Clinical and laboratory features of SARS-CoV-2 variants across multiple rounds of pandemic waves in hospitalized children in an Iranian referral hospital

Abstract

Background Since the onset of the COVID-19 pandemic, SARS-CoV-2 has evolved into independent new forms, variants of concern (VOCs). While epidemiological data showed increased transmissibility of VOCs, their impact on clinical outcomes is less clear. This study aimed to investigate the differences between the clinical and laboratory features of children infected with VOCs. Methods This study included all cases with SARS-CoV-2-positive nasopharyngeal swabs obtained from patients referred to Children’s Medical Center (CMC), an Iranian referral hospital, between July 2021 and March 2022. The inclusion criteria for this study included all patients, regardless of age, who had a positive test anywhere in the hospital setting. Exclusion criteria for the study included those whose data was obtained from non-hospital outpatient settings, or referred from another hospital. The SARS-CoV-2 genome area encoding the S1 domain was amplified and sequenced. The type of variant in each sample was identified based on the mutations in the S1 gene. Demographic characteristics, clinical data, and laboratory findings were collected from the patient’s medical records. Results This study included 87 pediatric cases with confirmed COVID-19, with a median age of 3.5 years (IQR: 1-8.12). Data from sequencing reveals the type of variants as 5 (5.7%) alpha, 53 (60.9%) Delta, and 29 (33.3%) Omicron. The incidence of seizure was higher in patients with Alpha and Omicron infection compared to the Delta group. A higher incidence of diarrhea was reported in Alpha-infected patients, and a higher risk of disease severity, distress, and myalgia was associated with Delta infection. Conclusion Laboratory parameters did not mostly differ among the patients infected with Alpha, Delta, and Omicron. However, these variants may manifest different clinical features. Further studies with larger sample sizes are required to fully understand the clinical manifestations of each variant.

Relationship between the Viral Load in Patients with Different COVID-19 Severities and SARS-CoV-2 Variants

“…Other studies found similar results; one of them showed that during the outbreak of the SARS-CoV-2 Delta variant in Vietnam, the case fatality rate was higher [ 27 ]. Another study which included 87 pediatric cases, infected with Alpha (5.7%), Delta (60.9%), and Omicron (33.3%) variants, showed that severe disease, distress, and myalgia were more frequent in Delta-infected patients [ 28 ]. Zachary and collaborators studied 102315 confirmed COVID-19 cases, of which 20, 770 were infected with the Delta variant, 52, 605 with the Omicron B.1.1.529 variant, and 28, 940 with the Omicron BA.2 subvariants.…”

Post-discharge follow-up of pediatric COVID-19 patients: insights into serological dynamics

“…In the early stages of the Coronavirus disease 2019 (COVID-19) pandemic, the proportion of confirmed cases among children was relatively low, and children were thought to be rarely affected by SARS-CoV-2 ( Mahmoudi et al, 2020 ; Wu and McGoogan, 2020 ; Mohammadpour et al, 2022 ). Subsequent studies have consistently shown that children and adolescents are susceptible to SARS-CoV-2 infection, however, a large percentage of children are either asymptomatic or mildly symptomatic, and the true incidence of infection is underestimated due to low testing rates in children ( Mahmoudi et al, 2023 ). Despite generally milder symptoms, children with COVID-19 are shown to be at a lower risk of hospitalization and severe complications ( Vosoughi et al, 2022 ; Sedik, 2023 ).…”