COVID-19 and Children: From an Epidemiological Perspective

Yıl 2020, COVID-19, 1 - 8, 24.07.2020

Banu Çakır

https://doi.org/10.12956/tchd.766593

Öz

COVID-19, caused by SARS-CoV-2, has rapidly progressed globally started from early days of 2020 and was disseminated to 187 countries and territories by April. As of May 3, 2020, COVID-19 has led to a total of 3,507,442 cases and 245,241 related deaths, globally. Turkey, was successful to delay the first COVID-19 case until March 10, yet, case numbers increased fast, reaching to the top 7th rank in the list of countries with the highest case numbers. It is fortunate that the case-fatality ratio was relatively low, with a somewhat stable course around 2.5%. Somewhat stable course of new case numbers, with an apparent decrease through the end of April led to onset of normalization attempts in the country. The future course of the pandemic will be mainly determined by compliance of the general public with personal hygiene, mask use and social distancing.
Globally, COVID-19-related morbidity and mortality rates are lower among children than in adults. Underlying mechanisms for this difference has not been clarified, yet, may be linked to lower exposure rates among children, their immune response may be different and/or higher rates of asymptomatic cases may have lower admissions/testing among children. However, it is important to emphasize that children are prone to SARS-CoV-2, too and all relevant preventions should be ensured. This issue should also be considered in evaluating potential risk of infection transfer from asymptomatic youngsters to the elderly and/or to those with chronic diseases.
Data on COVID-19-related case numbers and deaths have not been published so far for children. This requires urgent consideration for related reporting and novel research activities on health burden of COVID-19 on Turkish children. Success in combating the COVID-19 pandemic requires concurrent efforts for clinical management of patients together with epidemiological studies of available national data and establishment of specific research to provide evidence for national and international preventive interventions. Learnings from this pandemic will provide direct evidence for management of future pandemics, and all related parties should be motivated to prepare detailed reporting of ongoing efforts and their outputs.

Anahtar Kelimeler

COVID-19,, Child health,, Epidemiology,, Prevention,, Morbidity,, Transmission

COVID-19 ve Çocukların Etkilenimi: Epidemiyolojik Açıdan Değerlendirmeler

Öz

SARS-CoV-2 virüsünün neden olduğu COVID-19 hastalığı, 2020 yılının ilk günlerinden itibaren hızla yayılarak, Nisan ayı sonunda 187 ülke ve bölgeye yayılım göstermiş; 3 Mayıs 2020 itibarı ile dünyada 3,507,442 vaka ve ilişkili 245,241 ölüme neden olmuştur. Türkiye, ilk vakanın görüldüğü 10 Mart 2020 tarihinden sonra vaka sayılarındaki hızla artma sonucu 50 gün içinde vaka sayısı en yüksek 7. ülke konumuna yükselmiş, ancak bu arada ölüm sayılarını göreceli olarak aşağı sınırlarda (%2.5 civarında) tutmayı başarmıştır. Nisan ayının sonuna doğru vaka sayılarında düzleşme ve aşağı doğru gidiş ile gündelik yaşamdaki kısıtlamaların azaltılması konusundaki çalışmalar başlamıştır. Toplumun kişisel hijyen, sosyal mesafenin korunması ve maske kullanımına uyum düzeyine bağlı olarak salgının ülkemizdeki süreci değişiklik gösterebilecektir.
Dünya genelinde çocukluk çağında COVID-19 vaka ve ölüm sayıları, yetişkinlere kıyasla daha düşüktür. Bunun altında yatan nedenler çocukların enfeksiyonla daha az karşılaşmaları, bağışıklık sistemi cevaplarının yetişkinlerden farklı olması ve/veya asemptomatik olmaları nedeniyle daha az hastane başvuru/test yapılması kaynaklı olabileceği konusunda yayınlar olsa da sonuçları henüz kesinlik kazanmamıştır. Öte yandan, COVID-19 pandemisinin çocukların yaşamı için de bir risk olduğu kesindir ve bu konuda yeterli önlemler alınmalıdır. Bu paralelde asemptomatik ve sağlıklı görünümdeki çocukların enfeksiyonu taşıma konusundaki tehlike hem topluma yönelik kısıtlamalar planlanırken hem de özellikle yaşlı ve kronik hastalığı olan kişilerin bireysel korunmasında dikkate alınmalıdır.
Türkiye’deki vaka sayıları içinde çocuklara ait yüzdeler ve ilişkili risk faktörleri konusunda yayınlanmış bir bilgi henüz yoktur. Bu konuda yapılacak çalışmalara ivedikle ihtiyaç duyulmaktadır. Pandemi dahilinde bir yandan salgına bağlı hastalık yükü ile başa çıkarken, bir yandan da verilerin detaylı inceleme ve analizlerinin yapılması, literatüre katkı sağlayacak çalışmalar ile ulusal ve uluslararası mücadele planlarına katkı sağlanması değerlidir; bu pandemide öğrenilenlerin detaylı olarak yapılması bundan sonraki pandemiler için kanıta dayalı hazırlık sürecine doğrudan katkı sağlayacaktır ve desteklenmelidir.

Anahtar Kelimeler

Bulaş,, COVID-19,, Çocuk sağlığı,, Epidemiyoloji,, Korunma

Kaynakça

• 1. COVID-19 Map. Johns Hopkins Coronavirus Resource Center. Erişim tarihi: 7 Mayıs 2020 Available from: https://coronavirus.jhu.edu/map.html.
• 2. COVID-19 Pandemic. Worldometer coronavirus section. Erişim tarihi: 7 Mayıs 2020 Available from:https://www.worldometers.info/coronavirus/
• 3. Weiss SR, Navas-Martin S. Coronavirus pathogenesis and the emerging pathogen severe acute respiratory syndrome coronavirus. Microbiol Mol Biol Rev 2005; 69:635.
• 4. World Health Organization. Director-General's remarks at the media briefing on 2019-nCoV on 11 February 2020. Erişim tarihi: 7 Mayıs 2020 Available from:https://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020
• 5. World Health Organization (WHO). WHO Director-General's opening remarks at the media briefing on COVID-19 -- 11 March 2020. Erişim tarihi: 7 Mayıs 2020 Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
• 6. What is pandemics? WHO. Erişim tarihi: 7 Mayıs 2020 Available from:https://www.who.int/csr/disease/swineflu/frequently_asked_questions/pandemic/en/
• 7. Liu SL, Saif LJ, Weiss SR, Su L. No credible evidence supporting claims of the laboratory engineering of SARS_CoV-2. Emerg Microbes Infect 2020;9(1):505-507
• 8. Centers for Disease Control and Prevention. 2019 Novel coronavirus, Wuhan, China. Information for Healthcare Professionals. Erişim tarihi: 7 Mayıs 2020 Available from: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html
• 9. World Health Organization. Novel Coronavirus (2019-nCoV) technical guidance. Erişim tarihi: 7 Mayıs 2020 Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance
• 10. Amanat F, Krammer F. SARS_CoV-2 Vaccines: Status report. Immunity. 2020. doi: 10.1016/j.immuni.2020.03.007.
• 11. Kissler SM, Tedijanto C, Goldstein E, Grad YH, Lipsitch. Projecting the transmission dynamic of SARS-CoV-2 through the postpandemic period. Science. 2020:eeabb5793 doi: 10.1126/science.abb5793
• 12. Rothman KJ. Greenland S. Modern epidemiology. Second ed. Lippincott-Raven Publishers. 1998. Philadelphia, PA. ISBN: 0-316-75780-2
• 13. LitCovid. A curated literature hub for tracking up-to-date scientific information about the 2019 novel Coronavirus. Erişim tarihi: 7 Mayıs 2020 Available from: https://www.ncbi.nlm.nih.gov/research/coronavirus/publication/32339231.
• 14. Nie X, Fan L, Mu G, Tan Q, Wang M, Xie Y et al. epidemiological characteristics and incubation period of 7,015 confirmed cases with Coronavirus Disease 2019 outside Hubei province in China. 2020. J Infectious Dis. PMID: 32339231 PMC: 7197553.
• 15. Centers for Disease Control and Prevention. 2019 Novel coronavirus, Wuhan, China. Information for Healthcare Professionals. Erişim tarihi: 7 Mayıs 2020 Available from:https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html
• 16. World Health Organization. Novel Coronavirus (2019-nCoV) technical guidance. Erişim tarihi: 7 Mayıs 2020 Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance
• 17. Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID-19 Among Children in China. Pediatrics 2020. e20200702. doi: 10.1542/peds.2020-0702.
• 18. Lu X, Zhang L, Du H, et al. SARS-CoV-2 Infection in Children. N Engl J Med 2020; 382:1663-1665 doi: 10.1056/NEJMc2005073
• 19. Wei M, Yuan J, Liu Y, et al. Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China. JAMA 2020 323;13:1313-1314. doi:10.1001/jama.2020.2131
• 20. CDC COVID-19 Response Team. Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:422.
• 21. Zimmermann P, Curtis N. Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children. Pediatr Infect Dis J 2020;39(5):355-368. doi: 10.1097/INF.0000000000002660.
• 22. Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr 2020;109(6):1088-1095. doi: 10.1111/apa.15270.
• 23. NYC Health. Coronavirus Disease 2019 (COVID-19) daily data summary. Erişim tarihi: 8 Mayıs 2020. Available from: https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-daily-data-summary.pdf
• 24. Disease background of COVID-19. European Centers for Disease Control and Prevention. Erişim tarihi: 8 Mayıs 2020. Available from: https://www.ecdc.europa.eu/en/2019-ncov-background-disease.
• 25. Pearce N. Classification of epidemiological study designs. Int J Epidemiol 2012;41(2):393-397. https://doi.org/10.1093/ije/dys049
• 26. The European Surveillance System (TESSy). European Centers for Disease Control and Prevention. Erişim tarihi: 8 Mayıs 2020. Available from: https://www.ecdc.europa.eu/en/publications-data/european-surveillance-system-tessy
• 27. Balasubramanian S, Ras NM, Goenka A, Roderik M, Ramanan AV. Coronavirus Disease (COVID-19) in Children - What We Know So Far and What We Do Not?. 2020. Indian Pediatr PMID:32273490
• 28. COVID-NET. A weekly summary of US COVID-19 hospitalization data. Erişim tarihi: 8 Mayıs 2020. Available from: https://gis.cdc.gov/grasp/COVIDNet/COVID19_5.html (Accessed on May 01, 2020).
• 29. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; 382:1708-1720. doi: 10.1056/NEJMoa2002032
• 30. Myers LC, Parodi SM, Escobar GJ, Liu VX. Characteristics of Hospitalized Adults With COVID-19 in an Integrated Health Care System in California. JAMA 2020. doi:10.1001/jama.2020.7202
• 31. Hu Z, Song C, Xu C, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci 2020; 63:706.-711. doi: 10.1007/s11427-020-1661-4
• 32. Wang Y, Liu Y, Liu L, et al. Clinical outcome of 55 asymptomatic cases at the time of hospital admission infected with SARS-Coronavirus-2 in Shenzhen, China. J Infect Dis 2020. doi: 10.1093/infdis/jiaa119.
• 33. Denina M, Scolfaro C, Silvestro E, et al. Lung ultrasound in children with COVID-19. Pediatrics 2020 (pre-publication release). Erişim tarihi: 7 Mayıs 2020. Available from: https://pediatrics.aappublications.org/content/early/2020/04/17/peds.2020-1157
• 34. Cao Q, Chen YC, Chen CL, Chiu CH. SARS-CoV-2 infection in children: Transmission dynamics and clinical characteristics. J Formos Med Assoc 2020; 119(3):670-673. doi: 10.1016/j.jfm
• 35. ECDC rapid risk assessment. Coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK – seventh update 25 March 2020 Erişim tarihi: 7 Mayıs 2020. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/RRA-seventh-update-Outbreak-of-coronavirus-disease-COVID-19.pdf
• 36. Lu X, X Yu, Dui H, Wong GW-K. SARS‐CoV‐2 infection in children – Understanding the immune responses and controlling the pandemic https://doi.org/10.1111/pai.13267
• 37. Chiotos K, Hayes M, Kimberlin DE, et al. Multicenter initial guidance on use of antivirals for children with COVID-19/SARS-CoV-2. J Pediatric Infect Dis Soc 2020. Erişim tarihi: 7 Mayıs 2020. Available from: https://academic.oup.com/jpids/article/doi/10.1093/jpids/piaa045/5823622?searchresult=1
• 38. United States Centers for Disease Control and Prevention. Coronavirus disease (COVID-19). People who are at higher risk for severe illness. Erişim tarihi: 7 mayıs 2020 Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html (Accessed on April 08, 2020).
• 39. CDC COVID-19 Response Team. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 - United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:382.
• 40. Wadhera RK, Wadhera P, Gaba P, et al. Variation in COVID-19 Hospitalizations and Deaths Across New York City Boroughs. JAMA 2020.
• 41. She J, Liu L, Liu W. COVID-19 epidemic. Disease characteristics in children. J Med Virol 2020. doi: 10.1002/jmv.25807
• 42. United States National Institutes of Health Coronavirus disease 2019 (COVID-19) treatment guidelines. Erişim tarihi: 7 Mayıs 2020. Available from: https://www.covid19treatmentguidelines.nih.gov/
• 43. Chiotos K, Hayes M, Kimberlin DE, et al. Multicenter initial guidance on use of antivirals for children with COVID-19/SARS-CoV-2. J Pediatric Infect Dis Soc 2020. DOI: 10.1093/jpids/piaa045/5823622
• 44. Jones VG, Mills M, Suarez D, Hogan CA, Debra Y, Bradley Segal J et al. COVID-19 and Kawasaki disease: novel virus and novel case. Hosp Pediatr 2020.PMID. 32265235.
• 45. Kelvin AA, Halperin S. COVID-19 in children: the link in the transmission chain. Lancet Infectious Diseases doi:10.1016/S1473-3099(20)30236-X
• 46. Castagnoli R, Votto M, Licari A, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review. JAMA Pediatr 2020. doi: 10.1001/jamapediatrics.2020.1467.
• 47. Paret M, Lighter J, Pellett Madan R, et al. SARS-CoV-2 infection (COVID-19) in febrile infants without respiratory distress. Clin Infect Dis 2020. doi: 10.1093/cid/ciaa452.
• 48. Qiu H, Wu J, Hong L, et al. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis 2020. doi:10.1016/S1473-3099(20)20198-5
• 49. Parri N, Lenge M, Buonsenso D, Coronavirus Infection in PediatricEmergency Departments (CONFIDENCE) Research Group. Children with Covid-19 in Pediatric Emergency Departments in Italy. N Engl J Med 2020. doi: 10.1056/NEJMc2007617.
• 50. United States Centers for Disease Control and Prevention. Symptoms of coronavirus. Erişim tarihi: 7 Mayıs 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
• 51. Asadi L, Tabatabaei RS, Safinejad H, Mohammadi M. New Corona Virus (COVID-19) management in pregnancy and childbirth. Archieves of Clinical Infectious Diseases. 2020 Doi: 10.5812/archcid.102938
• 52. Coronavirus disease (COVID-19) and breastfeeding. Centers for Disease Control and Prevention. 2020. Erişim tarihi: 7 Mayıs 2020. Available from: https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/covid-19-and-breastfeeding.html
• 53. T.C. Sağlık Bakanlığı COVID-19 web sayfası Erişim tarihi: 7 Mayıs 2020. Available from: https://covid19.saglik.gov.tr
• 54. Mental health considerations for children quarantined because of COVID-19. 2020. http://doi.org/10.1016/S2352-4642(29)30096-1.