Clinical characteristics of children and adults infected with severe acute respiratory syndrome coronavirus 2 Omicron variant BA.5 or BA.2
Objective To understand and compare the clinical characteristics of children and adults infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron variant BA.5 and BA.2 subtypes in Shanghai City.Methods The clinical data of 524 children hospitalized with coronavirus disease 2019(COVID-19)at the Children's Hospital of Fudan University during the period of BA.5 predominance from December 1,2022 to January 20,2023 were collected,which included age,gender,clinical symptoms and laboratory examination results.And the clinical data of household close contacts were also collected.The clinical data of children and their household contacts infected with Omicron BA.2 subtypes during the period of BA.2 predominance from April 4 to April 30,2022 were collected and compared.The clinical characteristic of critical and non-critical cases,child and adult cases during the period of BA.5 predominance were compared.Statistical analyses were conducted using independent samples t-test,Mann-Whitney U test,chi-square test or Fisher's exact test.Results The age of 524 hospitalized children was five days to 16 years old.Among them,301(57.4％)were male and 223(42.6％)were female.Additionally,there were 29 critical cases(5.5％)and 495 non-critical cases(94.5％).Critical cases had significantly higher fever peak,more shortness of breath occurrence,more pneumonia and underlying diseases compared to non-critical cases,with statistically significant differences(t=12.06,x2=34.90,10.04 and 31.10,respectively,all P＜0.05).Regarding laboratory examinations,critical cases exhibited significantly higher frequencies of decreased lymphocyte count,elevated levels of C-reactive protein,procalcitonin and interleukin-6,abnormal liver function and kidney function,and abnormal creatine kinase isoenzyme compared to non-critical cases,with statistically significant differences(x2=8.18,Z=-4.61,Z=-4.28,Z=-5.13,x2=195.90,Fisher's exact test and x2=136.13,respectively,all P＜0.05).Non-critical children cases infected with Omicron variant BA.5 subtype exhibited a higher proportion of symptomatic infections compared to adults.Among children,the occurrence rates of fever and gastrointestinal symptoms(nausea,vomiting,diarrhea)were higher,whereas among adults,the occurrence rate of cough was higher.The differences were statistically significant(x2=11.16,11.83,8.50 and 28.14,respectively,all P＜0.05).From December 1,2022 to January 20,2023,a total of 588 children cases and 791 adult cases were collected,while from April 4 to April 30,2022,a total of 355 children cases and 755 adult cases were collected.In the children group,the occurrence rates of cough,convulsions and critical cases were higher in BA.5 subtype-infected children compared to those infected with the BA.2 subtype,with statistically significant differences(X2=37.95,40.78 and 15.54,respectively,all P＜0.001).In the adult group,BA.5 subtype-infected individuals had higher fever peak,longer duration of fever,and higher occurrence of fever,cough and gastrointestinal symptoms,compared to those infected with the BA.2 subtype.The differences were statistically significant(t=-4.40,Z=-9.64,x2=47.29,124.09 and 29.90,respectively,all P＜0.001).Conclusions During the peak periods of BA.5 subtype of the Omicron variant in Shanghai City,critical cases have severe systemic symptoms and a higher prevalence of underlying diseases compared to non-critical cases.Among non-critical cases infected with BA.5 subtype,the proportion of symptomatic infections in children is higher than adults,with fever and gastrointestinal symptoms more common than adults,while cough symptoms are more common seen in adults.The occurrence rate of convulsions and critical cases is higher in children infected with variant BA.5 subtype compared to those infected with BA.2 subtype.The systemic symptoms are more severe in adults infected with BA.5 subtype compared to those infected with BA.2 subtype.
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