Clinical Experience With Severe Acute Respiratory Syndrome Coronavirus 2–Related Illness in Children: Hospital Experience in Cape Town, South Africa

• Published in: Clinical infectious diseases Vol. 72; no. 12; pp. e938 - e944
• Main Authors: van der Zalm, Marieke M, Lishman, Juanita, Verhagen, Lilly M, Redfern, Andrew, Smit, Liezl, Barday, Mikhail, Ruttens, Dries, da Costa, A’ishah, van Jaarsveld, Sandra, Itana, Justina, Schrueder, Neshaad, Van Schalkwyk, Marije, Parker, Noor, Appel, Ilse, Fourie, Barend, Claassen, Mathilda, Workman, Jessica J, Goussard, Pierre, Van Zyl, Gert, Rabie, Helena
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 15.06.2021
• Subjects: Child; Child, Preschool; COVID-19; HIV Infections - complications; HIV Infections - epidemiology; Hospitals; Humans; Infant; Online Only; SARS-CoV-2; South Africa - epidemiology; South Africa; COVID-19; MIS-C; sub-Saharan Africa; children; respiratory virus infections
• ISSN: 1058-4838; 1537-6591; 1537-6591
• DOI: 10.1093/cid/ciaa1666

Abstract Background Children seem relatively protected from serious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related disease, but little is known about children living in settings with high tuberculosis and human immunodeficiency virus (HIV) burden. This study reflects clinical data on South African children with SARS-CoV-2. Methods We collected clinical data of children aged <13 years with laboratory-confirmed SARS-CoV-2 presenting to Tygerberg Hospital, Cape Town, between 17 April and 24 July 2020. Results One hundred fifty-nine children (median age, 48.0 months [interquartile range {IQR}, 12.0–106.0 months]) were included. Hospitalized children (n = 62), with a median age of 13.5 months (IQR, 1.8–43.5 months) were younger than children not admitted (n = 97; median age, 81.0 months [IQR, 34.5–120.5 months]; P < .01.). Thirty-three of 159 (20.8%) children had preexisting medical conditions. Fifty-one of 62 (82.3%) hospitalized children were symptomatic; lower respiratory tract infection was diagnosed in 21 of 51 (41.2%) children, and in 11 of 16 (68.8%) children <3 months of age. Respiratory support was required in 25 of 51 (49.0%) children; 13 of these (52.0%) were <3 months of age. One child was HIV infected and 11 of 51 (21.2%) were HIV exposed but uninfected, and 7 of 51 (13.7%) children had a recent or new diagnosis of tuberculosis. Conclusions Children <1 year of age hospitalized with SARS-CoV-2 in Cape Town frequently required respiratory support. Access to oxygen may be limited in some low- and middle-income countries, which could potentially drive morbidity and mortality. HIV infection was uncommon but a relationship between HIV exposure, tuberculosis, and SARS-CoV-2 should be explored. South African children hospitalized with COVID-19 respiratory tract infection were young and required respiratory support. This underscores the need for widespread implementation of oxygen and noninvasive respiratory support strategies in resource-limited settings to limit mortality due to COVID-19.