The symptoms of the flu and COVID-19 can be similar in children: both are known to cause fever, cough and fatigue, and keep children out of school by parents.
And while rare, the chance of either virus leading to critical illness in children may also be similar, research by a team of pediatric intensive care researchers suggests.
One in three children in a multihospital cohort admitted to the pediatric intensive care unit for COVID-19 or influenza required Mechanic ventilationaccording to the study of Clinical Infectious Diseases carried out by the team of Researchers Overcoming COVID-19 of the multi-hospital Pediatric Intensive Care Network (PICFLU).
“Seriously ill children with either virus have comparable outcomes in terms of needing respiratory support or blood pressure medication to treat shock,” said Heidi Flori, MD, FAAP, a pediatric intensivist at CS Mott Children’s Hospital in University of Michigan Health and a member of the PICFLU and Overcoming COVID-19 Research Team.
Vaccines can protect children
Flori says the data reinforces the importance of taking steps to protect children from both infections through vaccinations, especially as the new school season begins.
“Whether it’s the flu or COVID, there seems to be a general public perception that neither causes serious illness in children,” he said.
“But for those of us who work in pediatric ICU care, we’ve seen infections lead to critical illness and sometimes death in the young. Vaccines are the best tools we have.”
The researchers compared 179 children with influenza infection to 381 with COVID-19 at 16 US hospitals. Patients with critical COVID-19 stayed longer in the PICU than children with critical influenza, and mortality was low (2-3%) but similar in both groups.
The study, led by Natasha Halasa, MD, a pediatric infectious disease expert at Vanderbilt University Medical Center, also suggests slight differences in the impact of viruses on different age and demographic groups.
Children hospitalized with COVID-19 were generally older than those with influenza. Almost half of the children with the flu were between eight months and less than five years old, while more than four-fifths of those with COVID-19 were between 5 and 17 years old, of which more than half comprised the age group older, between 13 and 17 years.
Two-thirds of the study children hospitalized with influenza or COVID-19 also had an underlying medical condition, but one-third were otherwise healthy. Respiratory conditions were the most common underlying condition in both groups.
Health disparities in the youngest and oldest age groups
About half of the children with critical influenza and a quarter with COVID-19 were white. By comparison, about 40% of children with the flu and more than two-thirds of those with COVID-19 were African American or Hispanic.
“Our data suggest that the health disparities we saw in older COVID age groups may also exist among younger patients,” Flori said.
The study excluded 850 children who were diagnosed with a rare but serious COVID-related condition called multisystem inflammatory syndrome, or MIS-C.
MIS-C, which causes severe inflammation in vital organs and tissues, has been linked to more than 8,000 pediatric cases and 70 deaths nationwide. Children with the condition were separated out in this specific research because MIS-C is considered a post-acute infection, Flori says, noting that the network has focused other studies specifically on MIS-C.
While rare, even healthy children can end up in the ICU for the flu or COVID
Every year, millions of children get the seasonal flu. Annual flu-related hospitalizations among American children under the age of five ranged from 7,000 to 26,000 between 2010 and 2020, according to the Centers for Disease Control and Prevention. While relatively rare, some children also die from the flu each year: The CDC reports a range of 37 to 199 deaths during regular flu seasons between 2004 and 2020.
During the omicron-dominant period of COVID-19 (December 2021 to February 2022), hospitalization rates associated with COVID-19 in children aged 5 to 11 years were also almost double among unvaccinated children than among children vaccinated, according to the CDC.
Flori says that because the PICFLU network had long been in place to pool data between peer hospitals to analyze critical illness in flu kids, the group was well positioned to do the same work for COVID-19 when the pandemic hit.
“While there is a relatively low number of serious illnesses and deaths in children from both the flu and COVID, it’s not zero,” he said. “Children get seriously ill and every year there are deaths from infections that lead to hospitalizations and other long-term health risks.
“Many of the children in our study cohort had other underlying health problems, but a third of them were perfectly healthy and still ended up in the ICU,” he added. “No one is 100% immune. This should give all of us pause. Increasing flu and COVID-19 vaccination coverage among children can help us prevent hospitalization and serious outcomes.”
Natasha B Halasa et al, Life-threatening complications of influenza versus coronavirus disease 2019 (COVID-19) in US children, Clinical Infectious Diseases (2022). DOI: 10.1093/cid/ciac477
University of Michigan
Citation: Comparison of life-threatening influenza and COVID-19 illness in children (September 13, 2022) Retrieved September 14, 2022 from https://medicalxpress.com/news/2022-09-life-threatening -la-flu-covid-illness-kids. html
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