Study: SCD Children With Omicron Infection at Risk of Severe Symptoms

Over 80% of SCD children with COVID-19 variant admitted to ICU

Patricia Inácio, PhD avatar

by Patricia Inácio, PhD |

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Children with sickle cell disease (SCD) are at a high risk of developing severe symptoms after infection with the SARS-CoV-2 Omicron variant, one of the most recent variants of the virus that causes COVID-19, according to a new French study.

In fact, more than 85% of children infected with Omicron were hospitalized in intensive care units, data show.

Researchers said their study highlights “the urgent need to expand vaccination for COVID-19 in children with SCD” ages 5 and older — a group the team said had a low vaccination rate.

The results were published as a letter, titled “Severe cases of COVID-19 in children with sickle cell disease during the Omicron wave in France: a plea for vaccination,” in the British Journal of Haematology.

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Adults with SCD, particularly older patients, were reported to be at a higher risk of severe disease when infected with SARS-CoV-2, the virus that causes COVID-19. In the first waves of the pandemic, COVID-19 seemed to affect mostly adults, while children in general were spared infection.

However, viruses can acquire mutations that change their behavior over time. When this happens, scientists consider it a new variant.

One of the most recent variants of SARS-CoV-2 — called Omicron — has been considered less severe for adults in general, but has resulted in a higher number of children hospitalized.

Vaccinations urged for children 5–11

Despite such data, “little is known about the severity of the Omicron variant in patients with SCD, especially in children,” the researchers wrote.

Now, investigators in France analyzed the outcomes of SCD children infected with the SARS-CoV-2 Omicron variant from December 2021 to April 2022.

In France, vaccination against COVID-19 has been recommended for SCD children ages 5–11 since November 2021. For adolescents ages 12 and older, such vaccinations have be recommended even longer, since May 2021.

The team contacted all physicians caring for people with SCD, both adults and children, in France, and inquired about sickle cell patients hospitalized with severe COVID-19.

During the four-month period of Omicron spread, a total of 29 SCD patients were hospitalized with severe disease. Among them, 17 (59%) were children, with median age of 9.4 years.

The majority — 13 children, or 76.5% — had the most severe form of SCD, meaning they inherited defective copies of the beta-globin (HBB) gene from both parents.

Although most of the children (76.5%) were eligible for COVID-19 vaccines, only two were vaccinated. One 14-year-old patient had received one dose, while a 16-year-old had gotten two doses.

A total of 14 children (82.7%) showed severe acute chest syndrome (ACS) and all had bone pain. One child, meanwhile, had severe anemia linked to mild ACS.

Blood clots were detected in two patients, including in the lungs (pulmonary embolism) and in the deep veins of the legs (deep vein thrombosis).

Another two children developed multisystem inflammatory syndrome (MIS), a condition characterized by inflammation affecting different body parts.

The majority (88.2%) were admitted to the intensive care unit. All survived and none had to be intubated for assisted breathing with mechanical ventilation.

In 13 cases (86.7%), however, non-invasive respiratory assistance was required, such as through a high-flow nasal cannula. Blood transfusions were required in 16 patients (94.1%).

The median length of the children’s hospital stay was 13 days, with hospitalizations ranging from 8 to 33 days.

“The Omicron variant has been demonstrated to lead to less severe forms of COVID-19 in adults, a reduction that has been at least partly attributed to the widespread distribution of COVID-19 vaccines,” the researchers wrote.

Data from the U.S. National COVID Cohort Collaborative (N3C) mirrors that of the French study, however, according to researchers.

The U.S. data showed that the “COVID-19 pediatric ICU rate increased during the Omicron surge and that more than one-fifth of children in the ICU infected with SARS-CoV-2 developed severe symptoms,” they wrote.

Even though none of the children required mechanical ventilation and no deaths occurred, these findings show that SCD children developed severe symptoms after being infected with the Omicron SARS-CoV-2 variant.

Prior reports showed that COVID-19 vaccines reduced the risk of Omicron-associated hospitalization in children ages 5–11, and prevented critically ill cases in adolescents. Another study suggested a low incidence of related condition MIS in adolescents vaccinated for COVID-19.

Overall, and despite the ongoing debate on whether all healthy children should get vaccinated, this study emphasizes what the researchers say is an urgent need to expand COVID-19 vaccination.

The researchers recommend vaccines for all SCD patients ages 5 and older, noting “there was a low rate of vaccination among the children reported in this study who were hospitalized with severe outcomes.”