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Association of Vaccinations and Clinical Manifestations in Children with COVID–19

54 Pages Posted: 23 Apr 2020

See all articles by Shijian Liu

Shijian Liu

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Chunhui Yuan

Huazhong University of Science and Technology - Department of Laboratory Medicine

Jianfei Lin

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Wenqi Gao

Huazhong University of Science and Technology - Institute of Maternal and Child Health

Dan Tian

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Xiaonan Cai

Huazhong University of Science and Technology - Institute of Maternal and Child Health

Jiajun Yuan

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Feiyan Xiang

Huazhong University of Science and Technology - Institute of Maternal and Child Health

Yan Yang

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Xinru Huang

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Ruizhen Li

Huazhong University of Science and Technology - Department of Child Healthcare

Yun Xiang

Huazhong University of Science and Technology - Department of Laboratory Medicine

Hongmei Shan

Shanghai Jiao Tong University (SJTU) - Department of Special Service Clinic

Li Zhao

Shanghai Jiao Tong University (SJTU) - Department of Special Service Clinic

Bin Dong

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Min Zhou

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Shilu Tong

Queensland University of Technology - School of Public Health and Social Work

Tongxin Chen

Shanghai Jiao Tong University (SJTU) - Department of Rheumatology and Immunology

Jianbo Shao

Huazhong University of Science and Technology - Wuhan Children’s Hospital

Liebin Zhao

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Han Xiao

Huazhong University of Science and Technology - Institute of Maternal and Child Health

More...

Abstract

Background: The aim of the present study was to explore the association of vaccinations and clinical manifestations in pediatric patients with Coronavirus Disease 2019 (COVID–19).

Methods: Pediatric patients with COVID–19 were recruited from Wuhan Children’s Hospital and Shanghai Children’s Medical Center, including 248 laboratory–confirmed and 56 suspected cases from January 21 to March 12, 2020. Suspected and confirmed cases were diagnosed basing on the Novel Coronavirus 2019 Diagnosis and Treatment Protocol, seventh version. The associations of initial symptoms with age, vaccinations, pathogens, and cytokines were determined via Chi–square tests, Spearman correlations, and logistic regressions.

Findings: We assessed 248 (81.58%) laboratory–confirmed cases and 56 (18.42%) suspected cases of COVID–19. The median age of all patients was 6.82 years (interquartile range: 2.08–10.20), and 186 cases (61.18%) were boys; furthermore, 30.26% of all patients were asymptomatic cases. The percentage of asymptomatic cases vaccinated with Bacillus Calmette Guerin (BCG) was not significantly higher than that without BCG vaccination (86/280 [30.71%] vs 6/13 [46.15%], P = 0.203), initial symptoms was not corrected with immunized influenza vaccine ( P = 0.267). Significant correlations were found between age and immunoglobulin (Ig) A (P < 0.001), IgE (P = 0.021), IgG (P < 0.001), complement C4 (P = 0.031), interleukin (IL)–10 (P = 0.003), and tumor necrosis factor (TNF)–α (P = 0.044). Compared to parameters in pediatric patients with normal body temperatures, patients with fever had higher high sensitivity C reactive protein (hs-CRP) (P < 0.001), IL–4 (P = 0.005), IL–10 (P = 0.038), TNF–α (P = 0.004), and TNF–γ (P = 0.036).

Interpretation: Pediatric COVID–19 patients with BCG vaccinations exhibit similar clinical manifestations compared to those without BCG vaccinations, and the severity of symptoms in pediatric patients may be related to the maturity of immune function.

Funding Statement: This study was partly supported by Top Medical Young Talents of Hubei Province, the National Science Foundation of China [81872637], Shanghai Municipal Commission of Health and Family Planning[201840324], Science and Technology Development Program of Pudong Shanghai New District [PKJ2017–Y01], Shanghai Professional and Technical Services Platform [18DZ2294100], and Shanghai Science and Technology Commission of Shanghai Municipality (17411965300, 17XD1402800,19441904400].

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: This study was approved by the Institutional Review Board of Wuhan Children’s Hospital (IEC–2020R003–E01) and Shanghai Children’s Medical Center (SCMCIRB– K2020019–1).

Keywords: COVID-19; pediatric cases; Bacillus Calmette Guerin; immunoglobulins; cytokines

Suggested Citation

Liu, Shijian and Yuan, Chunhui and Lin, Jianfei and Gao, Wenqi and Tian, Dan and Cai, Xiaonan and Yuan, Jiajun and Xiang, Feiyan and Yang, Yan and Huang, Xinru and Li, Ruizhen and Xiang, Yun and Shan, Hongmei and Zhao, Li and Dong, Bin and Zhou, Min and Tong, Shilu and Chen, Tongxin and Shao, Jianbo and Zhao, Liebin and Xiao, Han, Association of Vaccinations and Clinical Manifestations in Children with COVID–19 (4/6/2020). Available at SSRN: https://ssrn.com/abstract=3572882 or http://dx.doi.org/10.2139/ssrn.3572882

Shijian Liu

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Shanghai, 200127
China

Chunhui Yuan

Huazhong University of Science and Technology - Department of Laboratory Medicine

Wuhan
China

Jianfei Lin

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Shanghai, 200127
China

Wenqi Gao

Huazhong University of Science and Technology - Institute of Maternal and Child Health

China

Dan Tian

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Shanghai, 200127
China

Xiaonan Cai

Huazhong University of Science and Technology - Institute of Maternal and Child Health

China

Jiajun Yuan

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Shanghai, 200127
China

Feiyan Xiang

Huazhong University of Science and Technology - Institute of Maternal and Child Health

China

Yan Yang

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Shanghai, 200127
China

Xinru Huang

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Shanghai, 200127
China

Ruizhen Li

Huazhong University of Science and Technology - Department of Child Healthcare

Wuhan
China

Yun Xiang

Huazhong University of Science and Technology - Department of Laboratory Medicine

Wuhan
China

Hongmei Shan

Shanghai Jiao Tong University (SJTU) - Department of Special Service Clinic

Shanghai, 200127
China

Li Zhao

Shanghai Jiao Tong University (SJTU) - Department of Special Service Clinic

Shanghai, 200127
China

Bin Dong

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Shanghai, 200127
China

Min Zhou

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute

Shanghai, 200127
China

Shilu Tong

Queensland University of Technology - School of Public Health and Social Work

Queensland
Australia

Tongxin Chen

Shanghai Jiao Tong University (SJTU) - Department of Rheumatology and Immunology

Shanghai
China

Jianbo Shao

Huazhong University of Science and Technology - Wuhan Children’s Hospital ( email )

China

Liebin Zhao (Contact Author)

Shanghai Jiao Tong University (SJTU) - Child Health Advocacy Institute ( email )

Shanghai, 200127
China

Han Xiao

Huazhong University of Science and Technology - Institute of Maternal and Child Health

China