Comparison of Symptoms Associated With SARS-CoV-2 Variants Among Children in Canada

Abstract

ImportanceClinical manifestations of SARS-CoV-2 variants have not been systematically compared in children.ObjectiveTo compare symptoms, emergency department (ED) chest radiography, treatments, and outcomes among children with different SARS-CoV-2 variants.Design, Setting, and ParticipantsThis multicenter cohort study was performed at 14 Canadian pediatric EDs. Participants included children and adolescents younger than 18 years (hereinafter referred to as children) tested for SARS-CoV-2 infection in an ED between August 4, 2020, and February 22, 2022, with 14 days of follow-up.Exposure(s)SARS-CoV-2 variants detected on a specimen collected from the nasopharynx, nares, or throat.Main Outcomes and MeasuresThe primary outcome was presence and number of presenting symptoms. The secondary outcomes were presence of core COVID-19 symptoms, chest radiography findings, treatments, and 14-day outcomes.ResultsAmong 7272 participants presenting to an ED, 1440 (19.8%) had test results positive for SARS-CoV-2 infection. Of these, 801 (55.6%) were boys, with a median age of 2.0 (IQR, 0.6-7.0) years. Children with the Alpha variant reported the fewest core COVID-19 symptoms (195 of 237 [82.3%]), which were most often reported by participants with Omicron variant infection (434 of 468 [92.7%]; difference, 10.5% [95% CI, 5.1%-15.9%]). In a multivariable model with the original type as the referent, the Omicron and Delta variants were associated with fever (odds ratios [ORs], 2.00 [95% CI, 1.43-2.80] and 1.93 [95% CI, 1.33-2.78], respectively) and cough (ORs, 1.42 [95% CI, 1.06-1.91] and 1.57 [95% CI, 1.13-2.17], respectively). Upper respiratory tract symptoms were associated with Delta infection (OR, 1.96 [95% CI, 1.38-2.79]); lower respiratory tract and systemic symptoms were associated with Omicron variant infection (ORs, 1.42 [95% CI, 1.04-1.92] and 1.77 [95% CI, 1.24-2.52], respectively). Children with Omicron infection most often had chest radiography performed and received treatments; compared with those who had Delta infection, they were more likely to have chest radiography performed (difference, 9.7% [95% CI, 4.7%-14.8%]), to receive intravenous fluids (difference, 5.6% [95% CI, 1.0%-10.2%]) and corticosteroids (difference, 7.9% [95% CI, 3.2%-12.7%]), and to have an ED revisit (difference, 8.8% [95% CI, 3.5%-14.1%]). The proportions of children admitted to the hospital and intensive care unit did not differ between variants.Conclusions and RelevanceThe findings of this cohort study of SARS-CoV-2 variants suggest that the Omicron and Delta variants were more strongly associated with fever and cough than the original-type virus and the Alpha variant. Children with Omicron variant infection were more likely to report lower respiratory tract symptoms and systemic manifestations, undergo chest radiography, and receive interventions. No differences were found in undesirable outcomes (ie, hospitalization, intensive care unit admission) across variants.

The changing clinical presentation of COVID‐19 in children during the course of the pandemic

“…Similarly, and consistent with our findings, an increase of laryngotracheitis symptoms have also been reported during the Omicron wave in previous studies. A possible explanation could be the increased replication of the Omicron variant in the upper respiratory tract 24–27 . The higher frequency of fever observed in infants in our study could partly be attributed to clinicians hospitalising them more readily when presenting with fever, rather than it being inherently more common in this age group.…”

“…A possible explanation could be the increased replication of the Omicron variant in the upper respiratory tract. [24][25][26][27] The higher frequency of fever observed in infants in our study could partly be attributed to clinicians hospitalising them more readily when presenting with fever, rather than it being inherently more common in this age group.…”

Post–COVID-19 Condition in Children 6 and 12 Months After Infection

“…When a VOC or a variant linked to a VOC was identified, that report was used for classification purposes. If VOC testing was not performed or results were inconclusive, the SARS-CoV-2 variant was classified as previously described …”

“…If VOC testing was not performed or results were inconclusive, the SARS-CoV-2 variant was classified as previously described. 18 We assessed QoL using age-specific PedsQL-4.0 Generic Core Scales 19,20 which include 4 subscales focused on physical, emotional, social, and school functioning. 21 Each question uses a 5-point Likert response scale ranging from never to almost always for participants to report how much of a problem their child had during the preceding 7 days.…”

Characteristics and Presentations of Hospitalized Children Due to 3 Predominate COVID-19 Variants Within a Health Care Network

“…The objectives of this study are to describe differences in the demographic and clinical characteristics, severity of illness, and outcomes in pediatric patients during the different SARS-CoV-2 waves in our hospital network. Although there is already some literature from Canada and Chicago, for example, 9,10 describing the presenting symptoms of pediatric patients during each VoC, this article adds to the growing body of literature describing clinical presentations and admission diagnoses of pediatric patients hospitalized during the Alpha, Delta, and Omicron predominant periods, respectively, in the Northeast United States which was one of the hardest affected areas in the country. 7 The presentations of the different VoC of this virus are important information for patients, families, and providers to have to determine risk status with different circulating variants.…”