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Children with Cancer and COVID: Most do well, but what about the ones who aren’t?

Editor’s note: Get the most up-to-date COVID-19 news as well as guidance in Medscape’s Coronavirus Resource Center.

A new study which followed 131 children who were infected with SARS CoV-2 found that the majority (79%) did well and had only asymptomatic or mild disease.

However, others suffered from severe symptoms. 49 children (37 percent) were admitted to hospital 15 (11%) required admission to the ICU (ICU) and four (3%) passed away from the illness.

Dr Gabrielle Haeusler

The children with cancer who were at greater risk of having severe COVID-19 were suffering from an underlying condition, co-infection and neutropenia as noted by the researchers, who were led by Gabrielle Haeusler, MBBS PhD, of the Murdoch Children’s Research Institute, Parkville, Australia.

“We were surprised that most children had mild-to-moderate diseases, with as much as a third of kids diagnosed with cancer not being symptomatic,” Haeusler, an infectious diseases specialist at Melbourne’s Royal Children’s Hospital, Australia expressed his satisfaction with this “reassuring” finding.

However, the proportion of patients with severe disease that led to death and hospitalization is of concern, she added.

She also expressed concern about the high rate of transmission among family members. Nearly half of all cases of SARS-CoV-2 (44%) were part of a COVID-19 family cluster. “This highlights the importance of COVID-19 vaccination of all household and close contacts to help protect the patients, ” she added.

The study was published online on the 9th of October in the European Journal of Cancer.

According to the authors, these findings can aid in the management of this vulnerable population.

“At the time of the pandemic, there was no information about the effects of COVID-19 on children suffering from cancer. However, based on our understanding of other respiratory viruses that are prevalent in this patient population we assumed that it would cause severe illness,” Haeusler told Medscape Medical News.

She quickly devised an electronic database and protocol together with her colleagues to swiftly “capture details about the symptoms, signs, as well as the outcomes of COVID-19 among these individuals.”

She noted that “we were particularly interested in the severity of disease and the factors that could cause more severe illnesses.”

Participants were teens and children younger than 19 who had been diagnosed with cancer, had received bone marrow transplants or were infected by SARS-CoV-2. The median age of patients was 8 and they were from 10 different countries. The majority (78) were diagnosed with leukemia or Lymphoma. 48 had a solid tumour and five were diagnosed with primary immunodeficiency after receiving hematopoietic stromal cells transplants.

The most common COVID-19 symptoms were fever (71 percent of patients) cough (41%), and coryza (29%). Although the median time it took to identify the virus was 16 days for most patients however, one patient was sheds that lasted 779 days.

COVID-19 was used to delay or modify cancer chemotherapy for 35 percent of patients. A full recovery was documented in 95%.

Three risk factors were independently and strongly associated to increased disease severity: any co-infection [OR2.94], any co-infection 2.94], any co-infection [OR], 1.74], and severe baseline neutropenia (“OR,” 1.82).

Haeusler said that the study has identified factors that could be associated with more severe diseases …[ and that these factors could be utilized to assist healthcare professionals in managing these patients.

“Ongoing surveillance through international collaborative studies is crucial to continue to monitor the impact of newer variants and vaccine,” she added.

Haeusler did not disclose any financial relationships.

Eur J Cancer. Published online October 9 2021. Full text

Sharon Worcester is an award-winning medical journalist at MDedge News, part of the Medscape Professional Network.

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