Incidence and Severity of COVID-19 in the Pediatric Population
Tina Tan, MD, and Sean O’Leary, MD, discuss the evolving understanding regarding the severity and transmissibility of COVID-19 in the pediatric population.
Tina Tan, MD: Hello and thank you for joining this Peers & Perspectives® presentation entitled, “Advancing Pediatric Care With the Latest Updates on COVID-19 Vaccines for Children.” I am Dr Tina Tan, a professor of pediatrics at the Feinberg School of Medicine at Northwestern University, and a pediatric infectious disease physician at Ann & Robert H. Lurie Children’s Hospital of Chicago. Joining me today is Dr Sean O’Leary, who is a professor of pediatrics and infectious diseases at the University of Colorado School of Medicine. Welcome, Sean.
We are going to focus on the latest developments in COVID-19 vaccines for the pediatric population, including recommended vaccination schedules for children of varying age groups. We will also discuss strategies to effectively educate parents and caregivers on the benefits of the COVID-19 vaccination in children. Thank you so much for joining us, and let’s begin.
Sean, with the COVID-19 pandemic reaching the 3-year mark, we know from data that the CDC has put out that over 15.5 million children have come down with COVID-19 infections. What new insights have we gained regarding the incidence and severity of COVID-19 among children?
Sean O’Leary, MD: That is a great and important question. It has been a journey, hasn’t it? Early in the pandemic, we had this concept of knowing that the disease was severe in the elderly and people with chronic medical conditions. There was this impression very early in the pandemic that kids just do not get sick.
Tina Tan, MD: Right.
Sean O’Leary, MD: It very quickly became clear to all of us on the front lines that it was absolutely not true. We had plenty of sick kids in the hospital, and unfortunately, quite a few deaths, even early on. Then of course, we discovered MIS-C [multisystem inflammatory syndrome in children] as well. Through the pandemic, when you look at the numbers in terms of overall deaths, etc, the number of deaths in children pales in comparison to the overall number of deaths.
Tina Tan, MD: Right.
Sean O’Leary, MD: I think that has been something we’ve had to fight against through the pandemic, this concept that it is a benign illness in children and kids do not get sick. I think we have learned a lot since then. The way I like to put it is, while it is true that it is much more severe in the elderly, we know it is not a benign condition in children and that lots of kids do get very sick.
This brings us to where we are now in terms of how we are thinking about COVID-19 in kids. As you pointed out, there have been a lot of kids who have already been infected. We also have a lot of kids who have been vaccinated. I think what we can see is that we have learned that, yes, the infection does provide some protection, but we also have seen that vaccination on top of infection provides additional protection in the kids who get COVID-19. I think one of the bigger barriers for a lot of families is this concept that if a child has already had it once, twice, or three times, parents ask why their children should still get vaccinated. What we have seen across populations, not just in kids, but in adults as well, is that this so-called hybrid immunity does provide the best protection. That is point No. 1.
In terms of how much risk there is to a child now, as of today, compared to earlier in the pandemic, I think we are still learning about that. There are some uncertainties out there in terms of, do kids need a booster every single year? We can talk more about that. There are still some areas of uncertainty out there that we are collecting data about.
Tina Tan, MD: I completely agree, especially in the immunocompromised population. Some of those kids have gotten so sick, and I think people still were under the impression that kids are not going to get as sick. But there are certain groups of kids who do get very ill with this particular virus. What trends do we see with the emergence of all these subvariants of COVID-19, in terms of their virulence and transmissibility and how they affect children?
Sean O’Leary, MD: This is also something that has been, purely from a scientific perspective, fascinating to watch in these last 3 years, specifically the emergence of these different variants. I remember thinking around the time of Delta, and probably saying to several people, it is hard to imagine anything more contagious than Delta with this virus. Lo and behold, along comes Omicron. With the subvariants of Omicron that have continued to emerge, we are seeing increases in transmissibility.
I do not know if we have necessarily seen any increases in virulence. I would not call myself a card-carrying virologist, but in general, the goal of a virus is to infect more people, not necessarily to become more virulent or severe. That is what we have been seeing over these last years. The variants that are circulating right now, the subvariants of Omicron, are essentially the second most contagious virus that we have known to humankind, behind measles. They surpassed a lot of the other things we see out there that are highly transmissible. These are easy to catch, for sure.
Tina Tan, MD: Right. Very interestingly, there was a study that came out of Hong Kong that showed that BA.2, which is an Omicron variant, caused more severe disease in children than adults, which I found fascinating. Though, that was only in the Hong Kong area. They have not really looked at that in other areas of the world to see whether that holds out.
Sean O’Leary, MD: Right. I think we will have to wait and see because we have not seen necessarily those data in the United States.
Tina Tan, MD: I agree.
Sean O’Leary, MD: We still are having kids hospitalized for COVID-19, for sure. And I will say for COVID-19, not just with COVID-19. I know people bring that up a lot, “Oh, it was just incidentally picked up.” The majority of kids hospitalized who have COVID-19 are actually being hospitalized because they have COVID-19 and not for some incidental reason.
Tina Tan, MD: Right.
Sean O’Leary, MD: Sure, that is happening, but it is not the majority. I think the jury is still out in other parts of the world.
Tina Tan, MD: It is very interesting, these new Omicron subvariants, the XBB.1.5 and the BQ.1.1. Talk about transmissibility, people get sick within a couple of days of being exposed to somebody with these particular variants.
Sean O’Leary, MD: Yes.
Tina Tan, MD: It is very interesting, the information coming out that maybe these subvariants are a bit more immune evasive than the other COVID-19 subvariants that we’ve seen.
Sean O’Leary, MD: Yes. That makes sense, that is what a virus wants to do.
Tina Tan, MD: Right.
Transcript edited for clarity
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