![]() ![]() Similarly, risks from the disease need to be weighed against potential risks of vaccination in informing vaccination policy. If higher-risk groups are identified, they might benefit from vaccination and/or protective ‘shielding’ at times of high prevalence, whereas ‘shielding’ based upon erroneous assumptions of vulnerability is likely to cause significant secondary harms-for example, the effects of not attending school and restrictive or reduced socializing, affecting both development and mental health. ![]() We used detailed clinical data in the National Child Mortality Database (NCMD) 11, which is a comprehensive and unique mandatory national dataset of deaths of individuals younger than 18 years of age, to review the contribution of SARS-CoV-2 to death. The distinction between those who died of SARS-CoV-2 infection and those who died of an alternative cause with a coincidental positive SARS-CoV-2 test is important for understanding which CYP are truly at higher risk for severe disease or death.Īnswering this important question required detailed examination of all deaths in a large population, going beyond simple cause of death registration, to review the contribution of SARS-CoV-2 to death. This issue is made more difficult by the very high prevalence of asymptomatic infection at times of high prevalence, with reported prevalence up to 4–6% of United Kingdom CYP during December 2020 (ref. Furthermore, it remains unclear to what extent these rare deaths relate directly to the pathological processes of COVID-19 or whether CYP who died from alternative causes were coincidentally positive for SARS-CoV-2 around the time of death. As death from acute COVID-19 or PIMS-TS in CYP is extremely rare 4, 7, 8, those who have died have been poorly characterized 9. PIMS-TS, also called multisystem inflammatory syndrome in children, is a rare syndrome characterized by persistent fever, inflammation (neutrophilia, lymphopenia and raised C-reactive protein) and evidence of single- or multi-organ dysfunction that might occur concurrently or after infection 6. Severe illness and death associated with SARS-CoV-2 in CYP is rare and can be due to either acute COVID-19 or pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) 2, 5. This, in combination with a mild or asymptomatic phenotype 2, provides a challenge for describing how SARS-CoV-2 directly affects CYP. ![]() Although many CYP present with the typical fever, cough and shortness of breath, they also present with broader non-specific symptoms, including abdominal pain, nausea, headache and sore throat 1, 3. The clinical manifestations of COVID-19 in CYP are different than those in adults 1. Therefore, CYP have comprised a very low proportion of all hospitalizations and deaths from coronavirus disease 2019 (COVID-19) globally 4. SARS-CoV-2 infection is usually mild and asymptomatic in CYP 1, 2, 3. Identifying CYP at risk of severe illness and death after SARS-CoV-2 infection is essential to guide families, clinicians and policymakers about future shielding policies, school attendance, novel therapeutic agents and vaccine prioritization. New variants might have different mortality risks and should be evaluated in a similar way. These results are important for guiding decisions on shielding and vaccinating children. CYP older than 10 years, Asian and Black ethnic backgrounds and comorbidities were over-represented in SARS-CoV-2-related deaths compared with other CYP deaths. In total, 99.995% of CYP with a positive SARS-CoV-2 test survived. Of these deaths, 25 were due to SARS-CoV-2 infection (mortality rate, two per million), including 22 due to coronavirus disease 2019-the clinical disease associated with SARS-CoV-2 infection-and 3 were due to pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. ![]() Here we show that, of 12,023,568 CYP living in England, 3,105 died, including 61 who were positive for SARS-CoV-2. The predominant SARS-CoV-2 variants were wild-type and Alpha. To distinguish between CYP who died as a result of SARS-CoV-2 infection and those who died of another cause but were coincidentally infected with the virus, we undertook a clinical review of all CYP deaths with a positive SARS-CoV-2 test from March 2020 to February 2021. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is rarely fatal in children and young people (CYP, <18 years old), but quantifying the risk of death is challenging because CYP are often infected with SARS-CoV-2 exhibiting no or minimal symptoms. ![]()
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