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.
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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.
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PURPOSE: The study evaluates the effects on sero-immunity, health status and quality of life of children and adolescents after the upsurge of the Omicron variant in Germany. METHODS: This multicenter cross-sectional study (IMMUNEBRIDGE Kids) was conducted within the German Network University Medicine (NUM) from July to October 2022. SARS-CoV-2- antibodies were measured and data on SARS-CoV-2 infections, vaccinations, health and socioeconomic factors as well as caregiver-reported evaluation on their children's health and psychological status were assessed. RESULTS: 497 children aged 2-17 years were included. Three groups were analyzed: 183 pre-schoolchildren aged 2-4 years, 176 schoolchildren aged 5-11 years and 138 adolescents aged 12-18 years. Positive antibodies against the S- or N-antigen of SARS-CoV-2 were detected in 86.5% of all participants (70.0% [128/183] of pre-schoolchildren, 94.3% of schoolchildren [166/176] and 98.6% of adolescents [136/138]). Among all children, 40.4% (201/497) were vaccinated against COVID-19 (pre-schoolchildren 4.4% [8/183], schoolchildren 44.3% [78/176] and adolescents 83.3% [115/138]). SARS-CoV-2 seroprevalence was lowest in pre-school. Health status and quality of life reported by the parents were very positive at the time of the survey (Summer 2022). CONCLUSION: Age-related differences on SARS-CoV-2 sero-immunity could mainly be explained by differences in vaccination rates based on the official German vaccination recommendations as well as differences in SARS-CoV-2 infection rates in the different age groups. Health status and quality of life of almost all children were very good independent of SARS-CoV-2 infection and/or vaccination. TRIAL REGISTRATION: German Registry for Clinical Trials Identifier Würzburg: DRKS00025546 (registration: 11.09.2021), Bochum: DRKS00022434 (registration:07.08.2020), Dresden: DRKS 00022455 (registration: 23.07.2020).
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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.
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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
(1) Background: When the Omicron variant of SARS-CoV-2 first emerged in Germany in January 2022, data on related disease severity among children and adolescents were not yet available. Given Omicron's high transmissibility, the ability to assess its impact on admission and hospitalization rates in children's hospitals is critical for the purpose of understanding the scope of its burden on the German healthcare system. (2) Methods: From 24 January 2022 to 31 July 2022, SARS-CoV-2 cases admitted to German pediatric hospitals were monitored via a national, clinician-led reporting system (CLRS) established by the German Society for Pediatric Infectious Diseases (DGPI). Cases treated on general wards and intensive care units, as well as patient age and the need for respiratory support, were recorded. (3) Results: From January to July 2022, a median of 1.7 cases (range 0.4-3) per reporting pediatric hospital per day was hospitalized in general wards, whereas a median of 0.1 cases (range 0-0.4 cases) was admitted to intensive care units. Of all hospitalized patients, 4.2% received respiratory support. (4) Conclusions: Despite the high incidence rates documented in connection with the Omicron variant in early 2022, the number of pediatric hospital admissions, and especially the number of cases with the need for intensive care treatment and respiratory support due to symptomatic SARS-CoV-2 infection, remained relatively low. Higher Omicron incidence rates had only a modest impact on SARS-CoV-2-related admissions and hospitalization in German children's hospitals.
Subject(s)
COVID-19 , SARS-CoV-2 , Adolescent , Child , Humans , COVID-19/epidemiology , Hospitalization , Germany/epidemiologyABSTRACT
Although children and adolescents have a lower burden of SARS-CoV-2-associated disease compared to adults, assessing the risk for severe outcomes among SARS-CoV-2-infected children remains difficult due to a high rate of undetected cases. We combine data from three data sources - a national seroprevalence study (the SARS-CoV-2 KIDS study), the nationwide, state-based reporting system for PCR-confirmed SARS-CoV-2 infections in Germany, and a nationwide registry on children and adolescents hospitalized with either SARS-CoV-2 or pediatric inflammatory multisystem syndrome (PIMS-TS, also known as MIS-C) - in order to provide estimates on the risk of hospitalization for COVID-19-related treatment, intensive care admission, and death due to COVID-19 and PIMS-TS in children. The rate of hospitalization for COVID-19-related treatment among all SARS-CoV-2 seropositive children was 7.13 per 10,000, ICU admission 2.21 per 10,000, and case fatality was 0.09 per 10,000. In children without comorbidities, the corresponding rates for severe or fatal disease courses were substantially lower. The lowest risk for the need of COVID-19-specific treatment was observed in children aged 5-11 without comorbidities. In this group, the ICU admission rate was 0.37 per 10,000, and case fatality could not be calculated due to the absence of cases. The overall PIMS-TS rate was 2.47 per 10,000 SARS-CoV-2 infections, the majority being children without comorbidities. CONCLUSION: Overall, the SARS-CoV-2-associated burden of a severe disease course or death in children and adolescents is low. This seems particularly the case for 5-11-year-old children without comorbidities. By contrast, PIMS-TS plays a major role in the overall disease burden among all pediatric age groups. WHAT IS KNOWN: ⢠SARS-CoV-2-associated burden of disease in children is considered to be low, but accurate risk estimates accounting for clinically undiagnosed infections are lacking. ⢠Asymptomatic SARS-CoV-2 infections are common in children. WHAT IS NEW: ⢠We provide risk estimates for hospitalization for COVID-19-related treatment, ICU admission, death from COVID-19, and PIMS-TS for children with SARS-CoV-2 infections by pooling different data sources. ⢠The risk for PIMS-TS exceeds the risk for severe COVID-19 in all age groups; the risk for severe COVID-19 is the lowest in 5-11 years old.
Subject(s)
COVID-19 , Adolescent , Adult , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , Child , Child, Preschool , Germany/epidemiology , Humans , SARS-CoV-2 , Seroepidemiologic Studies , Systemic Inflammatory Response SyndromeABSTRACT
BACKGROUND: In addition to widely used basic hygiene measures in school, school closures are applied to contain SARS-CoV-2 spread, although the effect on the pandemic is unclear. We proposed a simple approach to disentangle the effect of school closures from other lockdown measures on the pandemic course based on publicly available data in Germany. METHODS: We used data on the number of SARS-CoV-2 cases from the onset of the pandemic to 14th April 2021. We compared the proportion of children (5-14 years old) in all cases prior to the lockdown measures, including school closure, to that during a ten-week lockdown in Germany. The total number of paediatric cases occurring during lockdown was compared to the number expected in absence of school closures. The latter was calculated based on the actual weekly number of all cases and the pre-lockdown proportion of paediatric cases. RESULTS: The proportion of children in all cases was 2.3 percentage points lower at the nadir than the proportion before the lockdown. The estimated total number of paediatric cases prevented by school closures was estimated at 13,246 amounting to 24% of the expected cases in absence of school closures. CONCLUSION: School closure during the winter lockdown reduced the number of expected SARS-CoV-2 cases in children in absence of school closures. The contribution of these prevented cases to the total population incidence is small. These data might provide the basis to model the effect of school closures in addition to basic hygiene measures on the course of the COVID-19 pandemic.
Subject(s)
COVID-19 , Pandemics , Adolescent , COVID-19/epidemiology , COVID-19/prevention & control , Child , Child, Preschool , Communicable Disease Control , Germany , Humans , Pandemics/prevention & control , SARS-CoV-2 , SchoolsABSTRACT
BACKGROUND: The efficacy of the BioNTech-Pfizer BNT162b2 vaccination in the elderly (≥80 years) could not be fully assessed in the BioNTech-Pfizer trial due to low numbers in this age group. We aimed to evaluate the effectiveness of the BioNTech-Pfizer (BNT162b2) vaccine to prevent SARS-CoV-2 infection and severe outcomes in octo- and novo-generians in a German state setting. METHODS AND FINDINGS: A prospective observational study of 708,187 persons aged ≥80 years living in Bavaria, Germany, was conducted between Jan 9 to Apr 11, 2021. We assessed the vaccine effectiveness (VE) for two doses of the BNT162b2 vaccine with respect to SARS-CoV-2 infection and related hospitalisations and mortality. Additionally, differences in VE by age groups ≥80 to ≤89 years and ≥90 years were studied. Analyses were adjusted by sex. By the end of follow-up, 63.8% of the Bavarian population ≥80 years had received one dose, and 52.7% two doses, of the BNT162b2 vaccine. Two doses of the BNT162b2 vaccine lowered the proportion of SARS-CoV-2 infections and related outcomes, resulting in VE estimates of 68.3% (95% confidence interval (CI) 65.5%, 70.9%) for infection, 73.2% (95% CI 65.3%, 79.3%) for hospitalisation, and 85.1% (95% CI 80.0%, 89.0%) for mortality. Sex differences in the risk of COVID-19 outcomes observed among unvaccinated persons disappeared after two BNT162b2 vaccine doses. Overall, the BNT162b2 vaccine was equally effective in octo- and novo-genarians. CONCLUSIONS: Two doses of BioNTech-Pfizer's BNT162b2 vaccine is highly effective against COVID-19 outcomes in elderly persons.