Abstract
Adults with Down Syndrome (DS) are at higher risk for severe outcomes of coronavirus disease 2019 (COVID-19) than the general population, but evidence is required to understand the risks for children with DS, which is necessary to inform COVID-19 shielding advice and vaccination priorities. We aimed to determine the epidemiological and clinical characteristics of COVID-19 in children with DS. Using data from an international survey obtained from a range of countries and control data from the United States, we compared the prevalence of symptoms and medical complications and risk factors for severe outcomes between DS and non-DS paediatric populations with COVID-19. Hospitalised COVID-19 patients <18 years with DS had a higher incidence of respiratory symptoms, fever, and several medical complications from COVID-19 than control patients without DS <18 years. Older age, obesity, and epilepsy were significant risk factors for hospitalisation among paediatric COVID-19 patients with DS, and age and thyroid disorder were significant risk factors for acute respiratory distress syndrome. Mortality rates were low in all paediatric COVID-19 patients (with and without DS), contrasting with previous findings in adults with DS (who exhibit higher mortality than those without DS). Children with DS are at increased risk for more severe presentations of COVID-19. Efforts should be made to ensure the comprehensive and early detection of COVID-19 in this population and to identify children with DS who present comorbidities that pose a risk for a severe course of COVID-19. Our results emphasize the importance of vaccinating children with DS as soon as they become eligible.
Highlights
Down Syndrome (DS) is associated with genetic factors and medical comorbidities that may lead to increased vulnerability to a severe course of coronavirus disease 2019(COVID-19)—the illness caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)
The age distribution was slightly different between the Trisomy 21 Research Society (T21RS) individuals with Down Syndrome and the CDC controls without Down Syndrome (Table A3)
As severe COVID-19 cannot be assessed by mortality alone, we aimed to evaluate the rate of several indicators for severe COVID-19 among 328 children with DS and compare these to 224 children from the general population
Summary
Down Syndrome (DS) is associated with genetic factors and medical comorbidities that may lead to increased vulnerability to a severe course of coronavirus disease 2019(COVID-19)—the illness caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2). Down Syndrome (DS) is associated with genetic factors and medical comorbidities that may lead to increased vulnerability to a severe course of coronavirus disease 2019. (COVID-19)—the illness caused by the severe acute respiratory syndrome coronavirus 2. Immune dysregulation among individuals with DS increases vulnerability to viral infections, while anatomical airway features increase the vulnerability to respiratory illnesses [1,2,3]. Respiratory illnesses are a major cause of premature mortality in people with DS [4,5], and children with DS show a high susceptibility to recurrent respiratory infections [6]. Many non-respiratory comorbidities of DS, such as obesity, diabetes, or heart conditions, are known risk factors for morbidity and mortality from COVID-19 in the general population [2,3]. Some reports have highlighted a few cases of children who had one or more comorbidities, including cardiovascular anomalies, obesity, and/or obstructive sleep apnoea [7,8], but these reports were based on only 55 and 4 participants, respectively
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