Iranian Pediatric COVID-19 Epidemiology and Clinical Characteristics

Abstract

Background. Despite the worldwide spread of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), information about the epidemiological and clinical patterns of this infection is still largely unknown in children. In addition, the prevalence of this disease is still very high in some parts of the world, including Iran. Thus, this study aims to evaluate the epidemiological features, laboratory and imaging findings, and the type of treatments in children with novel coronavirus 2019 (COVID-19). Method. This study is conducted from March 2020–March 2021 by using the medical records of hospitalized confirmed COVID-19 children younger than 18 years in five cities of Iran: Tehran, Ahwaz, Isfahan, Bandar-Abbas, and Khorramabad. In addition to demographic and epidemiological data, we also studied clinical signs and treatments. Results. In total 278 confirmed COVID-19 children, the average age was 5.3 years, and 59.4%were boys. A total of 37.8% had an underlying disease, in which the most common was a malignancy. The most common symptoms were fever and cough. In this group of pediatrics, some abnormal laboratory findings have been seen. GGO (Ground-Glass Opacity) had been diagnosed in 58.6% of children. 3.6% needed oxygen therapy with ventilators, and 83.09% had received antibiotic treatments with the majority of ceftriaxone. Also, 10% had got steroids. In this study, the mortality rate was 4.3%. Conclusion. In this study, most of the children who died had an underlying disease, so timely care and action is important in them. Most children admitted to our study received antibiotics and were prescribed antivirals and steroids for a smaller number. Also, a small number of children received oxygen therapy, most of whom were in the age group of 1 to 5 years.

Prognosis of COVID-19 in the middle eastern population, knowns and unknowns

“…It was found that the most common symptoms reported in children, i.e., <18 years old, are cough and dyspnea ( Rabizadeh et al, 2020 ; Fahimzad et al, 2021 ) and fever and cough ( Hosseninasab et al, 2020 ; Mahmoudi et al, 2020 ; Armin et al, 2021 ; Hoseinyazdi et al, 2021 ; Mamishi et al, 2021 ; Soleimani et al, 2021 ; Keshavarz Valian et al, 2022 ). Gastrointestinal symptoms including vomiting, nausea, and diarrhea were reported but to a lesser extent ( Hosseninasab et al, 2020 ; Mamishi et al, 2020 ; Armin et al, 2021 ; Fahimzad et al, 2021 ; Pourakbari et al, 2021 ). Interestingly, neurological symptoms such as seizure, fatigue, and headache were also described ( Cheraghali et al, 2021 ; Fahimzad et al, 2021 ).…”

“…In COVID-19 children, compared to those admitted to the general ward, ICU patients had more acute respiratory distress syndrome, shock, and acute cardiac injury as complications ( Fahimzad et al, 2021 ). The mortality rate appears to be low in infected children of Iran ( Hosseninasab et al, 2020 ; Armin et al, 2021 ; Hoseinyazdi et al, 2021 ; Mamishi et al, 2021 ; Pourakbari et al, 2021 ), ranging from 0 death ( Esmaeili Dooki et al, 2020 ; Soleimani et al, 2021 ) to 11% ( Mahmoudi et al, 2020 ; Mamishi et al, 2020 ; Armin et al, 2021 ). Interestingly, in one study the mortality rate was 20%, however, this was in children with underlying malignancies, namely acute lymphocytic and acute myeloid leukemia ( Navaeian et al, 2021 ).…”

“…It was found that the most common symptoms reported in children, i.e., <18 years old, are cough and dyspnea (Rabizadeh et al, 2020;Fahimzad et al, 2021) and fever and cough (Hosseninasab et al, 2020;Mahmoudi et al, 2020;Armin et al, 2021;Hoseinyazdi et al, 2021;Mamishi et al, 2021;Soleimani et al, 2021;Keshavarz Valian et al, 2022). Gastrointestinal symptoms including vomiting, nausea, and diarrhea were reported but to a lesser extent (Hosseninasab et al, 2020;Mamishi et al, 10.3389/fmicb.2022.974205 Frontiers in Microbiology 13 frontiersin.org Armin et al, 2021;Fahimzad et al, 2021;Pourakbari et al, 2021). Interestingly, neurological symptoms such as seizure, fatigue, and headache were also described (Cheraghali et al, 2021;Fahimzad et al, 2021).…”

“…In one study, it was found that among hospitalized children with acute respiratory infection, those with COVID-19 had a higher frequency of respiratory distress and fever compared to those without (Hosseninasab et al, 2020). Furthermore, laboratory findings showed that hospitalized children with COVID-19 are more likely to have elevated inflammatory markers such as C-reactive protein, erythrocyte sedimentation rate (ESR), liver enzymes like alanine aminotransferase and aspartate aminotransferase (Armin et al, 2021;Hoseinyazdi et al, 2021;Mamishi et al, 2021); leukocytosis and leukopenia were also observed in one study (Armin et al, 2021). Prognosis of COVID-19 in Iranian children ranges from mild (Armin et al, 2021;Fahimzad et al, 2021) to severe disease (Mahmoudi et al, 2020;Ghazizadeh Esslami et al, 2021;Mamishi et al, 2021).…”

“…Furthermore, laboratory findings showed that hospitalized children with COVID-19 are more likely to have elevated inflammatory markers such as C-reactive protein, erythrocyte sedimentation rate (ESR), liver enzymes like alanine aminotransferase and aspartate aminotransferase (Armin et al, 2021;Hoseinyazdi et al, 2021;Mamishi et al, 2021); leukocytosis and leukopenia were also observed in one study (Armin et al, 2021). Prognosis of COVID-19 in Iranian children ranges from mild (Armin et al, 2021;Fahimzad et al, 2021) to severe disease (Mahmoudi et al, 2020;Ghazizadeh Esslami et al, 2021;Mamishi et al, 2021). In two studies, the SARS-CoV-2 infection manifested as a hyperinflammatory syndrome with multi-organ involvement similar to Kawasaki disease shock syndrome (Mamishi et al, 2021) and as MIS-C (Mamishi et al, 2020).…”