Epidemiology of SARS-CoV-2 infection and SARS-CoV-2 positive hospital admissions among children in South Africa

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Authors

Kufa, Tendesayi
Jassat, Waasila
Cohen, Cheryl
Tempia, Stefano
Masha, Maureen
Wolter, Nicole
Walaza, Sibongile
Gottburg, Anne
Govender, Nelesh P.
Hunt, Gillian

Journal Title

Journal ISSN

Volume Title

Publisher

Wiley Open Access

Abstract

INTRODUCTION : We describe epidemiology and outcomes of confirmed SARS-CoV-2 infection and positive admissions among children <18 years in South Africa, an upper-middle income setting with high inequality. METHODS : Laboratory and hospital COVID-19 surveillance data, 28 January - 19 September 2020 was used. Testing rates were calculated as number of tested for SARS-CoV-2 divided by population at risk; test positivity rates were calculated as positive tests divided by total number of tests. In-hospital case fatality ratio (CFR) was calculated based on hospitalized positive admissions with outcome data who died in-hospital and whose death was judged SARS-CoV-2 related by attending physician. FINDINGS : 315 570 children aged <18 years were tested for SARS-CoV-2; representing 8.9% of all 3 548 738 tests and 1.6% of all children in the country. Of children tested, 46 137 (14.6%) were positive. Children made up 2.9% (n = 2007) of all SARS-CoV-2 positive admissions to sentinel hospitals. Among children, 47 died (2.6% case-fatality). In-hospital deaths were associated with male sex [adjusted odds ratio (aOR) 2.18 (95% confidence intervals [CI] 1.08–4.40)] vs female; age <1 year [aOR 4.11 (95% CI 1.08–15.54)], age 10–14 years [aOR 4.20 (95% CI1.07–16.44)], age 15–17 years [aOR 4.86 (95% 1.28–18.51)] vs age 1–4 years; admission to a public hospital [aOR 5.07(95% 2.01–12.76)] vs private hospital and ≥1 underlying conditions [aOR 12.09 (95% CI 4.19–34.89)] vs none. CONCLUSIONS : Children with underlying conditions were at greater risk of severe SARS-CoV-2 outcomes. Children > 10 years, those in certain provinces and those with underlying conditions should be considered for increased testing and vaccination.

Description

SUPPORTING INFORMATION : TABLE S1: Description of SARS-CoV-2 rRT-PCR positive children <18 years in South Africa, 1 March 2020–19 September 2020 (N = 45 609). TABLE S2: Description of SARS-CoV-2 rRT-PCR positive hospital admissions among children <18 years in South Africa by province, 1 March 2020–19 September 2020 (N = 2007). TABLE S3: Distribution of non-missing variables among children with complete follow up and included in multivariable model (N = 1817). TABLE S4: Factors associated with in-hospital death among SARS-CoV-2 rRT-PCR positive admissions in children <18 years, South Africa, 1 March 2020–19 September 2020. FIGURE S1: Number of SARS-CoV-2 rRT-PCR tests*, percent positive tests and associated- hospital admissions among children <18 years by province and epidemiology week, South Africa, 1 March 2020–19 September 2020.

Keywords

Adolescents, Children, COVID-19 pandemic, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Incidence, Mortality, Testing rate

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Citation

Kufa, T., Jassat, W., Cohen, C., et al. Epidemiology of SARS-CoV-2 infection and SARS-CoV-2 positive hospital admissions among children in South Africa. Influenza and Other Respiratory Viruses 2022;16(1):34-47. doi: 10.1111/irv.12916.