Thursday, May 19

How sick are children and adolescents of covid-19? And should they be vaccinated?

  • Ketil Størdal

    Pediatrician, OUS and professor, University of Oslo

  • German Tapia

    Senior researcher, FHI

  • Karin Magnusson

    Researcher, FHI

  • Margrethe Greve-Isdahl

    Chief Physician, FHI

Widespread infection of covid-19 in the autumn of 2021 has not given rise to a wave of hospitalized children and young people, the post authors write.

Norwegian data show that the proportion of young people admitted with covid-19 has fallen for each wave of infection.

The knowledge is Aftenposten’s commitment to research and science, where researchers and professionals from all over the country contribute articles.

The pandemic hits skewed. That the infection pressure is greatest in cities in southern Norway is old news.

For children and young people, country background outside the Nordic countries, overcrowding, low family income and having a large family are all independent risk factors for becoming infected.

With all these factors combined, the probability of becoming infected is ten times higher than without such risk factors.

Social inequality challenges young people’s health, especially in a pandemic. To answer whether such risk factors also result in serious illness, we can analyze data from Norwegian health registries, which is a unique source of knowledge.

One in a thousand is hospitalized

Barely two out of a thousand children and young people who have been diagnosed with covid-19 have become so ill that they have had to be hospitalized. If testing has captured 50–60 per cent of all infected people, as the National Institute of Public Health (NIPH) assumes, the actual proportion admitted is around one in a thousand.

The lowest probability of hospitalization is in the age group 5–11 years. Then the registry studies show that once you have contracted the virus, chronic illness is what increases the likelihood of being admitted: One in four inpatients has a chronic illness.

But also 99 percent of chronically ill children with covid-19 go through the infection without hospitalization. The hospital stays are short, with a median length of stay of one day for Norwegian children and young people. This indicates that most people who are admitted to hospital are not seriously ill.

Complications and after-effects

Multiorgan Inflammation Syndrome In Children (MIS-C) is a complication that can occur a few weeks after infection. The condition is due to an overactivation of the immune system which causes fever for several days and affects several organs.

Because blood pressure and circulation can be affected, about one in three children with this condition has needed intensive care. The condition is rare: Among 3,000-4,000 infected children, only one will be affected by MIS-C.

Effective treatment exists, and international data indicate that one recovers completely. In Norway, half of the 45 young people with MIS-C have been discharged after five days in hospital.

How is it going in the long run?

In a study recently published in the British Medical Journal, we have studied how often children and adolescents who have had covid-19 without hospitalization use health services after compared to before they became infected.

We find that the general practitioner contact is more frequent in the first four weeks after the infection. Use of medical services is back to basics after four weeks for young people over 16 years and after 12 weeks for children between 5 and 15 years.

Children from one to five years had increased contact with the general practitioner also for three to six months after the infection, but the increase is only 13 percent.

Put another way: Among a thousand children, 30 have doctor visits in a normal week. Among a thousand children who had had covid-19, there were 34 doctor visits a week.

We find that the general practitioner contact is more frequent in the first four weeks after the infection

Diagnostic codes for respiratory symptoms dominated at general practitioner visits. This means that you may have been bothered by a cough or tightness in the breast even after the infection. This is also known from other respiratory infections in children, especially in the youngest.

There were no signs of serious illness after covid-19 in the long term: Contact with specialist health services was the same before and after infection for the age groups under 20 years.

Do different virus variants make any difference?

Early in the outbreaks of the alpha and delta variants, there was great concern that new variants could affect children and young people more severely than the Wuhan virus.

Norwegian data show that the proportion of young people admitted with covid-19 has fallen for each wave of infection.

Part of the explanation is that the dark numbers for infection were higher at the beginning of the pandemic. Concerns about an unknown virus probably also contributed to several admissions in the first wave of infection.

One source of error that has given unfounded fear is that everyone is examined for covid-19 when they are admitted to hospital

Nor does it appear for the omicron variant that young people become more ill, based on data from other countries.

One source of error that has given unfounded fear is that everyone is examined for covid-19 when they are admitted to hospital. Surveillance data do not distinguish children who are admitted due to coronary heart disease from those who are diagnosed with the virus when they are admitted with broken bones and chronic diseases.

When corrected, the omicron appears to be milder than previous versions of the virus.

Maybe old acquaintances are worse for children?

Widespread infection of covid-19 in the autumn of 2021 has not resulted in a wave of hospitalized children and young people. On the contrary, it was an old acquaintance who hit Norway hard: During a few days in October, more people were admitted with RS virus than covid-19 has managed in almost two years.

Every winter, the pediatric wards deal with outbreaks of respiratory infections such as RS virus and influenza, followed by a large influx of sick young children. The unusual thing about this year’s season is that the peak of infection came in the autumn, and that so many became ill within a few weeks.

More than 2,500 children were admitted with RS virus in the autumn of 2021. This can be explained by “immunity debt”, where many more children than normal lacked immunity to common viruses, and which made many exposed to disease at the same time.

Thus, strict infection control measures may appear to be beneficial in the short term, but lead to waves of infection afterwards because children are not continuously exposed to infections they will encounter sooner or later.

What does Norwegian data mean for the vaccination councils?

Norway is privileged with good health registries that can be linked together to monitor the pandemic. We also gain knowledge from other studies that contribute to the assessment of vaccination of children. Good knowledge of the vaccines’ effects and side effects from Norwegian conditions is important in order to be able to fine-tune the vaccination councils and maintain confidence in professional councils.

The most important thing for recommending new vaccines to children is the benefit to the individual. When the risk of serious illness is small, side effects of the vaccine must be minimal.

In Norway, we have considered that the child’s benefit from the vaccine should outweigh society’s need for children to be vaccinated

In Norway, we have considered that the child’s benefit from the vaccine should outweigh society’s need for children to be vaccinated. This is particularly relevant with omicron, where the vaccines appear to provide poorer protection against the spread of infection.

The vaccines can protect against disease, but if the risk of serious illness is small, natural infection can be beneficial in the long run.

Chronic illness in the child or someone close to them may speak in favor of having the child vaccinated. Healthy children have little to fear if they become infected.


Reference-www.aftenposten.no

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