ABSTRACT
Hintergrund Die COVID-19-Pandemie stellte besondere Herausforderungen an die in Deutschland existierenden Strukturen zur Impfprävention bezüglich (1) des Verständnisses der Rolle und Ziele der Akteure und des Interesses der Kinder;(2) der Definition adäquater Kriterien zur Beurteilung des Risikos für schwere Erkrankungen bei Kindern. Fragestellungen Unterscheiden sich die Prioritäten unterschiedlicher Interessengruppen bei Empfehlungen zur COVID-19-Impfung? Welche Daten zur Pathogenität unterschiedlicher Varianten des „severe acute respiratory syndrome coronavirus 2" (SARS-CoV‑2) sind nötig, und wie veränderten sich diese im Verlauf der Pandemie? Methoden Die Perspektiven von Public Health sowie der Kinder und ihrer Eltern werden anhand von Daten und Veröffentlichungen zum Verlauf der COVID-19-Pandemie in Deutschland analysiert. Ergebnisse Die Perspektiven von Politik und Kindern unterscheiden sich, sind aber legitim, wenn sie klar benannt werden. Das für Impfentscheidungen aus Perspektive der Kinder entscheidende Risiko für schwere Verläufe oder das „paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV‑2" (PIMS-TS) pro 10.000 SARS-CoV‑2-Infektionen, nahm im Verlauf der Pandemie mit Dominanz der Omikron-Varianten ab. Schwere Verläufe bei COVID-19 betreffen weiterhin überwiegend Kinder mit Grundkrankheiten. Die altersstratifizierte Analyse von geimpften und ungeimpften Kindern zeigt, dass sich die Veränderungen in der Viruspathogenität im Verlauf der Pandemie insbesondere in dem abnehmenden PIMS-TS-Risiko widerspiegeln. Die allgemeine Reduktion der schweren COVID-19-Verläufe wiederum lässt sich durch die „Variants-of-concern"(VOC)-Eigenschaften, zunehmende Impfrate und Immunität nach einer SARS-CoV‑2-Infektion erklären. Schlussfolgerungen Das Hauptziel der COVID-19-Impfung für Kinder und Jugendliche ist die Verminderung von schweren Krankheitsverläufen. In pädiatrischen Risikogruppen sollte eine bestmögliche Immunität/Immunprotektion durch eine Impfung angestrebt werden. Ob eine Impfung nachwachsender gesunder Kinderkohorten oder Nachimpfung bei bereits infizierten/geimpften Kinderkohorten – mit dem Ziel einer hybriden Immunität – nötig ist, kann derzeit nicht beurteilt werden.
ABSTRACT
Background: The COVID-19 pandemic posed special challenges for the existing structures for vaccination prevention in Germany with respect to 1) understanding the role and aims of those involved and the interests of the children and 2) the definition of adequate criteria and assessment of the risk of severe diseases in children. Objectives: Do the priorities of different groups of interest differ in the recommendations for COVID-19 vaccination? Which data on the pathogenicity of different variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) are necessary and how did they change during the pandemic? Methods: The tasks, objectives and perception of politics and the German national vaccination advisory committee regarding vaccination of children are discussed in the face of summarized recent data on clinical manifestations of pediatric SARS-CoV2 infections among children and adolescents in Germany, which could be estimated by combining different German data sources. Results: The perspectives of politics and children differ but are legitimate when they are clearly stated. The decisive risk for a severe course or the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV2 (PIMS-TS) per 10,000 SARS-CoV2 infections for the decision on vaccination from the perspective of children, decreased during the course of the pandemic with dominance of the omicron variant. Severe courses of COVID-19 still predominantly affect children with underlying diseases. The age-stratified analysis of vaccinated and nonvaccinated children showed that the alterations in the pathogenicity of the virus in the course of the pandemic is particularly reflected in the reduction in the risk of PIMS-TS. The general reduction of severe courses of COVID-19 again can be explained by the characteristics of variants of concern (VOC) as well as increasing vaccination rates and immunity following a SARS-CoV2 infection. Conclusion: The primary goal of COVID-19 vaccination in children and adolescents is the prevention of severe courses of the disease. In pediatric risk groups the best possible immunity or immune protection by vaccination should be strived for. It is currently unclear whether catch-up vaccination in already infected or vaccinated children or whether forthcoming healthy children will need vaccination, aiming for hybrid immunity.
ABSTRACT
PURPOSE: SARS-CoV-2 infections cause COVID-19 and have a wide spectrum of morbidity. Severe disease courses among children are rare. To date, data on the variability of morbidity in relation to variant of concern (VOC) in children has been sparse and inconclusive. We compare the clinical severity of SARS-CoV-2 infection among children and adolescents in Germany during the Wildtype and Alpha combined, Delta and Omicron phases of the COVID-19 pandemic. METHODS: Comparing risk of COVID-19-related hospitalization, intensive care unit (ICU) admission and death due to COVID-19 in children and adolescents, we used: (1) a multi-center seroprevalence study (SARS-CoV-2-KIDS study); (2) a nationwide registry of pediatric patients hospitalized with SARS-CoV-2 infections; and (3) compulsory national reporting for RT-PCR-confirmed SARS-CoV-2 infections in Germany. RESULTS: During the Delta predominant phase, risk of COVID-19-related hospitalization among all SARS-CoV-2 seropositive children was 3.35, ICU admission 1.19 and fatality 0.09 per 10,000; hence about halved for hospitalization and ICU admission and unchanged for deaths as compared to the Wildtype- and Alpha-dominant period. The relative risk for COVID-19-related hospitalization and ICU admission compared to the alpha period decreased during Delta [0.60 (95% CI 0.54; 0.67) and 0.51 (95% CI 0.42; 0.61)] and Omicron [0.27 (95% CI 0.24; 0.30) and 0.06 (95% CI 0.05; 0.08)] period except for the < 5-year-olds. The rate of case fatalities decreased slightly during Delta, and substantially during Omicron phase. CONCLUSION: Morbidity caused by SARS-CoV-2 infections among children and adolescents in Germany decreased over the course of the COVID-19 pandemic, as different VOCs) emerged.
ABSTRACT
Importance: During the COVID-19 pandemic, a reduction in quality of life and physical and mental health among children and adolescents has been reported that may be associated with SARS-CoV-2 infection and/or containment measures. Objective: To assess the association of SARS-CoV-2 seropositivity with symptoms that may be related to myalgic encephalomyelitis and/or chronic fatigue syndrome (ME/CFS) among children and adolescents. Design, Setting, and Participants: This substudy of the cross-sectional SARS-CoV-2 seroprevalence surveys in Germany (SARS-CoV-2 KIDS) was performed in 9 pediatric hospitals from May 1 to October 31, 2021. Pediatric patients were recruited during an inpatient or outpatient visit regardless of the purpose of the visit. Parental questionnaires and serum samples were collected during clinically indicated blood draws. The parental questionnaire on demographic and clinical information was extended by items according to the DePaul Symptom Questionnaire, a pediatric screening tool for ME/CFS in epidemiological studies in patients aged 5 to 17 years. Exposures: Seropositivity was determined by SARS-CoV-2 IgG antibodies in serum samples using enzyme-linked immunosorbent assays. Main Outcomes and Measures: Key symptoms of ME/CFS were evaluated separately or as clustered ME/CFS symptoms according to the DePaul Symptom Questionnaire, including fatigue. Results: Among 634 participants (294 male [46.4%] and 340 female [53.6%]; median age, 11.5 [IQR, 8-14] years), 198 (31.2%) reported clustered ME/CFS symptoms, including 40 of 100 SARS-CoV-2-seropositive (40.0%) and 158 of 534 SARS-CoV-2-seronegative (29.6%) children and adolescents. After adjustment for sex, age group, and preexisting disease, the risk ratio for reporting clustered ME/CFS symptoms decreased from 1.35 (95% CI, 1.03-1.78) to 1.18 (95% CI, 0.90-1.53) and for substantial fatigue from 2.45 (95% CI, 1.24-4.84) to 2.08 (95% CI, 1.05-4.13). Confinement to children and adolescents with unknown previous SARS-CoV-2 infection status (n = 610) yielded lower adjusted risks for all symptoms except joint pain ME/CFS-related symptoms. The adjusted risk ratio was 1.08 (95% CI, 0.80-1.46) for reporting clustered ME/CFS symptoms and 1.43 (95% CI, 0.63-3.23) for fatigue. Conclusions and Relevance: These findings suggest that the risk of ME/CFS in children and adolescents owing to SARS-CoV-2 infection may be very small. Recall bias may contribute to risk estimates of long COVID-19 symptoms in children. Extensive lockdowns must be considered as an alternative explanation for complex unspecific symptoms during the COVID-19 pandemic.
Subject(s)
COVID-19 , Fatigue Syndrome, Chronic , Adolescent , COVID-19/complications , COVID-19/epidemiology , Child , Communicable Disease Control , Cross-Sectional Studies , Fatigue Syndrome, Chronic/epidemiology , Fatigue Syndrome, Chronic/psychology , Female , Germany/epidemiology , Humans , Immunoglobulin G , Male , Pandemics , Quality of Life , SARS-CoV-2 , Seroepidemiologic Studies , Post-Acute COVID-19 SyndromeABSTRACT
The rate of SARS-CoV-2 infections in children remains unclear due to many asymptomatic cases. We present a study of cross-sectional seroprevalence surveys of anti-SARS-CoV-2 IgG in 10,358 children recruited in paediatric hospitals across Germany from June 2020 to May 2021. Seropositivity increased from 2.0% (95% CI 1.6, 2.5) to 10.8% (95% CI 8.7, 12.9) in March 2021 with little change up to May 2021. Rates increased by migrant background (2.8%, 4.4% and 7.8% for no, one and two parents born outside Germany). Children under three were initially 3.6 (95% CI 2.3, 5.7) times more likely to be seropositive with levels equalising later. The ratio of seropositive cases per recalled infection decreased from 8.6 to 2.8. Since seropositivity exceeds the rate of recalled infections considerably, serologic testing may provide a more valid estimate of infections, which is required to assess both the spread and the risk for severe outcomes of SARS-CoV-2 infections.