Critically Ill Kids – Influenza vs COVID-19

Written by John Korducki

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A few notable demographic differences in critically ill children with influenza or COVID-19 were observed—influenza patients were younger, while COVID patients were more likely to be Black, Hispanic, and were more likely to be obese; a majority of both cohorts had one or more underlying medical condition.

Why does this matter?
Data regarding demographics and presenting symptoms in children for COVID-19 were previously lacking and can be used to target viral testing, management, and vaccine strategies for providers and families.

COVID and flu, kids get it bad too
This cohort study attempted to identify if there were differences in demographics and life-threatening complications in severe COVID-19 and influenza in pediatric patients. Critical illness in both cohorts was generously defined as critical acute respiratory illness with admission to the ICU with ≥1 sign of systemic illness (temperature ≥38°C or ≤35°C, leukocytosis, elevated C-reactive protein or procalcitonin, or altered mental status) and ≥1 sign of acute respiratory illness (cough, shortness of breath, tachypnea or retractions, invasive or noninvasive mechanical ventilation, need for oxygen to maintain at least 92% saturation, or pulmonary infiltrate or hyperinflation on chest imaging). Notably, this COVID cohort came in the pre-vaccine era from March 2020 to December 2020 and prior to the Omicron and Delta variants. Previous studies indicate that vaccination is effective at preventing progression to severe disease in pediatric patients with flu and patients aged 12-18 with COVID1,2. Keeping with this, the average age was 13.8 years in children with severe COVID vs 5.2 years in flu. Patients with severe COVID were more likely to be Black (27.6% vs 14.5%), Hispanic (36.2% vs 24.0%), obese (42.2% vs 21.4%), and have one or more underlying medical condition (78.5% vs 66.4%). The two groups showed no differences in need for invasive mechanical ventilation (30.2% in each), vasopressors (19.6% flu vs 19.9% COVID), and death (2.2% flu vs 2.9% COVID). Only 39% of the influenza cohort had received full vaccination. COVID patients had longer hospital length of stay (7d vs 5d) and duration of time in the ICU (4d vs 2d). I would like to see data for the later waves of COVID variants and the post-vaccination era. I see these data being useful in vaccine education and discussions with families, particularly those with underlying medical conditions.

Life-Threatening Complications of Influenza vs Coronavirus Disease 2019 (COVID-19) in US Children. Clin Infect Dis. 2023 Feb 8;76(3):e280-e290. doi: 10.1093/cid/ciac477.

Works Cited

  1. Olson SM, Newhams MM, Halasa NB, et al. Vaccine effectiveness against life- threatening influenza illness in US children. Clin Infect Dis 2022; 75:230–8.
  2. Olson SM, Newhams MM, Halasa NB, et al. Effectiveness of BNT162b2 vaccine against critical Covid-19 in adolescents. N Engl J Med 2022; 386:713–23.
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