Omicron variants. Retrospective medical record review was performed;Chi-squared and Fischer exact test were used to compare groups. Results. A total of 269 of 1031 (26%) SOT recipients tested positive for SARS-CoV-2 during the study period. By organ, 87/335 (26%) heart, 57/224 (25%) kidney, 92/405 (23%) liver, and 25/67 (37%) lung recipients had COVID-19 infection. By era, there were 99 (37%) original strain/ Alpha, 65 (24%) Delta, and 105 (39%) Omicron. The patients' median age was 12.72 years (IQR 6.6, 15.1) with a minority of recipients being female (42%). Common comorbidities included hypertension (50%), obesity (13%), diabetes (10%), and chronic kidney disease (10%);34% had no comorbidities aside from chronic immunosuppression post-transplant. Overall, 80% of recipients were symptomatic (Figure 1), and 50 (19%) required hospitalization. Hospitalization rates were highest (29%) during Delta, compared with 18% for original/ Alpha and 13% for Omicron (p=0.02) eras. Need for respiratory support, ICU admission, and all-cause mortality did not vary by era (Table 1). Three SOT recipients (2 original/Alpha and 1 Delta) were diagnosed with multi-inflammatory syndrome in children (MIS-C). Conclusion. Our study suggests that pediatric SOT recipients have a high risk for hospitalization and short-term complications with COVID-19;Omicron appears to cause less severe disease, including MIS-C. Additional studies are needed to understand long-term complications of COVID-19 in SOT recipients.
ABSTRACT
Background. Vaccine hesitancy (VH) is adversely affecting the public health response to the COVID-19 pandemic. Similarly, influenza vaccine uptake is suboptimal. We aimed to monitor trends in VH with respect to influenza, SARS-CoV-2, and routine childhood vaccines. Methods. We conducted a repeated cross-sectional survey in English and Spanish of caregiver influenza and SARS-CoV-2 knowledge, attitudes, behaviors, and associated VH among hospitalized children 6 mo-18 yrs at a large pediatric medical institution. Caregivers were enrolled over 3 influenza seasons (S);2019-2020 (S1), 2020-2021 (S2), and 2021-2022 (S3). VH was assessed using the Parent Attitudes about Childhood Vaccines (PACV) survey;PACV score >= 50 denoted VH. Descriptive statistics were used. Results. During 3 influenza seasons, 269/282 (95%), 295/307 (96%), and 384/418 (92%) of approached caregivers were enrolled in S1, S2, and S3 respectively. Most parents (45%) identified as Hispanic/Latino, 35% as White, and 20% as Black/African American. By report, 94% of children in S1, 91% in S2, and 91% in S3 were up-to-date with routine childhood vaccines. Based on PACV score, 13% of parents were VH in 19-20 compared to 17% in 20-21 and 19% in 21-22. Approximately 70% of caregivers gave or planned to give their child the influenza vaccine across seasons. Following the COVID-19 pandemic, caregivers were less likely to believe that the 'flu can be a dangerous infection in children,' and to agree that 'all children over 6 months of age should receive the flu shot every year'. Decreased concern persisted or did not recover during the pandemic (Table 1). Parents were consistently scared of their child getting COVID-19 but fewer (49% versus 38%) were scared of their child getting the SARS-CoV-2 vaccine in S3. More (50% versus 71%) caregivers in S3 were willing to receive the SARS-CoV-2 vaccine themselves and 46% in S2 and 54% of caregivers in S3 had or planned to vaccinate their child against COVID-19 (Table 2). Conclusion. Our results suggest a trend that VH may be increasing. During the COVID-19 pandemic, caregivers of hospitalized children were less concerned about influenza than pre-pandemic. Intention to vaccinate children against COVID-19 remains suboptimal.
ABSTRACT
Background: EBV infections cause significant morbidity and mortality in pediatric SOTR and can be complicated by post-transplant lymphoproliferative disorder (PTLD). Contemporary data on CHL EBV DNAemia and the development of PTLD are limited. Methods: A retrospective cohort study of patients ≤ 21 years of age who received heart, lung, liver, kidney, or multi-organ transplants at TCH between 2011–2018 was conducted. Primary outcome was CHL EBV DNAemia, defined as peripheral blood lymphocyte EBV values ≥ 500 copies/ug or whole blood EBV values ≥ 10,000 IU/mL for ≥ 6 months. Associations with CHL EBV DNAemia were measured using chi-squared or Fisher exact test and multivariate logistic regression. Time to CHL EBV DNAemia was assessed using Kaplan-Meier method. Results: Among 687 SOTR (152 heart, 87 lung, 259 liver, 175 kidney, 14 multi-organ), 87 (13%) developed CHL EBV DNAemia;this included 15 (9%) heart, 9 (10%) lung, 59 (22%) liver, 2 (1%) kidney, and 2 (14%) multi-organ recipients. Receiving a heart [OR 2.1, 95% CI (2.1 – 62.4)], lung [7.7, 95% CI (1.5 – 39.3)], liver [OR 31.8, 95% CI (4.9 – 208.7)], or multi-organ [OR 18.3, 95% CI (2.0 – 170)] transplant and being 1–5 years of age [OR 4.0, 95% CI (1.6 – 9.8)] were associated with CHL EBV DNAemia. SOTR transplanted from 2015–2018 were less likely to develop CHL EBV DNAemia than those transplanted from 2011–2014 [OR 0.5, 95% CI (0.3 – 0.8)]. EBV risk status, CMV risk status, gender, and induction therapy were not associated with developing CHL EBV DNAemia.The median maximum peripheral blood lymphocyte and whole blood EBV values for those with CHL EBV DNAemia were 9475 (993 – 258151) copies/ug and 22093 (564 – 550000) IU/mL, respectively. Organ transplanted (p< 0.01), age (p< 0.01), and EBV risk status (p< 0.01) were associated with time to CHL EBV DNAemia (Figure 1). PTLD occurred in 28 (4%) of SOTR;14 (50%) had preceding CHL EBV DNAemia (p< 0.01).Figure 1 Time to CHL EBV DNAemia. Conclusion: This cohort of pediatric SOTR demonstrates a low prevalence of CHL EBV DNAemia and PTLD. Receiving a heart, lung, liver, or multi-organ transplant and being 1–5 years of age were associated with developing CHL EBV DNAemia. SOTR who developed CHL EBV DNAemia were more likely to develop PTLD, suggesting that further interventions targeting this group may be warranted. Disclosures: Flor M. Munoz, MD, MSc, Gilead: Grant/Research Support Elizabeth A. Moulton, MD, PhD, Pfizer: Co-investigator for SARS-CoV-2 pediatric vaccine trials.
ABSTRACT
Background. Texas Children's Hospital (TCH) is the largest pediatric solid organ transplant (SOT) program in the US, performing heart, kidney, liver, and lung transplants. Limited data exists about SARS-CoV-2 infection (COVID-19) in the pediatric SOT populations. We evaluated the impact of COVID-19 in a cohort of PCR positive SOT candidates and recipients. We hypothesized that COVID-19 would more severely impact SOT recipients compared to transplant candidates. Methods. Patients with SOT or transplant candidates at TCH with a positive SARS-CoV-2 RT-PCR test since March 1, 2020 to April 12, 2021 were included in the cohort. Retrospective medical record review was performed, and descriptive statistics were used. Results. A total of 103 SOT patients were identified, 13 candidates and 90 recipients. Of the SOT candidates, there were 1 heart, 3 kidney, and 9 liver transplant candidates. The SOT recipient cohort included 33 heart, 6 lung, 20 kidney, 33 liver and 2 multi-visceral recipients. A significant difference in age was observed between candidates and recipients with candidates being younger with median age of 4.5 years as opposed to recipient's median age of 12.8 years (p=0.0003). The majority of patients, 70 of 101 (69%), were symptomatic. Most common symptoms reported were fever in 34/70 (49%), cough in 31/70 (44%), and headache in 19/70 (27%). A higher percentage of candidates (31%, 4 of 13) were hospitalized for acute COVID-19 infection compared to (17%, 15 of 90) of recipients. A transplant candidate who ultimately died from underlying illness and COVID-19 was the only patient in the cohort who required mechanical ventilation. More deaths (2/13, 15%) occurred in transplant candidates with COVID-19 compared to transplant recipients with COVID-19 (1/90, 1%, p=0.04);however, 2 of the deaths occurred after recovery from acute COVID-19 illness. Conclusion. Our study suggests that pediatric candidates who are actively listed for transplant with underlying conditions have more severe acute COVID-19 illness than pediatric SOT recipients despite their immunosuppression based on the higher mortality observed in the transplant candidates. Prospective studies are needed to better understand which specific patients are at increased risk for mortality from COVID-19.
ABSTRACT
Background. SARS-CoV-2 vaccine hesitancy (VH) is hindering nationwide vaccination efforts;little is known about caregiver SARS-CoV-2 vaccine acceptance for children. We aimed to identify associations with SARS-CoV-2 VH in caregivers of hospitalized children. Methods. We conducted a prospective cross-sectional survey in English and Spanish of caregiver COVID-19 knowledge, attitudes, behaviors, and associated VH among hospitalized children 6 months - 18 years at a large pediatric medical institution. Parents were approached daily, averaging 4-5 days/week, from 12/8/2020--4/5/2021. VH was assessed using the Parent Attitudes about Childhood Vaccines (PACV) survey;PACV score ≥50 denoted VH. Descriptive statistics and multivariable logistic regression were used. Responses were categorized. Results. 295/307 (96%) of approached caregivers enrolled;79% were ≥ 30 years, 68% were married/ living with a partner, and 57% had at least some college. 36% identified as white, 19% Black, and 46% Hispanic/ Latino. 53% of caregiver children had public insurance. 91% of caregivers self-reported their children were up to date with routine vaccines. 17% of caregivers were vaccine-hesitant overall. 50% of caregivers were willing to receive COVID-19 vaccine themselves. Figure 1 shows intention to vaccinate their child by PACV score. 65% knew someone who was hospitalized for COVID-19. 67% were scared of their child getting COVID-19. However, 49% were scared of their child getting the vaccine, 28% did not want to vaccinate their child and 27% were neutral in the intention to vaccinate their child. Caregivers who did not intend to vaccinate their child were more likely to be Black (27% vs. 16%, p=0.04) and less likely to be Hispanic/ Latino (33% vs. 49%, p=0.02). Table 1 shows attitudes, beliefs, and behaviors surrounding the COVID-19 pandemic and vaccine in caregivers who did or did not intend to vaccinate their child. Figure 1 COVID-19 vaccine uptake by PACV score Table 1 Caregiver attitudes, beliefs, and behaviors surrounding the COVID-19 pandemic and the COVID-19 vaccine Conclusion. The majority of caregivers believe that SARS-CoV-2 vaccine will help control the pandemic, but less than half plan to vaccinate their children. A quarter of caregivers expressed uncertainty regarding the vaccine and therefore may be amenable to education and discussion. COVID-19 VH is different from VH towards routine vaccinations. More research is needed to address COVID-19 specific VH.
ABSTRACT
Background. Influenza vaccine is recommended for all children ≥6 months, yet uptake is suboptimal. We aimed to quantify child influenza vaccine coverage and identify factors associated with influenza vaccine hesitancy (VH) before and during the COVID-19 pandemic. Methods. We conducted a prospective, repeated cross-sectional assessment in English and Spanish of caregiver influenza knowledge, attitudes, behaviors, and associated VH among hospitalized children 6 months through 18 years at a large pediatric medical institution. Caregivers were enrolled 4-5 days per week, between 12/11/2019--1/31/2020 and 12/8/2020--4/5/2021. VH was assessed using the Parent Attitudes about Childhood Vaccines (PACV) survey;PACV score ≥50 denoted VH. Descriptive statistics and multivariable logistic regression were used. Results. During 2019-2020 and 2020-2021 influenza seasons, 269/282 (95%) and 295/307 (96%) of approached caregivers enrolled, respectively. By caregiver report, 94% of children in 2019-2020 and 91% in 2020-2021 were up-to-date with routine childhood vaccines (p=0.13). Specific to influenza vaccine, 73% and 68% of children received or planned to receive influenza vaccine in 2019-2020 and 2020-2021, respectively (p=0.13). Based on PACV score, 13% of parents were VH in 2019-2020 compared with 17% in 2020-2021 (p=0.24;Figure 1). Caregivers who had not/did not intend to vaccinate their children had a higher family income (71% vs. 57% >$30,000, p< 0.01) and were less likely to be Hispanic/ Latino (35% vs. 47%, p=0.02). 77% of caregivers were satisfied with information about influenza vaccine received from healthcare providers. Overall, 36% believed "you can get the flu from the flu shot." In 2020-2021, caregivers were less likely to believe that "flu can be a dangerous infection in children," to be "scared of my child getting the flu" and to agree that "all children over 6 months of age should receive the flu shot every year" (Table 1). Conclusion. During the COVID-19 pandemic, caregivers of hospitalized children were less concerned about influenza than pre-pandemic and misinformation about influenza and influenza vaccine persisted. Increased efforts may be needed to educate caregivers about the importance of influenza immunization during the 2021-22 season.