Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study
- PMID: 32220650
- PMCID: PMC7158906
- DOI: 10.1016/S1473-3099(20)30198-5
Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study
Abstract
Background: Since December, 2019, an outbreak of coronavirus disease 2019 (COVID-19) has spread globally. Little is known about the epidemiological and clinical features of paediatric patients with COVID-19.
Methods: We retrospectively retrieved data for paediatric patients (aged 0-16 years) with confirmed COVID-19 from electronic medical records in three hospitals in Zhejiang, China. We recorded patients' epidemiological and clinical features.
Findings: From Jan 17 to March 1, 2020, 36 children (mean age 8·3 [SD 3·5] years) were identified to be infected with severe acute respiratory syndrome coronavirus 2. The route of transmission was by close contact with family members (32 [89%]) or a history of exposure to the epidemic area (12 [33%]); eight (22%) patients had both exposures. 19 (53%) patients had moderate clinical type with pneumonia; 17 (47%) had mild clinical type and either were asymptomatic (ten [28%]) or had acute upper respiratory symptoms (seven [19%]). Common symptoms on admission were fever (13 [36%]) and dry cough (seven [19%]). Of those with fever, four (11%) had a body temperature of 38·5°C or higher, and nine (25%) had a body temperature of 37·5-38·5°C. Typical abnormal laboratory findings were elevated creatine kinase MB (11 [31%]), decreased lymphocytes (11 [31%]), leucopenia (seven [19%]), and elevated procalcitonin (six [17%]). Besides radiographic presentations, variables that were associated significantly with severity of COVID-19 were decreased lymphocytes, elevated body temperature, and high levels of procalcitonin, D-dimer, and creatine kinase MB. All children received interferon alfa by aerosolisation twice a day, 14 (39%) received lopinavir-ritonavir syrup twice a day, and six (17%) needed oxygen inhalation. Mean time in hospital was 14 (SD 3) days. By Feb 28, 2020, all patients were cured.
Interpretation: Although all paediatric patients in our cohort had mild or moderate type of COVID-19, the large proportion of asymptomatic children indicates the difficulty in identifying paediatric patients who do not have clear epidemiological information, leading to a dangerous situation in community-acquired infections.
Funding: Ningbo Clinical Research Center for Children's Health and Diseases, Ningbo Reproductive Medicine Centre, and Key Scientific and Technological Innovation Projects of Wenzhou.
Copyright © 2020 Elsevier Ltd. All rights reserved.
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Comment in
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Toward a clinically based classification of disease severity for paediatric COVID-19 - Authors' reply.Lancet Infect Dis. 2021 Jan;21(1):22-23. doi: 10.1016/S1473-3099(20)30397-2. Epub 2020 May 15. Lancet Infect Dis. 2021. PMID: 32422200 Free PMC article. No abstract available.
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Toward a clinically based classification of disease severity for paediatric COVID-19.Lancet Infect Dis. 2021 Jan;21(1):22. doi: 10.1016/S1473-3099(20)30396-0. Epub 2020 May 15. Lancet Infect Dis. 2021. PMID: 32422205 Free PMC article. No abstract available.
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Children are protected against SARS-CoV-2 infection.J Clin Virol. 2020 Jul;128:104451. doi: 10.1016/j.jcv.2020.104451. Epub 2020 May 20. J Clin Virol. 2020. PMID: 32454427 Free PMC article. No abstract available.
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