A Retrospective Study of 186 Patients Reveals the Strongest Immunity in the Early Two Years of Life Against Coronavirus Disease 2019
36 Pages Posted: 9 Apr 2020More...
Background: The morbility and mortality of patients with coronavirus disease 2019 (COVID-19) is associated with age. However, it remains mysterious what factors influence the immunity to the infection and determine the disease outcome.
Methods: Here we have comprehensively investigated the clinical features of 186 cases including 25 pediatric patients under ten years old and analyzed the factors that influence their disease outcomes.
Findings: Although disease severity of COVID-19 was associated with age, the infection was found even in children regardless of age. In contrast to adults, pediatric mainly had mild symptoms and did not display fatigue, myalgia, chill, shortness-of-breath, anorexia, and headache. None of them required intensive care even though 84.0% had patchy shadows on radiographical imaging. The majority had only a few laboratory abnormalities, such as high-sensitivity C-reactive protein and serum amyloid A. Patients under two years old had a shorter time to become COVID-19 PCR-negative than the older patients, with a significant increase in lymphocyte counts after recovery. Furthermore, none of the younger children had co-infection of mycoplasma pneumonia. The slow recovery of the older children linked to the co-infection of mycoplasma pneumonia. No particular treatment had shown significantly to shorten the duration of illness.
Interpretation: All the age groups of children under ten years old were susceptible to SARS-CoV-2 infection. However, children under two years old had stronger immunity to the virus and recovered faster than the older patients. Co-infection of mycoplasma pneumonia may affect the duration of illness. In addition to antiviral treatment, antibiotics should be used to treat the older pediatric patients for bacterial co-infections.
Funding Statement: This study was supported by the following fundings: the Hubei Provincial Department of Science and Technology Innovation Group Programme (2019CFA034), the Foundation for Free Exploration of Hubei University of Medicine (FDFR201802), the Shiyan Municipal Guided Emergent Scientific Research Programme for the Prevention and Control of New Coronavirus Pneumonia (20Y12), the National Natural Science Foundation of China (81972668), and the National Key Research and Development Program of China (SQ2018YFA090045-01). We sincerely acknowledge all the healthcare workers in the diagnosis and treatment of patients in Taihe Hospital (New Coronavirus Pneumonia Consultation Panel, Department of Pediatrics, Department of Infectious Disease, Fever Clinic, New Coronavirus Pneumonia Medical Emergency Team, Laboratory Department, Department of Radiology, Nursing Department, and Material Supply Department)
Declaration of Interests: The authors declare no competing interest.
Ethics Approval Statement: Ethics approval was obtained from the Medical Ethics Committee of Taihe Hospital (Reference number: 202002). Waiver of informed consent was approved for the aggregated data. All the data collected are not allowed to share in the public for non-research purpose.
Keywords: SARS-CoV-2; COVID-19; coronavirus; clinical feature; outcome; immunity; trained immunity; vaccine; mycoplasma; co-infection
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