Increasing reports of severe COVID-19 illness in children -- coupled with the fact that little is known about how and why the disease may behave differently in this younger population -- demand that a set of critical steps be taken now to ensure children get the attention they need, according to an article published in Pediatric Research.
The article, authored by research experts from I-ACT for Children and other leading pediatric researchers, outlines a roadmap for better understanding the disease in children and ensuring that potential treatments and vaccines are developed for children with the same level of urgency given to adults.
Although the volume and severity of the coronavirus has been greater in adults, there are scientific unknowns for children, and reports of severe illness are mounting. Studying the infection in children may help with broader efforts at containing the virus' spread.
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WHAT'S THE IMPACT
The authors outline five key areas of pediatric research that require urgent action.
One is understanding how COVID-19 infection develops and progresses in children, and the impact of a mother's infection during pregnancy on her newborn. The early suggestion that children are at lower risk of severe disease from COVID-19 infection remains unexplained and has not been confirmed; research aimed at defining the pathophysiology and course of the disease in children is essential for developing the best treatment and prevention strategies to address children's medical needs.
Two is ensuring the availability of widespread, rapid point-of-care diagnostic testing to assess prevalence and inform prevention strategies. Identifying infected children more extensively and more rapidly can help define the role children may be playing in spreading the infection, as well as help researchers understand the course of the disease in these children.
The authors suggest that limited availability of testing has likely resulted in a significant underestimation of the number of infected children.
The third area of focus is conducting antibody testing of children as a marker for susceptibility. Defining the role specific antibodies play in determining immunity to COVID-19 infection is needed not only to advance vaccine strategies, but also to better understand the extent to which infants and children have responded to these infections, and therefore may be protected from new infections.
Another focus of further research: Establishing a dedicated framework for testing the safety and efficacy of new COVID-19 treatments in children. As treatments are being developed and tested in adults, planning can help ensure the collection of data that can be used to inform and accelerate pediatric studies, through use of extrapolation and other research methods. Studies of investigational agents in children should begin as soon as deemed ethically appropriate based on risk and benefit assessment.
The fifth area of focus is evaluating vaccines and other preventive measures for children.
As with new treatments, early preparation for inclusion of children in trials of new vaccines and other preventive agents is important -- and the authors said these trials should not be delayed once careful risk-benefit assessment justifies such inclusion. It is already clear that the risk for serious disease exists, and that the family impact of infection and disease in children can be significant.
THE LARGER TREND
In early April, the CDC calculated that in the U.S., about 1.7% of COVID-19 cases had occurred in children. Of those, 5.7% were hospitalized, compared with 10% of adults at that time. COVID-19 has led to serious illness and death in children ranging from newborns and young infants to those with underlying medical conditions.