May 14, 2020

Children with cancer are not at higher risk for COVID-19 infection, morbidity

A study published in JAMA Oncology suggests that paediatric patients with cancer may not be more vulnerable than other children to infection or morbidity resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Although the study was limited by small numbers, the data showed that the overall morbidity of paediatric patients with cancer with coronavirus disease 2019 (COVID-19) is low, with only 5% requiring hospitalisation for symptoms of COVID-19. The rate of SARS-CoV-2 infection among asymptomatic paediatric patients was very low.

“Starting in mid-March, 2020, we instituted a screening and testing plan to mitigate risk associated with COVID-19”, wrote Andrew Kung, MD, Memorial Sloan Kettering, New York, New York, and colleagues. “On presentation for outpatient or inpatient care, patients were screened for the presence of symptoms of COVID-19 or exposure to contacts with known SARS-CoV-2 infection.”

Between March 10, 2020, and April 12, 2020, a total of 335 tests for SARS-CoV-2 were performed on paediatric patients and their caregivers. Of the 178 unique paediatric patients (107 male and 71 female) tested (mean [SD] age 11.1 [8.5] years), 20 (11.2%) had positive test results  (mean [SD] age 15.9 [6.6] years). Of patients specifically tested for positive screening or symptoms (screen positive or symptom positive), the rate of positivity for SARS-CoV-2 was 29.3%.

By comparison, in the 120 asymptomatic patients without known exposure (screen negative and symptom negative), the rate of SARS-CoV-2 positivity was only 2.5% (29.3%; 95% CI, 18.1%-42.7% versus 2.5%; 95% CI, 0.5%-7.1%; P < 0.001). Of the 20 patients who tested positive for SARS-CoV-2, only 3 were female, a significant sex skewing when compared with paediatric patients who tested negative (15%; 95% CI, 3%-38% vs 43%; 95% CI, 35%-51%; P = 0.02), the authors said.

Only 1 paediatric patient required noncritical care hospitalisation for COVID-19 symptoms. Three other patients without significant COVID-19 symptoms were admitted for concomitant fever and neutropenia, cancer morbidity, or planned chemotherapy. All other paediatric patients had mild symptoms and were managed at home.

“We also instituted testing of adult caregivers of patients,” the authors wrote. “Of the 74 individuals tested, 13 (17.6%) tested positive for SARS-CoV-2. Notably among 68 asymptomatic and unexposed caregivers (screen negative and symptom negative), 10 (14.7%) tested positive for SARS-CoV-2. Simultaneous detection of virus in patient and caregiver was found in 5 patient/caregiver dyads, whereas 5 patients were negative for virus despite close exposure to caregivers with COVID-19.”

“Unrecognised SARS-CoV-2 infection in asymptomatic caregivers is a major infection control consideration,” the authors wrote. “Consistent with the sex difference previously seen in adults with critical disease, there is a male bias in SARS-CoV-2 infections in children, suggesting a biological basis in skewed infectivity.”

“We are encouraged by these latest findings that kids with cancer are not more endangered by COVID-19 and their symptoms are mild like in healthy children,” said Dr. Kung. “These findings allow us to continue lifesaving cancer-directed therapy with standard precautions and safeguards but without heightened concern about adverse effects from COVID-19 infection.”