Risk of SARS-CoV-2 reinfections in children: prospective national surveillance, January 2020 to July 2021, England

AbstractBackgroundReinfection after primary SARS-CoV-2 infection is uncommon in adults, but little is known about the risks, characteristics, severity or outcomes of reinfection in children.MethodsWe used national SARS-CoV-2 testing data in England to estimate the risk of reinfection ≥90 days after primary infection from 01 January 2020 to 31 July 2021, which encompassed both the Alpha and Delta waves in England. Disease severity was assessed by linking reinfection cases to national hospitalisation, intensive care admission and death registrations datasets.FindingsReinfection rates closely followed community infection rates, with a small peak during the Alpha wave and a larger peak during the Delta wave. In children aged ≤16 years, there were 688,418 primary infections and 2,343 reinfections. The overall reinfection rate was 66·88/100,000 population, being higher in adults (72.53/100,000) than in children (21·53/100,000). Reinfection rates after primary infection were 0·68% overall, 0·73% in adults and 0·34% in children. Of the 109 reinfections in children admitted to hospital, 78 (72%) had underlying comorbidities. Hospitalisation rates were similar for the first (64/2343, 2·73%) and second episode (57/2343, 2·43%). Intensive care admission was rare after primary infection (n=7) or reinfection (n=4), mainly in children with comorbidities. 44 deaths occurred after primary infection within 28 days of diagnosis (44/688,418, 0·01%), none after possible reinfections.InterpretationThe risk of SARS-CoV-2 reinfection is strongly related to exposure due to community infection rates, especially during the Delta variant wave. Children had a lower risk of reinfection than adults, but reinfections were not associated with more severe disease or fatal outcomes.FundingPHE/UKHSAResearch in ContextEvidence Before this studyWe searched PubMed with the terms “COVID-19” or “SARS-CoV-2” with “reinfection” to identify publications relating to SARS-CoV-2 reinfections from 01 January until 15 November 2021. There were few publications relating to SARS-CoV-2 reinfections, and these primarily related to adults. Published studies reported very low rates of reinfection during the first few months after primary infection in adults. COVID-19 vaccines provide effective immune protection against SARS-CoV-2 infection, but recent studies have reported increasing risk of breakthrough infection with time since primary vaccination due to waning immunity. Several SARS-CoV-2 variants, including the beta, gamma and delta variants have been shown to partially evade immunity after natural infection and vaccination, potentially increasing the risk of reinfections and breakthrough infections, respectively. Data on reinfections in children are lacking and restricted mainly to case reports in immunocompromised children.Added Value of This StudyWe used national SARS-CoV-2 testing data during the first 19 months of the pandemic to estimate the risk of reinfection in children compared to adults during a period that encompassed both the Alpha and the Delta variant waves in England. We found that the risk of reinfection correlated with the risk of SARS-CoV-2 exposure and therefore, closely reflected community infection rates, with most reinfections occurring during the Delta variant wave. Whilst acknowledging the limitation of using national testing data, we found that children had a lower risk of reinfection compared to adults and that the risk of reinfection in children increased with age. Reinfections were not associated with severe disease in terms of hospitalization or intensive care admission and there were no fatalities within 28 days of the reinfection episode in children.Implications of all the Available EvidenceSARS-CoV-2 reinfections are rare in children, especially younger children, and occurred mainly during the Delta wave in England. Reinfections were not associated with more severe disease or fatal outcomes in children. COVID-19 vaccination will provide further protection against primary infections and reinfections in children.

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Faculty Opinions recommendation of RBC transfusions in children requiring intensive care admission after traumatic injury*.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718472512.793498005 ◽

2014 ◽

Author(s):

Daniel Sloniewsky

Keyword(s):

Intensive Care ◽

Traumatic Injury ◽

Intensive Care Admission

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Risk Factors for Pediatric Intensive Care Admission among Asthmatic Children in Aseer, South-West Saudi Arabia

Indian Journal of Public Health Research & Development ◽

10.37506/v11/i2/2020/ijphrd/195069 ◽

2020 ◽

Vol 11 (2) ◽

pp. 1684

Author(s):

Mohammed Abdullah Alshehri ◽

Mohannad Mohammed Al gossadi Alsheri ◽

Reema Mohammed Al gossadi Alsheri ◽

Renad Mohammed Al gossadi Alsheri

Keyword(s):

Risk Factors ◽

Saudi Arabia ◽

Intensive Care ◽

Pediatric Intensive Care ◽

Intensive Care Admission ◽

Asthmatic Children ◽

South West

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Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards

10.1002/14651858.cd005529 ◽

2005 ◽

Cited By ~ 4

Author(s):

J McGaughey ◽

F Alderdice ◽

R Fowler ◽

A Kapila ◽

M Moutray

Keyword(s):

Intensive Care ◽

General Hospital ◽

Critically Ill ◽

Early Warning ◽

Early Warning Systems ◽

Adult Patients ◽

Warning Systems ◽

Intensive Care Admission ◽

Hospital Wards

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COVID-19 in obstetrics 2020: the experience at a New York City medical center

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0365 ◽

2020 ◽

Vol 48 (9) ◽

pp. 892-899

Author(s):

Ashlesha K. Dayal ◽

Armin S. Razavi ◽

Amir K. Jaffer ◽

Nishant Prasad ◽

Daniel W. Skupski

Keyword(s):

New York ◽

Medical Center ◽

Severe Disease ◽

Infection Rates ◽

Health Crisis ◽

The Public ◽

Public Health Crisis ◽

Asymptomatic Carriage ◽

Global Spread ◽

Workforce Flexibility

AbstractThe global spread of the SARS-CoV-2 virus during the early months of 2020 was rapid and exposed vulnerabilities in health systems throughout the world. Obstetric SARS-CoV-2 disease was discovered to be largely asymptomatic carriage but included a small rate of severe disease with rapid decompensation in otherwise healthy women. Higher rates of hospitalization, Intensive Care Unit (ICU) admission and intubation, along with higher infection rates in minority and disadvantaged populations have been documented across regions. The operational gymnastics that occurred daily during the Covid-19 emergency needed to be translated to the obstetrics realm, both inpatient and ambulatory. Resources for adaptation to the public health crisis included workforce flexibility, frequent communication of operational and protocol changes for evaluation and management, and application of innovative ideas to meet the demand.

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Correction to: Lung ultrasound to predict pediatric intensive care admission in infants with bronchiolitis (LUSBRO study)

European Journal of Pediatrics ◽

10.1007/s00431-021-04003-4 ◽

2021 ◽

Author(s):

Sara Bobillo-Perez ◽

Clara Sorribes ◽

Paula Gebellí ◽

Nuria Lledó ◽

Marta Castilla ◽

...

Keyword(s):

Intensive Care ◽

Lung Ultrasound ◽

Pediatric Intensive Care ◽

Intensive Care Admission

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Endogenously Produced SARS-CoV-2 Specific IgG Antibodies May Have a Limited Impact on Clearing Nasal Shedding of Virus during Primary Infection in Humans

Viruses ◽

10.3390/v13030516 ◽

2021 ◽

Vol 13 (3) ◽

pp. 516

Author(s):

Shuyi Yang ◽

Keith R. Jerome ◽

Alexander L. Greninger ◽

Joshua T. Schiffer ◽

Ashish Goyal

Keyword(s):

Production Rate ◽

Neutralizing Antibodies ◽

Primary Infection ◽

Natural Infection ◽

Viral Clearance ◽

Clinical Severity ◽

Igg Antibodies ◽

Igm Antibodies ◽

Specific Igg ◽

Specific Igg Antibodies

While SARS-CoV-2 specific neutralizing antibodies have been developed for therapeutic purposes, the specific viral triggers that drive the generation of SARS-CoV-2 specific IgG and IgM antibodies remain only partially characterized. Moreover, it is unknown whether endogenously derived antibodies drive viral clearance that might result in mitigation of clinical severity during natural infection. We developed a series of non-linear mathematical models to investigate whether SARS-CoV-2 viral and antibody kinetics are coupled or governed by separate processes. Patients with severe disease had a higher production rate of IgG but not IgM antibodies. Maximal levels of both isotypes were governed by their production rate rather than different saturation levels between people. Our results suggest that an exponential surge in IgG levels occurs approximately 5–10 days after symptom onset with no requirement for continual antigenic stimulation. SARS-CoV-2 specific IgG antibodies appear to have limited to no effect on viral dynamics but may enhance viral clearance late during primary infection resulting from the binding effect of antibody to virus, rather than neutralization. In conclusion, SARS-CoV-2 specific IgG antibodies may play only a limited role in clearing infection from the nasal passages despite providing long-term immunity against infection following vaccination or prior infection.

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Improved but still high short- and long-term mortality rates after myocardial infarction in patients with diabetes mellitus: a time-trend report from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admission

Heart ◽

10.1136/hrt.2006.097956 ◽

2006 ◽

Vol 93 (12) ◽

pp. 1577-1583 ◽

Cited By ~ 95

Author(s):

A. Norhammar ◽

J. Lindback ◽

L. Ryden ◽

L. Wallentin ◽

U. Stenestrand ◽

...

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Intensive Care ◽

Time Trend ◽

Mortality Rates ◽

Intensive Care Admission ◽

Patients With Diabetes ◽

Short And Long Term ◽

Long Term Mortality

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Early resuscitation orders in hospitalized oldest-old with COVID-19: A multicenter cohort study

Palliative Medicine ◽

10.1177/02692163211018342 ◽

2021 ◽

pp. 026921632110183

Author(s):

Ruth Piers ◽

Eva Van Braeckel ◽

Dominique Benoit ◽

Nele Van Den Noortgate

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Hospital Mortality ◽

Oldest Old ◽

Case Report Form ◽

Resuscitation Orders ◽

Intensive Care Admission ◽

Treatment Limitation ◽

Early Decision

Background: In particular older people are at risk of mortality due to corona virus disease 2019 (COVID-19). Advance care planning is essential to assist patient autonomy and prevent non-beneficial medical interventions. Aim: To describe early (taken within 72 h after hospital admission) resuscitation orders in oldest-old hospitalized with COVID-19. Setting/participants: A cohort of patients aged 80 years and older admitted to the acute hospital in March and April 2020 with COVID-19 were retrospectively recruited from 10 acute hospitals in Belgium. Recruitment was done through a network of geriatricians. Results: Overall, 766 octogenarians were admitted of whom 49 were excluded because no therapeutic relationship with the geriatrician and six because of incomplete case report form. Early decisions not to consider intensive care admission were taken in 474/711 (66.7%) patients. This subgroup was characterized by significantly higher age, higher number of comorbidities and higher frailty level. There was a significant association between the degree of the treatment limitation and the degree of premorbid frailty ( p < 0.001). Overall in-hospital mortality was 41.6% in patients with an early decision not to consider intensive care admission (67.1% in persons who developed respiratory failure vs 16.7% in patients without respiratory failure ( p < 0.001)). Of 104 patients without early decision not to consider intensive care admission but who developed respiratory failure, 59 were eventually not transferred to intensive care unit with in-hospital mortality of 25.4%; 45 were transferred to the intensive care unit with mortality of 64.4%. Conclusions: Geriatricians applied all levels of treatment in oldest-old hospitalized with COVID-19. Early decisions not to consider intensive care admission were taken in two thirds of the cohort of whom more than 50% survived to hospital discharge by means of conservative treatment.

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