Omicron causes increase in pediatric laryngitis visits in US hospital

The omicron variant of the coronavirus caused an increase in visits for inflammation in the larynx (laryngitis or laryngotracheobronchitis) in children at a children’s hospital in Seattle, in the United States.

During the delta wave, between May 30, 2021 and November 30, 401 children whose average age was 2.3 years were treated at the medical center, of which only six (2.8%) had a confirmed case. by Covid-19 (205 were discarded and 190 were not tested).

Between December 1, 2021 and January 15, 2022, the period of dissemination of the omicron, there were 107 visits, of which 27 (48.2%) were confirmed as the main cause of infection by the coronavirus. Of the remainder, 29 were ruled out as being by Covid and 51 were not tested. In the period, the prevalence of the variant in the USA reached almost 100% of all samples sequenced.

The monthly rate of consultations for laryngotracheobronchitis, also known as croup, doubled in the last month at the hospital, from two to five consultations until the last day 15. The average age of the children seen at the beginning of the year was similar, 2.25 years old.

Croup is mainly caused by the parainfluenza virus, but researchers at Seattle Children’s Hospital have seen a decrease in recent weeks in cases of croup caused by this virus.

The main symptoms are difficulty breathing, hoarseness and “dog” cough. The infection usually starts with flu or cold-like signs, with cough and low-grade fever.

Children aged 1 to 6 years are especially prone to this disease, which can also be caused by bacteria. Treatment is usually with medications such as corticosteroids and epinephrine to decrease the inflammatory reaction in the airways.

Many cases of croup, however, are not tested for an infectious agent, hence the discrepancy between confirmed and undetected cases in the two periods. In the study, which was published on the preprints platform medRxiv (not yet peer-reviewed), the authors state that after January 15, the hospital changed the protocol for testing against Covid and influenza due to the shortage of supplies and, therefore, Therefore, it was not possible to continue investigating the cause of the hospital visits.

Hospitalization of children under the age of 5 with symptoms of flu or Covid, however, increased in early 2022 reaching the peak since the beginning of the pandemic, according to data released by the Centers for Disease Control and Prevention (CDC).

On January 8, US hospitals recorded 239 cases of hospitalization for Covid in children aged 0 to 4 years, the highest number since the beginning of the pandemic. On November 27, before the wave of the omni, the country recorded 46 pediatric hospitalizations.

In Brazil, the largest pediatric hospital in SP saw a jump in serious cases of Covid in healthy children in the last month. In addition to the increase in serious cases, hospital care for children under 5 also exploded at Hospital Sabará, west of São Paulo.

Many children still develop Covid sequelae up to three months after infection. According to pediatrician and director of Sbim (Brazilian Society of Immunizations), Renato Kfouri, the age group from 0 to 2 years old is the one with the highest risk of hospitalization and death in relation to the age group from 2 to 11.

In the country, children from 5 to 11 years old can already receive immunizations against Covid, but those under 5 years old must still wait to have an approved vaccine.

Last week, pharmaceutical Pfizer filed an application for authorization for emergency use of its pediatric vaccine in the range of 0 to 4 years in the United States. Despite the request, the company’s two-dose trials at one-tenth the adult dose did not provide the expected protective results.

According to the drugmaker, which is now testing a third dose of the vaccine or a combination of two doses of 3µg and a third dose of 10µg (equivalent to the dose given to children aged 5 to 11 years), the request was made even with the ongoing studies to accelerate the regulatory process when and if the tests are satisfactory.