Paediatric COVID-19 in South, Southeast Asia: Peculiarities of the pandemic in the region

In South and Southeast Asia, children younger than 12 months of age, with comorbidities, or who present with coughs are more likely to develop severe episodes of the novel coronavirus disease (COVID-19), according to a recent study.

“This study aims to describe and compare the clinical epidemiology of paediatric COVID-19 infection in Southeast Asia (Singapore, Malaysia, and Indonesia), South Asia (India and Pakistan), Japan, and China,” the researchers said. “We also identify risk factors for severe COVID-19 among children in the region.”

Data drawn from eight hospitals across seven countries yielded a cumulative sample of 849 children suspected of having COVID-19; 260 (30.6 percent) were eventually laboratory-confirmed. The primary outcome was disease severity, as defined by the World Health Organization: mild, moderate, severe, or critical. Other endpoints included the need for respiratory support, hospital mortality, and organ dysfunction.

Though led by researchers from Singapore, the team was comprised of professionals from all over the region, including Malaysia, Pakistan, Indonesia, Japan, China, and India.

Outcome reports were available for 256 of 260 participants. Severe/critical COVID-19 occurred in 26 patients, with a corresponding prevalence of 10.2 percent. Compared with older children, infants younger than 12 months of age were significantly more likely to develop severe/critical disease (30.8 percent vs 7.8 percent; p=0.002). [Am J Trop Med Hyg 2021;doi:10.4269/ajtmh.21-0299]

Similarly, severe/critical COVID-19 occurred significantly more frequently in children with comorbidities (76.9 percent vs 12.6 percent; p<0.001).

In terms of secondary outcomes, the researchers documented 12 patients who developed pulmonary organ dysfunction, half of whom needed invasive respiratory support; five were also deemed to have paediatric acute respiratory distress syndrome. On the other hand, five children required noninvasive respiratory support.

Overall, six kids died, yielding a mortality rate of 2.3 percent. All deaths occurred in South Asian centres (Pakistan: n=5; India: n=1).

Multivariable logistic regression analysis confirmed that being an infant was a strong risk factor for severe/critical COVID-19, increasing its odds by nearly five times (adjusted odds ratio [aOR], 4.65, 95 percent confidence interval [CI], 1.90–11.38).

Other significant and independent predictors were the presence of comorbidities (aOR, 8.08, 95 percent CI, 1.79–36.41) and cough on presentation (aOR, 2.41, 95 percent CI, 1.32–4.39).

“The rate of severe/critical COVID-19 disease was 0.8 percent to 5.3 percent in Singapore, Malaysia, Japan, and China compared with 16 percent in India, 37.5 percent in Indonesia, and 78 percent in Pakistan,” the researchers said. “The higher rates in India, Indonesia, and Pakistan were possibly a manifestation of testing and hospitalization prioritization for children with more severe clinical manifestation.”

Though such differences in testing and healthcare could explain the variances described in the study, “differences in COVID-19 infection rates and outcomes could also be present as a result of genetic factors, cultural practices, environmental exposures, or combinations of biological and social factors,” they explained.

“The results of our study indicate that, even within the ‘Asian’ racial group, these differences may exist, and in-depth studies to disentangle the role of each contributing factor is vital,” the researchers added.