Analysis of COVID-19–Related Croup and SARS-CoV-2 Variant Predominance in the US

Lefchak, Brian; Nickel, Amanda; Lammers, Shea; Watson, Dave; Hester, Gabrielle; Bergmann, Kelly R.

doi:10.1001/jamanetworkopen.2022.20060

Cited by 14 publications

(10 citation statements)

References 5 publications

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“…Previous studies of the characteristics of omicron BA.1/ BA.2 lineage infection revealed that BA.1/BA.2 infection was more likely to cause upper respiratory infections than lower respiratory infections; croup, in particular, was an important clinical feature of the presentation. 3,26,27 In the present study, the frequency of admission by croup did not differ significantly between BA.1/ BA.2 and BA.5 predominance periods (4.7% vs. 1.4%, P = 0.14). Besides, nausea/vomiting was more frequent during BA.1/BA.2 predominance than during BA.5 predominance (55.8% vs. 37.9%, P < 0.01) (Table 2).…”

Section: Discussioncontrasting

confidence: 49%

Comparison of Clinical Characteristics of Children Infected With Coronavirus Disease 2019 Between Omicron Variant BA.5 and BA.1/BA.2 in Japan

Ikuse

Aizawa

Yamanaka

et al. 2023

Pediatric Infectious Disease Journal

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Background: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants has dramatically altered the clinical profile of pediatric coronavirus disease 2019 (COVID-19). In Japan, we experienced a pandemic of omicron subvariant BA.1/BA.2 from January through June 2022. However, after the emergence of BA.5 in early July 2022, the number of children hospitalized with COVID-19 increased dramatically in Japan. Methods: We collected data on monthly numbers of cases and clinical characteristics of hospitalized children with COVID-19 in 13 hospitals, the total number of pediatric COVID-19 cases, and COVID-19 vaccination rates in Niigata, Japan, for the period from January 2020 through August 2022. We compared clinical presentation during the periods of BA.1/BA.2 predominance (January–June 2022) and BA.5 predominance (July–August 2022) and estimated vaccine effectiveness (VE) against hospitalization during the BA.5-predominant period. Results: Between January 1, 2020, and August 31, 2022, 49,387 children (19,085 children/100,000 population) were newly diagnosed as having COVID-19, and 393 were hospitalized for COVID-19. Hospitalization for febrile seizure, especially complex seizure, was significantly higher during BA.5 predominance than during BA.1/BA.2 predominance (27.9% vs. 7.0%, P < 0.01). VE against hospitalization during BA.5 predominance was estimated to be 75% (95% confidence interval, 48%–88%, P < 0.01). Conclusions: The emergence of BA.5 significantly affected children in Japan; the number with complex febrile seizure who required hospitalization was higher than during BA.1/BA.2 predominance. The COVID-19 vaccination rate in children must be increased to prevent hospitalization for COVID-19 and to prepare for current and future variant outbreaks.

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Section: Discussioncontrasting

confidence: 49%

Comparison of Clinical Characteristics of Children Infected With Coronavirus Disease 2019 Between Omicron Variant BA.5 and BA.1/BA.2 in Japan

Ikuse

Aizawa

Yamanaka

et al. 2023

Pediatric Infectious Disease Journal

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“…Limitations of our study were the absence of a control group and lack of viral testing to identify the proportion of cases associated with SARS-CoV-2, which has been identified with clinical croup. [5][6][7] The optimal dose of epinephrine via the MDI route is currently unknown and while we used cumulative doses of almost 2 mg, it is possible that the lack of treatment response in some children was the result of underdosing.…”

Section: Results Of This Collaborative Suggest Epinephrine Administra...mentioning

confidence: 99%

“…The mean age (±SD) was 36.4(±29.27) months. Pretreatment WCS was mild (score range 0-2) in 27 children (12.9%), moderate(3)(4) in 118 (56.2%), severe(5)(6)(7) in 60 (28.6%), and impending respiratory failure (≥8) in five (2.4%) children.…”

mentioning

confidence: 99%

Epinephrine metered‐dose inhaler for pediatric croup

Meckler

Alqurashi

Eltorki

et al. 2022

Academic Emergency Medicine

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Croup is a common childhood disease of young children caused by viral infections that trigger varying degrees of upper airway obstruction. While croup of all severity is effectively treated with systemic corticosteroids, 1 nebulized epinephrine provides rapid and safe reduction in respiratory distress that lasts for 1-2 h. 2The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) raised concerns about nebulization as an aerosol-generating medical procedure (AGMP), prompting a search for alternative delivery methods to provide effective epinephrine therapy in children with croup to minimize SARS-CoV-2 transmission. Primatene Mist is an epinephrine metered-dose inhaler (MDI) manufactured and available over the counter in the United States. 3

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“…As the Omicron variant prevailed, croup patients were more frequently observed compared to periods before, according to the authors of this study. Furthermore, the literature on the association between the Omicron variant and croup in children has been increasing [ 14 , 15 , 16 , 17 ]. In consideration of the study that showed that the Omicron variant replicates faster than all other SARS-CoV-2 variants studied in the bronchi but less efficiently in the lung parenchyma, the association was even more plausible [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Etiology and Epidemiology of Croup before and throughout the COVID-19 Pandemic, 2018–2022, South Korea

et al. 2022

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Omicron, a recent variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently globally dominating. We reviewed the etiology and epidemiology of croup over an approximately 5-year period, with an emphasis on the recent dominance of the Omicron variant. Children less than 5 years of age seen in the emergency department with diagnosis of croup from two large national tertiary hospitals were collected for the period from January 2018 through March 2022. Viral etiologies of the patients were compared with national surveillance data upon circulating respiratory viruses in the community. A total number of 879 croup cases were recognized during the study period. The most common pathogen was SARS-CoV-2 (26.9%), followed by HRV (23.8%), PIV1 (14.6%), PIV3 (13.1%), and CoV NL63 (13.1%), among seventeen respiratory viral pathogens tested by polymerase chain reaction. The viral identification rate was significantly higher in the Omicron period, with most of the pathogens identified as SARS-CoV-2. In the Omicron period, with the exponential increase in the number of COVID-19 cases in the community, croup associated with SARS-CoV-2 significantly increased, with a high detection rate of 97.2% (35 of 36) among croup cases with pathogen identified. The etiologic and epidemiologic data before and throughout the COVID-19 pandemic indicate that the association between croup and infection with the SARS-CoV-2 Omicron variant is highly plausible.

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Analysis of COVID-19–Related Croup and SARS-CoV-2 Variant Predominance in the US

Cited by 14 publications

References 5 publications

Comparison of Clinical Characteristics of Children Infected With Coronavirus Disease 2019 Between Omicron Variant BA.5 and BA.1/BA.2 in Japan

Comparison of Clinical Characteristics of Children Infected With Coronavirus Disease 2019 Between Omicron Variant BA.5 and BA.1/BA.2 in Japan

Epinephrine metered‐dose inhaler for pediatric croup

Etiology and Epidemiology of Croup before and throughout the COVID-19 Pandemic, 2018–2022, South Korea

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