Epidemiology and Clinical Characteristics of Human Coronaviruses-Associated Infections in Children: A Multi-Center Study

Kyo Jin Jo; Soo-Han Choi; Chi Eun Oh; HyeonA Kim; Bong Seok Choi; Dae Sun Jo; Su Eun Park

doi:10.3389/fped.2022.877759

Epidemiology and Clinical Characteristics of Human Coronaviruses-Associated Infections in Children: A Multi-Center Study

Front Pediatr. 2022 Apr 12:10:877759. doi: 10.3389/fped.2022.877759. eCollection 2022.

Authors

Kyo Jin Jo¹, Soo-Han Choi², Chi Eun Oh³, HyeonA Kim⁴, Bong Seok Choi⁴, Dae Sun Jo⁵, Su Eun Park¹

Affiliations

¹ Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, South Korea.
² Department of Pediatrics, Pusan National University Hospital, Busan, South Korea.
³ Department of Pediatrics, Kosin University College of Medicine, Busan, South Korea.
⁴ Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, South Korea.
⁵ Department of Pediatrics, Jeonbuk National University Medical School, Jeonju, South Korea.

Abstract

Background: Human coronaviruses (HCoVs) are associated with upper respiratory tract infections. Although studies have analyzed the clinical and epidemiological characteristics of HCoV-associated infections, no multi-center studies have been conducted in Korean children. We aimed to describe the epidemiology and clinical characteristics of HCoV-associated infection in children.

Methods: We retrospectively reviewed medical records of children in whom HCoVs were detected using multiplex reverse transcriptase-polymerase chain reaction amplification in five centers from January 2015 to December 2019.

Results: Overall, 1,096 patients were enrolled. Among them, 654 (59.7%) patients were male. The median age was 1 year [interquartile range (IQR), 0-2 years]. HCoVs were identified mainly in winter (55.9%). HCoV-229E, HCoV-OC43, and HCoOV-NL63 were detected mainly in winter (70.9, 55.8, and 57.4%, respectively), but HCoV-HKU1 was mainly identified in spring (69.7%). HCoV-OC43 (66.0%) was detected most frequently, followed by HCoV-NL63 (33.3%), and HCoV-229E (7.7%). Two different types of HCoVs were co-detected in 18 samples, namely. Alphacoronavirus-betacoronavirus co-infection (n = 13) and, alphacoronavirus-alphacoronavirus co-infection (n = 5). No betacoronavirus-betacoronavirus co-infection was detected. Patients were diagnosed with upper respiratory tract infection (41.4%), pneumonia (16.6%), acute bronchiolitis (15.5%), non-specific febrile illness (13.1%), croup (7.3%), and acute gastroenteritis (5.1%). There were 832 (75.9%) hospitalized patients with a median duration of hospitalization of 4 days (IQR, 3-5 days); 108 (9.9%) patients needed supplemental oxygen with 37 (3.4%) needing high-flow nasal cannula or mechanical ventilation. There were no deaths.

Conclusion: HCoV-associated infections exhibit marked seasonality with peaks in winter. Patients with lower respiratory tract infection, a history of prematurity, or underlying chronic diseases may progress to a severe course and may need oxygen therapy.

Keywords: children; human coronavirus; multi-center study; multiplex polymerase chain reaction; prognosis.