High rate of clinically unrecognized SARS-CoV-2 infections in pediatric palliative care patients

Abstract

Little is known about the frequency and clinical course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in pediatric patients with severe comorbidities. In this prospective cross-sectional trial, the seroprevalence of SARS-CoV-2-IgG in patients with life-limiting conditions being treated by a large specialized pediatric palliative home-care team was determined. In order to gain insight into the infection chain, close contacts of seropositive patients were also included in the study. We analyzed the sera of 39 patients and found a 25.6% seroprevalence for SARS-CoV-2. No SARS-CoV-2 infections were known prior to the study. No significant difference was found in the symptom load between seropositive and seronegative patients during the risk period for SARS-CoV-2 infections. Of the 20 close contacts tested, only one was seropositive for SARS-CoV-2.Conclusions: Our results indicate a substantially high prevalence of silent SARS-CoV-2 infections in pediatric palliative care patients. Surprisingly, no severe outcomes were seen in this fragile patient collective with severe comorbidities. The chain of infection and thus the reason for the high frequency of SARS-CoV-2 infections in pediatric palliative care patients remain unclear. What is Known:•Even though severe disease courses of COVID-19 have been reported in children, there are yet no established risk factors for SARS-CoV-2 in pediatric patients. What is New:•In this cross-sectional seroprevalence study of palliative pediatric patients with severe life-limiting conditions, a high rate of seropositive patients (25.6%) was found.•Surprisingly, all seropositive patients were previously unrecognized, despite the severe comorbidities of our collective.

The impact of the COVID‐19 pandemic on the future incidence of acute lymphoblastic leukaemia in children: Projections for Germany under a COVID‐19 related scenario

“…It is curious that when considering those infectious‐related models of BCP‐ALL risk in relation to the COVID‐19 pandemic, both inflation and reduction in the ALL incidence are conceivable. On one hand, an infection with the severe acute respiratory syndrome coronavirus type 2 (SARS‐CoV‐2), very common in young children, 6 may directly act as trigger of the second hit. Single cases of BCP‐ALL shortly after SARS‐CoV‐2 infection may support this scenario.…”

“…On one hand, an infection with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), very common in young children, 6 may directly act as trigger of the second hit. Single cases of BCP-ALL shortly after SARS-CoV-2 infection may support this scenario.…”

COVID-19 in pediatric palliative care patients: Multicenter, retrospective cohort study

“…We found only one study directly relevant to children with life-limiting conditions; the authors analyzed the sera of 39 patients and found a 26% seroprevalence for SARS-CoV-2, but all seropositive patients were previously unrecognized despite severe comorbidities. 14…”

“…We found only one study directly relevant to children with life-limiting conditions; the authors analyzed the sera of 39 patients and found a 26% seroprevalence for SARS-CoV-2, but all seropositive patients were previously unrecognized despite severe comorbidities. 14 Some studies present a severe course of COVID-19, including death in children with underlying conditions. [5][6][7]15,16 In our study population, children with congenital malformations and chromosomal abnormalities most often suffered from COVID-19 and two patients from this group had a fatal outcome.…”