Is cardiorespiratory disease associated with increased susceptibility of SARS-CoV-2 in children?

Abstract

BACKGROUND\nThere are limited data in pediatric populations evaluating whether chronic cardiorespiratory conditions are associated with increased risk of coronavirus disease 2019 (COVID-19). We aimed to compare the rates of chronic cardiac and respiratory disease in children testing positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2[+]) compared with those testing negative (SARS-CoV-2[-]) at our institution.\n\n\nMETHOD\nProspective cohort with nested case-control study of all children tested by polymerase chain reaction (PCR) for SARS-CoV-2 by nasopharyngeal/oropharyngeal sampling between March and October 2020. Children were identified prospectively via laboratory notification with age and sex-matching of SARS-CoV-2[+] to SARS-CoV-2[-] (1:2). Clinical data were extracted from the electronic medical record.\n\n\nRESULTS\nIn total, 179 SARS-CoV-2[+] children (44% females, median age 3.5\u2009years, range: 0.1-19.0\u2009years) were matched to 391 SARS-CoV-2[-] children (42% female, median age 3.7\u2009years, range: 0.1-18.3\u2009years). The commonest comorbidities showed similar frequencies in the SARS-CoV-2[+] and [-] groups: asthma (n\u2009=\u20099, 5% vs. n\u2009=\u200917, 4.4%, p\u2009=\u20090.71), congenital heart disease (n\u2009=\u20096, 3.4% vs. n\u2009=\u20097, 1.8%, p\u2009=\u20090.25) and obstructive sleep apnoea (n\u2009=\u20094, 2.2% vs. n\u2009=\u200910, 2.3%, p\u2009=\u20090.82). In the SARS-CoV-2[+] group, the prevalence of symptomatic disease was similar among children with and without cardiorespiratory comorbidities (n\u2009=\u200912, 75% vs. n\u2009=\u2009103, 57%, p\u2009=\u20090.35). A high proportion of children hospitalized with SARS-CoV-2 infection had cardiac comorbidities (23.8%).\n\n\nCONCLUSIONS\nIn this single site data set, rates of pre-existing cardiorespiratory disease were similar in SARS-CoV-2[+] and SARS-CoV-2[-] children. Rates of symptomatic infection were similar between children with and without cardiorespiratory comorbidity. High rates of comorbid cardiac disease were observed among hospitalized children with COVID-19 warranting further research to inform vaccine prioritization.