CC BY 4.0 · Journal of Child Science 2020; 10(01): e53-e62
DOI: 10.1055/s-0040-1714113
Review Article
Georg Thieme Verlag KG Stuttgart · New York

COVID-19 in Children: Present and Future Perspective, An Interim Review

1   Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
,
1   Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
,
1   Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
,
1   Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
,
2   KIIT School of Biotechnology, KIIT Deemed to be University, Bhubaneswar, Odisha, India
,
1   Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
› Institutsangaben
Funding None.
Weitere Informationen

Publikationsverlauf

04. Mai 2020

26. Mai 2020

Publikationsdatum:
29. Juli 2020 (online)

Abstract

Coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide. However, the mechanism by which the pathogen affects children is not understood completely. Children so far accounted for only1 to 6.4% of diagnosed cases and the mortality rate is also less. Though clinical findings are similar to adults, with fever and respiratory symptoms being prevalent, fewer numbers of children appear to develop severe pneumonia. Observed attenuated response to the virus may possibly be due to decrease in the expression of the angiotensin-converting enzyme 2 receptor in lungs, repeated viral exposure, and not having any underlying chronic diseases or immunosuppression. Suggested treatment included oxygen supplementation, mechanical ventilation in severe cases, nutritional support, and maintaining fluids and electrolyte balances. Although, no definitive pharmacological therapy is available, various combination of drugs like hydroxychloroquine, lopinavir/ritonavir, remdesivir, tocilizumab, and convalescent serum show promising result to an extent. As there is no specific therapeutic measure for this ailment, aggressive efforts are being made to develop a potential vaccine against the disease. Although few reports on epidemiology of COVID-19 in children have been published, comprehensive reports are lacking. The present article reviews on important issues such as epidemiological characteristics, postulations of milder disease, therapeutic aspect, and recent development of vaccination against COVID-19 in children.

Authors' Contributions

S.P., J.B., and N.M. developed the idea and concept. M.N. and J.P. conducted literature search and review. N.M., B.S., and S.P. drafted the manuscript and provided critical review. All authors read and approved the final manuscript for submission. The manuscript has been read and approved by all the authors and N.K.M. will correspond on behalf of all.


 
  • References

  • 1 Anderson RM, Fraser C, Ghani AC. , et al. Epidemiology, transmission dynamics and control of SARS: the 2002-2003 epidemic. Philos Trans R Soc Lond B Biol Sci 2004; 359 (1447): 1091-1105
  • 2 Ramadan N, Shaib H. Middle East respiratory syndrome coronavirus (MERS-CoV): a review. Germs 2019; 9 (01) 35-42
  • 3 Zimmermann P, Curtis N. Coronavirus infections in children including COVID-19: an overview of the epidemiology, clinical features, diagnosis, treatment and prevention options in children. Pediatr Infect Dis J 2020; 39 (05) 355-368
  • 4 Hon KL, Leung CW, Cheng WT. , et al. Clinical presentations and outcome of severe acute respiratory syndrome in children. Lancet 2003; 361 (9370): 1701-1703
  • 5 Nickbakhsh S, Mair C, Matthews L. , et al. Virus-virus interactions impact the population dynamics of influenza and the common cold. Proc Natl Acad Sci U S A 2019; 116 (52) 27142-27150
  • 6 Heimdal I, Moe N, Krokstad S. , et al. Human coronavirus in hospitalized children with respiratory tract infections: a 9-year population-based study from Norway. J Infect Dis 2019; 219 (08) 1198-1206
  • 7 Lu H, Stratton CW, Tang YW. The Wuhan SARS-CoV-2-what's next for China. J Med Virol 2020 . Doi: 10.1002/jmv.25738
  • 8 Zhang S, Diao MY, Duan L, Lin Z, Chen D. The novel coronavirus (SARS-CoV-2) infections in China: prevention, control and challenges. Intensive Care Med 2020; 46 (04) 591-593
  • 9 Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed 2020; 91 (01) 157-160
  • 10 Novel CP. ; Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China [in Chinese]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41 (02) 145-151
  • 11 Shim E, Tariq A, Choi W, Lee Y, Chowell G. Transmission potential and severity of COVID-19 in South Korea. Int J Infect Dis 2020; 93: 339-344
  • 12 Livingston E, Bucher K. Coronavirus disease 2019 (COVID-19) in Italy. JAMA 2020; 323 (14) 1335-1335
  • 13 CDC COVID-19 Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (12) 343-346
  • 14 Chen H, Guo J, Wang C. , et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 809-815
  • 15 Schwartz DA. An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS CoV-2:maternal corona virus infections and pregnancy outcomes. Arch Pathol Lab Med 2020; 144 (07) 799-805
  • 16 Guan WJ, Ni ZY, Hu Y. , et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382 (18) 1708-1720
  • 17 Dong Y, Mo X, Hu Y. , et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics 2020 (forth coming). Doi:10.1542/peds.2020-0702
  • 18 Xu Y, Li X, Zhu B. , et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med 2020; 26 (04) 502-505
  • 19 Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA 2020
  • 20 Sinha IP, Harwood R, Semple MG. , et al. COVID-19 infection in children. Lancet Respir Med 2020; 8 (05) 446-447
  • 21 Ozma MA, Maroufi P, Khodadadi E. , et al. Clinical manifestation, diagnosis, prevention and control of SARS-CoV-2 (COVID-19) during the outbreak period. Infez Med 2020; 28 (02) 153-165
  • 22 Lauer SA, Grantz KH, Bi Q. , et al. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med 2020; 172 (09) 577-582
  • 23 Leung C. The difference in the incubation period of 2019 novel coronavirus (SARS-CoV-2) infection between travelers to Hubei and nontravelers: the need for a longer quarantine period. Infect Control Hosp Epidemiol 2020; 41 (05) 594-596
  • 24 Li Q, Guan X, Wu P. , et al. Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. N Engl J Med 2020; 382 (13) 1199-1207
  • 25 van Doremalen N, Bushmaker T, Morris DH. , et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020; 382 (16) 1564-1567
  • 26 Li W, Moore MJ, Vasilieva N. , et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature 2003; 426 (6965): 450-454
  • 27 Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. ; HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395 (10229): 1033-1034
  • 28 Gattinoni L, Chiumello D, Caironi P. , et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes?. Intensive Care Med 2020; 1
  • 29 Musa S. Hepatic and gastrointestinal involvement in coronavirus disease 2019 (COVID-19): what do we know till now?. [Internet] Arab J Gastroenterol 2020; 21 (01) 3-8
  • 30 Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr 2020; 109 (06) 1088-1095
  • 31 Terpos E, Ntanasis-Stathopoulos I, Elalamy I. , et al. Hematological findings and complications of COVID-19. Am J Hematol 2020
  • 32 Lu X, Zhang L, Du H. , et al; Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 infection in children. N Engl J Med 2020; 382 (17) 1663-1665
  • 33 Dong Y, Mo X, Hu Y. , et al. Epidemiology of COVID-19 among children in China. Pediatrics 2020; e20200702
  • 34 Xia W, Shao J. Clinical and CT features in pediatric patients with COVID - 19 infection: different points from adults. Pediatr Pulmonol [Internet] 2020; 1-6
  • 35 Riphagen S, Gomez X, Gonzalez-martinez C, Wilkinson N, Theocharis P. Correspondence hyperinflammatory shock in children during. Lancet 2020; 6736: 2019-2020
  • 36 Pompili M, Shrivastava A, Serafini G. , et al. Bereavement after the suicide of a significant other. Indian J Psychiatry 2013; 55 (03) 256-263
  • 37 Pompili M, Gibiino S, Innamorati M. , et al. Prolactin and thyroid hormone levels are associated with suicide attempts in psychiatric patients. Psychiatry Res 2012; 200 (2-3): 389-394
  • 38 Wang Z, Zhou Q, Wang C. , et al. Clinical characteristics of children with COVID-19: a rapid review and meta-analysis. Med Rxiv 2020; x: 1-41
  • 39 Liu Y, Yan L, Wan L. , et al. Correspondence and severe cases of. Lancet Infect Dis 2020; 201: 2019-2020
  • 40 Wrapp D, Wang N, Corbett KS. , et al. Cryo-EM structure of the 2019-nCoV spike in the . prefusion conformation. Science 2020; 367 (6483): 1260-1263
  • 41 Henry BM, Lippi G, Plebani M. Laboratory abnormalities in children with novel coronavirus disease 2019. Clin Chem Lab Med 2020; 58 (07) 1135-1138
  • 42 Simon AK, Hollander GA, McMichael A. . Evolution of the immune system in humans from infancy to old age. Proceedings of the Royal Society B: Biological Sciences. 2015 December 22 282. (1821): 20143085
  • 43 Chen ZM, Fu JF, Shu Q. , et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World J Pediatr 2020; •••: 1-7
  • 44 Huang C, Wang Y, Li X. , et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506
  • 45 Chan JFW, Yuan S, Kok KH. , et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020; 395 (10223): 514-523
  • 46 Foust AM, Phillips GS, Chu WC. , et al. International expert consensus statement on chest imaging in pediatric COVID-19 patient management: imaging findings, imaging study reporting and imaging study recommendations. Radiol. Cardiothoracic Imaging. 2020; 2 (02) e200214
  • 47 Chen W, Lan Y, Yuan X. , et al. Detectable 2019-nCoV viral RNA in blood is a strong indicator for the further clinical severity. Emerg Microbes Infect 2020; 9 (01) 469-473
  • 48 Chen W, Lan Y, Yuan X. , et al. Detectable 2019-nCoV viral RNA in blood is a strong indicator for the further clinical severity. Emerg Microbes Infect 2020; 9 (01) 469-473
  • 49 Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 novel coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis 2020; ciaa200
  • 50 Wang S, Guo L, Chen L. , et al. A case report of neonatal COVID-19 infection in China. Clin Infect Dis 2020; ciaa225
  • 51 Zeng H, Xu C, Fan J. , et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA 2020
  • 52 Dong L, Tian J, He S. , et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA 2020 ; Doi: 10.1001/jama.2020.4621 [Internet]
  • 53 Kimberlin DW, Stagno S. Can SARS-CoV-2 infection be acquired in utero?: more definitive evidence is needed. JAMA 2020
  • 54 Guo YR, Cao QD, Hong ZS. , et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status. Mil Med Res 2020; 7 (01) 11
  • 55 Gautret P, Lagier JC, Parola P. , et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents 2020; •••: 105949
  • 56 Geleris J, Sun Y, Platt J. , et al. Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19. N Engl J Med 2020 Doi: 10.1056/NEJMoa2012410
  • 57 Karimi A, Tabatabaei SR, Rajabnejad M. , et al. An algorithmic approach to diagnosis and treatment of coronavirus disease 2019 (COVID-19) in children: Iranian expert's consensus statement. Arch Pediatr Infect Dis. 2020; 8 (02) e102400
  • 58 Sheahan TP, Sims AC, Leist SR. , et al. Comparative therapeutic efficacy of remdesivir and combination lopinavir, ritonavir, and interferon beta against MERS-CoV. Nat Commun 2020; 11 (01) 222
  • 59 Holshue ML, DeBolt C, Lindquist S. , et al; Washington State 2019-nCoV Case Investigation Team. First case of 2019 novel coronavirus in the United States. N Engl J Med 2020; 382 (10) 929-936
  • 60 Cvetkovic RS, Goa KL. Lopinavir/ritonavir: a review of its use in the management of HIV infection. Drugs 2003; 63 (08) 769-802
  • 61 Lim J, Jeon S, Shin HY. , et al. Case of the index patient who caused tertiary transmission of COVID-19 infection in Korea: the application of lopinavir/ritonavir for the treatment of COVID-19 infected pneumonia monitored by quantitative RT-PCR. J Korean Med Sci 2020; 35 (06) e79
  • 62 Arabi YM, Alothman A, Balkhy HH. , et al; And the MIRACLE trial group. Treatment of Middle East respiratory syndrome with a combination of lopinavir-ritonavir and interferon-β1b (MIRACLE trial): study protocol for a randomized controlled trial. Trials 2018; 19 (01) 81
  • 63 Cao B, Wang Y, Wen D. , et al. A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. N Engl J Med 2020; 382 (19) 1787-1799
  • 64 Hung IF, Lung KC, Tso EY. , et al. Triple combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial. Lancet 2020; S0140-6736(20)31042-4
  • 65 Ye Q, Wang B, Mao J. The pathogenesis and treatment of the ‘Cytokine Storm’ in COVID-19. J Infect 2020; 80 (06) 607-613
  • 66 Alhazzani W, Møller MH, Arabi YM. , et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19). Intensive Care Med 2020; 46 (05) 854-887
  • 67 Casadevall A, Pirofski LA. The convalescent sera option for containing COVID-19. J Clin Invest 2020; 130 (04) 1545-1548
  • 68 Shen C, Wang Z, Zhao F. , et al. Treatment of 5 critically ill patients with COVID-19 with convalescent plasma. JAMA 2020; 323 (16) 1582-1589
  • 69 Shoenfeld Y. Corona (COVID-19) time musings: our involvement in COVID-19 pathogenesis, diagnosis, treatment and vaccine planning. Autoimmun Rev 2020; 19 (06) 102538
  • 70 Xu X, Han M, Li T. , et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proceedings of the National Academy of Sciences; 2020 April 29
  • 71 Zhou Q, Wei XS, Xiang X. , et al. Interferon-a2b treatment for COVID-19. MedRxiv 2020. Doi: 10.1101/2020.04.06.20042580
  • 72 Care I, Sun Q, Qiu H, Huang M, Yang Y. Lower mortality of COVID - 19 by early recognition and intervention : experience from Jiangsu Province. Ann Intensive Care. 2020; 2–5 DOI: 10.1186/s13613-020-00650-2.
  • 73 Yang ZY, Kong WP, Huang Y. , et al. A DNA vaccine induces SARS coronavirus neutralization and protective immunity in mice. Nature 2004; 428 (6982): 561-564
  • 74 Jiang S, He Y, Liu S. SARS vaccine development. Emerg Infect Dis 2005; 11 (07) 1016-1020
  • 75 Wrapp D, Wang N, Corbett KS. , et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science 2020; 367 (6483): 1260-1263
  • 76 Alharbi NK, Padron-Regalado E, Thompson CP. , et al. ChAdOx1 and MVA based vaccine candidates against MERS-CoV elicit neutralising antibodies and cellular immune responses in mice. Vaccine 2017; 35 (30) 3780-3788
  • 77 Hegarty PK, Kamat AM, Zafirakis H, Dinardo A. . BCG vaccination may be protective against Covid-19. Preprint 2020
  • 78 Hamiel U, Kozer E, Youngster I. SARS-CoV-2 rates in BCG-vaccinated and unvaccinated young adults. JAMA 2020 ; Doi: 10.1001/jama.2020.8189
  • 79 World Health Organization. Guiding principles for immunization activities during the COVID-19 pandemic: interim guidance, 26 March 2020. World Health Organization; 2020
  • 80 Leung TF, Ng PC, Cheng FW. , et al. Infection control for SARS in a tertiary paediatric centre in Hong Kong. J Hosp Infect 2004; 56 (03) 215-222