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Background <p>Interpretations of pediatric COVID-19 severity are complicated by novel lineages and COVID-19 vaccine introduction. We estimated the risk of severe COVID-19 by SARS-CoV-2 lineage and vaccination status among hospitalized Canadian children.</p> Methods <p>Data were collected through the Canadian Paediatric Surveillance Program (April 2020–May 2021) and Canadian Immunization Monitoring Program, ACTive (June 2021–December 2022). Patients &lt;17 years hospitalized for COVID-19 (excluding incidental SARS-CoV-2) at 13 pediatric hospitals were included. Lineages were defined via genetic sequencing or dominant lineage upon hospitalization. Severe disease included intensive care, ventilatory/hemodynamic requirements, systemic complications, and/or death.</p> Results <p>We analyzed 3218 COVID-19 hospitalizations, including 81.4% admitted during Omicron predominance. Median age was highest among Delta cases (2.9 years, interquartile range [IQR] 0.2–10.9) and lowest among Omicron BQ.1 cases (0.6 years, IQR 0.2–1.8). Severe COVID-19 remained common in Omicron vs. ancestral cases (27.2% vs. 23.2%). The proportion of hospitalized cases aged 5–16 years declined following the introduction of age-specific COVID-19 vaccines. Vaccination reduced the risk of in-hospital severe disease for ages 12–16 years (two vs. zero doses; adjusted risk ratio 0.49, 95% confidence interval 0.32–0.77).</p> Conclusion <p>More children were hospitalized with Omicron lineages than all prior lineages. COVID-19 vaccination was associated with a lower burden of severe disease among ages 5–16 years.</p> Impact statement <p><UnorderedList Mark="Bullet"> <ItemContent> <p>This study estimates the effect of SARS-CoV-2 lineage, Omicron sub-lineage, and vaccination on COVID-19 disease severity, using data from two Canadian national surveillance programs.</p> </ItemContent> <ItemContent> <p>Few national studies describe the clinical presentation and severity of Omicron sub-lineages among hospitalized children.</p> </ItemContent> <ItemContent> <p>In Canada, Omicron lineages were associated with substantially more pediatric COVID-19 hospitalizations than all prior lineages combined, though risk of severe COVID-19 was highest during the Delta period.</p> </ItemContent> <ItemContent> <p>COVID-19 vaccines were associated with reductions in hospitalization (ages 5–16 years) and severe disease (ages 12–16 years) across Omicron sub-lineages.</p> </ItemContent> </UnorderedList></p>

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Pediatric COVID-19 severity by SARS-CoV-2 lineage and vaccine status in Canada: an IMPACT study

  • 期刊论文

  • 发表日期：

    2025年1月24日

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  • Daniel S. Farrar,
  • Julie A. Bettinger,
  • Aaron J. Campigotto,
  • Shelley L. Deeks,
  • Olivier Drouin,
  • Joanne E. Embree,
  • Elie Haddad,
  • Scott A. Halperin,
  • Tajdin Jadavji,
  • Kescha Kazmi,
  • Melanie King,
  • Charlotte Moore Hepburn,
  • Jesse Papenburg,
  • Rupeena Purewal,
  • Manish Sadarangani,
  • Laura Sauvé,
  • Rae S. M. Yeung,
  • Karina A. Top,
  • Fatima Kakkar,
  • Shaun K. Morris

摘要

Background

Interpretations of pediatric COVID-19 severity are complicated by novel lineages and COVID-19 vaccine introduction. We estimated the risk of severe COVID-19 by SARS-CoV-2 lineage and vaccination status among hospitalized Canadian children.

Methods

Data were collected through the Canadian Paediatric Surveillance Program (April 2020–May 2021) and Canadian Immunization Monitoring Program, ACTive (June 2021–December 2022). Patients <17 years hospitalized for COVID-19 (excluding incidental SARS-CoV-2) at 13 pediatric hospitals were included. Lineages were defined via genetic sequencing or dominant lineage upon hospitalization. Severe disease included intensive care, ventilatory/hemodynamic requirements, systemic complications, and/or death.

Results

We analyzed 3218 COVID-19 hospitalizations, including 81.4% admitted during Omicron predominance. Median age was highest among Delta cases (2.9 years, interquartile range [IQR] 0.2–10.9) and lowest among Omicron BQ.1 cases (0.6 years, IQR 0.2–1.8). Severe COVID-19 remained common in Omicron vs. ancestral cases (27.2% vs. 23.2%). The proportion of hospitalized cases aged 5–16 years declined following the introduction of age-specific COVID-19 vaccines. Vaccination reduced the risk of in-hospital severe disease for ages 12–16 years (two vs. zero doses; adjusted risk ratio 0.49, 95% confidence interval 0.32–0.77).

Conclusion

More children were hospitalized with Omicron lineages than all prior lineages. COVID-19 vaccination was associated with a lower burden of severe disease among ages 5–16 years.

Impact statement

This study estimates the effect of SARS-CoV-2 lineage, Omicron sub-lineage, and vaccination on COVID-19 disease severity, using data from two Canadian national surveillance programs.

Few national studies describe the clinical presentation and severity of Omicron sub-lineages among hospitalized children.

In Canada, Omicron lineages were associated with substantially more pediatric COVID-19 hospitalizations than all prior lineages combined, though risk of severe COVID-19 was highest during the Delta period.

COVID-19 vaccines were associated with reductions in hospitalization (ages 5–16 years) and severe disease (ages 12–16 years) across Omicron sub-lineages.