Comparative Analysis of Pediatric COVID-19 Infection in Southeast Asia, South Asia, Japan, and China

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  • 1 Children’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore;
  • 2 Duke-NUS Medical School, Singapore;
  • 3 SingHealth Duke-NUS Global Health Institute, Singapore;
  • 4 Pediatric Critical Care Medicine, Aga Khan University, Karachi, Pakistan;
  • 5 Department of Pediatrics, University Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia;
  • 6 Murni Teguh Memorial Hospital, Medan, Indonesia;
  • 7 Pediatric Intensive Care Unit, Hospital Pulau Pinang, Pulau Pinang, Malaysia;
  • 8 Infectious Disease Service, Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa Prefecture, Japan;
  • 9 Critical Care Treatment Center and Intensive Care Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, China;
  • 10 Pediatric Intensive Care Unit, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia;
  • 11 Pediatric Intensive Care and Emergency Units, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India;
  • 12 Center for Quantitative Medicine, Duke-NUS Medical School, Singapore;
  • 13 Medical College, Aga Khan University, Karachi, Pakistan;
  • 14 Pediatric Intensive Care Unit, Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa Prefecture, Japan;
  • 15 Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, Singapore;
  • 16 Infectious Disease Service, Department of Pediatrics, KK Women’s and Children’s Hospital, Singapore;
  • 17 Lee Kong Chian School of Medicine, Imperial College, Nanyang Technological University, Singapore

There is a scarcity of data regarding coronavirus disease 2019 (COVID-19) infection in children from southeast and south Asia. This study aims to identify risk factors for severe COVID-19 disease among children in the region. This is an observational study of children with COVID-19 infection in hospitals contributing data to the Pediatric Acute and Critical Care COVID-19 Registry of Asia. Laboratory-confirmed COVID-19 cases were included in this registry. The primary outcome was severity of COVID-19 infection as defined by the World Health Organization (WHO) (mild, moderate, severe, or critical). Epidemiology, clinical and laboratory features, and outcomes of children with COVID-19 are described. Univariate and multivariable logistic regression models were used to identify risk factors for severe/critical disease. A total of 260 COVID-19 cases from eight hospitals across seven countries (China, Japan, Singapore, Malaysia, Indonesia, India, and Pakistan) were included. The common clinical manifestations were similar across countries: fever (64%), cough (39%), and coryza (23%). Approximately 40% of children were asymptomatic, and overall mortality was 2.3%, with all deaths reported from India and Pakistan. Using the multivariable model, the infant age group, presence of comorbidities, and cough on presentation were associated with severe/critical COVID-19. This epidemiological study of pediatric COVID-19 infection demonstrated similar clinical presentations of COVID-19 in children across Asia. Risk factors for severe disease in children were age younger than 12 months, presence of comorbidities, and cough at presentation. Further studies are needed to determine whether differences in mortality are the result of genetic factors, cultural practices, or environmental exposures.

Author Notes

Address correspondence to Judith Ju Ming Wong, Children’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, 100 Bukit Timah Rd., Singapore. E-mail: judith.wong.jm@singhealth.com.sg

Financial support: This study was funded by the SingHealth Duke-NUS Global Health Institute Pilot Research Grant (project no. Duke-NUS/SDGHI_RGA[Khoo]/2020/0006; principle investigator, J. J. M. W.). The Singapore Clinical Research Institute supported this study in kind by providing database development and maintenance services. C. F. Y. is supported by the SingHealth Duke-NUS Academic Medicine COVID-19 Rapid Response Research Grant AM/COV001/2020 (SRDUKAMC2001).

Authors’ addresses: Judith Ju Ming Wong, Children’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore, Duke-NUS Medical School, Singapore, and SingHealth Duke-NUS Global Health Institute, Singapore, E-mail: judith.wong.jm@singhealth.com.sg. Qalab Abbas, Pediatric Critical Care Medicine, Aga Khan University, Karachi, Pakistan, E-mail: qalababbas@gmail.com. Soo Lin Chuah and Chin Seng Gan, Department of Pediatrics, University Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia, E-mails: chuahsl@ummc.edu.my and csgan@ummc.edu.my. Ririe Fachrina Malisie, Murni Teguh Memorial Hospital, Medan, Indonesia, E-mail: ririe.fachrina.malisie@usu.ac.id. Kah Min Pon, Pediatric Intensive Care Unit, Hospital Pulau Pinang, Pulau Pinang, Malaysia, E-mail: ponkahmin@yahoo.com. Tomohiro Katsuta, Infectious Disease Service, Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa Prefecture, Japan, E-mail: katsuta-7-@marianna-u.ac.jp. Hongxing Dang and Feng Xu, Critical Care Treatment Center and Intensive Care Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, China, E-mails: dhxdoc@163.com and xufeng9899@163.com. Pei Chuen Lee and Swee Fong Tang, Pediatric Intensive Care Unit, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia, E-mails: peichuen@ppukm.ukm.edu.my and sweefongtang@gmail.com. Muralidharan Jayashree, Pediatric Intensive Care and Emergency Units, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India, E-mail: mjshree64@gmail.com. Rehena Sultana, Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, E-mail: rehena.sultana@duke-nus.edu.sg. Quratulain Maha, Medical College, Aga Khan University, Karachi, Pakistan, E-mail: quratulain.maha@scholar.aku.edu. Naoki Shimizu, Pediatric Intensive Care Unit, Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa Prefecture, Japan, E-mail: naoki.shimizu@marianna-u.ac.jp. Luming Shi, Duke-NUS Medical School, Singapore, and Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, Singapore, E-mail: luming.shi@scri.cris.sg. Jan Hau Lee, Children’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore, and Duke-NUS Medical School, Singapore, E-mail: lee.jan.hau@singhealth.com.sg. Koh Cheng Thoon, Infectious Disease Service, Department of Pediatrics, KK Women’s and Children’s Hospital, Singapore, E-mail: thoon.koh.cheng@singhealth.com.sg. Chee Fu Yung, Duke-NUS Medical School, Singapore, Infectious Disease Service, Department of Pediatrics, KK Women’s and Children’s Hospital, Singapore, and Lee Kong Chian School of Medicine, Imperial College, Nanyang Technological University, Singapore, E-mail: yung.chee.fu@singhealth.com.sg.

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