Preliminary COVID-19 Disease Characteristics in US Pediatric Cases

A preliminary description of US pediatric coronavirus disease 2019 (COVID-19) cases found relatively few children are hospitalized, and fewer children than adults experience fever, cough, or shortness of breath. This is according to data from the Morbidity and Mortality Weekly Report.¹

As of April 22, 2020, the United States reported 839,836 cases and 46,079 deaths from COVID-19.² Data from the outbreak in China has suggested that pediatric COVID-19 cases may be less severe than cases in adults and that children experience different symptoms. Investigators, therefore, aimed to describe the disease characteristics among US pediatric patients using data from 149,760 laboratory-confirmed COVID-19 cases occurring between February 12 and April 2, 2020.

The ages of patients were available for 149,082 (99.6%) of cases, among which 2572 (1.7%) were patients aged <18 years. Data concerning important variables were only available for a small percentage of patients and included symptoms (9.4%), underlying conditions (13%), and hospitalization status (33%).

Among all 2,572 pediatric cases of COVID-19, the median age was 11 years. The highest number of cases occurred in patients aged 15 to 17 years; roughly one-third of reported cases (n=813; 32%) occurred in this age group. This was followed by children aged 10 to 14 years, who comprised 27% of all cases (n=682). Children aged < 1 year or between 5 and 9 years (n = 398 and 388, respectively) comprised 15%, each, of the total cases, and those aged 1 to 4 years comprised 11% (n=291). Of note, 57% of all cases occurred in boys. A total of 91% of pediatric cases were related to exposure to COVID-19 via a household or community member.

Hospitalization occurred in 5.7% of all pediatric patients (20% of those for whom hospitalization status was known) compared with 10% of patients aged 18 to 64 years (33% of those with known hospitalization status). Of the pediatric cases included in this analysis, 3 deaths were reported. At least 1 underlying medical condition was present in 23% of the 345 pediatric cases of COVID-19 that had data on such conditions; the most common conditions were chronic lung conditions (40 of 80), cardiovascular disease (25 of 80) and immunosuppression (10 of 80).

A total of 73% of pediatric patients had symptoms of fever, cough, or shortness of breath compared with 93% of adults aged 18-64 years during the same period. Among patients with known data for symptomology, 56% of pediatric patients reported fever,

54% cough, and 13% shortness of breath, compared with 71%, 80%, and 43%, respectively, of patients aged 18 to 64 years.

According to investigators, this data supports the previous findings that pediatric cases of COVID-19 might not have reported fever or cough as often as adults. They also noted that these results should be interpreted with caution due to the high percentage of cases missing data on important characteristics. Investigators further cautioned that, “although most cases reported among chil­dren to date have not been severe, clinicians should maintain a high index of suspicion for COVID-19 infection in children and monitor for progression of illness, particularly among infants and children with underlying conditions.”

Researchers emphasized that, “social distancing and everyday preventative behaviors remain important for all age groups because patients with less serious illness and those without symptoms likely play an important role in disease transmission.”

Reference

1. Bialek S, Gierke R, Hughes M, McNamara LA, Pilishvili T, Skoff T. Coronavirus disease 2019 in children – United States, February 12-April 2, 2020. Morb Mortal Wkly Rep. 2020;69:422-426.
2. Johns Hopkins University School of Medicine. Coronavirus COVID-19 global cases. Updated April 22, 2020. https://coronavirus.jhu.edu/map.html. Accessed April 22, 2020.