The Pediatric infectious disease journal · 2025
Severity of COVID-19 in Hospitalized Immunocompromised Children Across Canada.
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Di Chiara Costanza, Schober Tilmann, Farrar Daniel S, Bettinger Julie A, Drouin Olivier, Embree Joanne E, Halperin Scott A, Moore Hepburn Charlotte, Jadavji Tajdin, Kazmi Kescha, Purewal Rupeena, Sadarangani Manish, Sauvé Laura, Top Karina A, Kakkar Fatima, Papenburg Jesse, Morris Shaun K, for members of the Canadian Immunization Monitoring Program, ACTive (IMPACT)
Аннотация
BACKGROUND: The association of immunocompromised states with pediatric COVID-19 outcomes remains unclear. This study assessed COVID-19 severity in hospitalized children with and without immunocompromising conditions.
METHODS: Children <17 years hospitalized in Canada for COVID-19 (April 2020-December 2022) were identified through the Canadian Paediatric Surveillance Program and Canadian Immunization Monitoring Program, ACTive. Immunocompromised children (IC) were those with immune-compromising conditions and/or on immunosuppressive treatment. Severe COVID-19 was defined as intensive care unit admission, ventilator/hemodynamic support, organ complications or death. Adjusted risk ratios (aRR) for severe COVID-19 among IC versus nonimmunocompromised children (non-IC) were calculated using Poisson regression, adjusting for age, sex, other underlying conditions, SARS-CoV-2 lineage and vaccination.
RESULTS: Among 3218 children hospitalized for COVID-19, 354 (11.0%) were IC. IC were older [median age 6.7 years (interquartile range = 3.6-11.8)] than non-IC [1.2 years (interquartile range = 0.2-4.8); P < 0.001]. IC experienced less respiratory distress than non-IC (20.9% vs. 48.1%). Severe COVID-19 (14.1% vs. 29.0%; P < 0.001), respiratory support (16.1% vs. 35.6%; P < 0.001) and intensive care unit admission (5.9% vs. 17.4%; P < 0.001) were less frequent in IC. IC were less likely to have severe COVID-19 than non-IC [aRR = 0.46 (95% confidence interval [CI]: 0.32-0.65)], with both immunodeficiency [aRR = 0.53 (95% CI: 0.39-0.73)] and immunosuppression [aRR = 0.40 (95% CI: 0.23-0.73)] subcategories independently associated with reduced risk. Compared to non-IC with other conditions, IC had a lower risk of severe COVID-19 [aRR = 0.35 (95% CI: 0.25-0.47)].
CONCLUSIONS: Hospitalized IC exhibited a lower risk of severe COVID-19 than non-IC, potentially reflecting lower admission thresholds for IC with respiratory infections.
METHODS: Children <17 years hospitalized in Canada for COVID-19 (April 2020-December 2022) were identified through the Canadian Paediatric Surveillance Program and Canadian Immunization Monitoring Program, ACTive. Immunocompromised children (IC) were those with immune-compromising conditions and/or on immunosuppressive treatment. Severe COVID-19 was defined as intensive care unit admission, ventilator/hemodynamic support, organ complications or death. Adjusted risk ratios (aRR) for severe COVID-19 among IC versus nonimmunocompromised children (non-IC) were calculated using Poisson regression, adjusting for age, sex, other underlying conditions, SARS-CoV-2 lineage and vaccination.
RESULTS: Among 3218 children hospitalized for COVID-19, 354 (11.0%) were IC. IC were older [median age 6.7 years (interquartile range = 3.6-11.8)] than non-IC [1.2 years (interquartile range = 0.2-4.8); P < 0.001]. IC experienced less respiratory distress than non-IC (20.9% vs. 48.1%). Severe COVID-19 (14.1% vs. 29.0%; P < 0.001), respiratory support (16.1% vs. 35.6%; P < 0.001) and intensive care unit admission (5.9% vs. 17.4%; P < 0.001) were less frequent in IC. IC were less likely to have severe COVID-19 than non-IC [aRR = 0.46 (95% confidence interval [CI]: 0.32-0.65)], with both immunodeficiency [aRR = 0.53 (95% CI: 0.39-0.73)] and immunosuppression [aRR = 0.40 (95% CI: 0.23-0.73)] subcategories independently associated with reduced risk. Compared to non-IC with other conditions, IC had a lower risk of severe COVID-19 [aRR = 0.35 (95% CI: 0.25-0.47)].
CONCLUSIONS: Hospitalized IC exhibited a lower risk of severe COVID-19 than non-IC, potentially reflecting lower admission thresholds for IC with respiratory infections.