COVID-19 in Children with Down Syndrome: Data from the Trisomy 21 Research Society Survey
Authors: Emes David , Hüls Anke , Baumer Nicole , Dierssen Mara , Puri Shiela , Russel Lauren , Sherman Stephanie L. , Strydom Andre , Bargagna Stefania , Brandão Ana Cláudia , Costa Alberto C.S. , Chicoine Brian Allen , Ghosh Sujay , Rebillat Anne-Sophie , Sgandurra Giuseppina , Valentini Diletta , Rohrer Tilman R. , Levin Johannes , Lakhanpaul Monica ,   The Trisomy 21 Research Society COVID-19 Initiative
Published: July 2021

Importance

Adults with Down syndrome (DS) are at higher risk for severe outcomes of coronavirus disease 2019 (COVID-19), but further evidence is required to determine the exact risks for children with DS. The clinical features and epidemiological characteristics of COVID-19 in children with DS, and risk factors for severe outcomes, must be established to inform COVID-19 shielding advice and vaccination priority.

Objective

To determine risk factors for a severe course of COVID-19 in pediatric DS patients and to compare the prevalence of severe COVID-19 between pediatric patients with and without DS.

Design

This retrospective cohort study included pediatric cases (aged <18 years) with DS from the Trisomy 21 Research Society international survey and pediatric cases from the general population published by the US Centers for Disease Control and Prevention (COVID-NET) collected during the first wave of the COVID-19 pandemic (controls).

Setting

Cohorts included 328 children with DS (127 hospitalized, 39%) and 224 children without DS (all hospitalized) with COVID-19. Of the pediatric DS patients, 64.1% were from low-to-middle-income countries (LMICs), and 35.9% from high-income countries (HICs).

Participants

Clinicians, family members, or caregivers completed the survey on behalf of children with DS affected by COVID-19.

Results

Among the 328 COVID-19 patients with DS; older age, obesity, and epilepsy were significant risk factors for hospitalization; and age and thyroid disorder were significant risk factors for acute respiratory distress syndrome. The 127 hospitalized COVID-19 patients with DS had a higher incidence of cough, fever, nasal signs and shortness of breath than controls. Compared with controls, hospitalized children with DS (especially those from LMICs) had a higher prevalence of COVID-19-related medical complications (pneumonia, ARDS, acute renal failure).

Conclusions and relevance

Children with DS are at higher risk for severe COVID-19 than the general pediatric population. Efforts should be made to monitor the health of children and young people with DS during the ongoing pandemic and to report any COVID-19 signs and symptoms in a timely manner, especially for those who have comorbidities which are risk factors for severe COVID-19. When vaccination rollout for pediatric populations begins, children with DS should be prioritised.

Key Points

Question

What are the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) in paediatric patients with Down syndrome (DS)?

Findings

Hospitalised COVID-19 patients <18 years of age with DS from a range of countries had a higher incidence of respiratory symptoms, fever, and several medical complications from COVID-19 than patients without DS <18 years from the United States (US). 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), in contrast to previous findings in adults with DS (who exhibit higher mortality than those without DS).

Significance

Children with DS are at increased risk for more severe presentations of COVID-19. Efforts should be made to ensure 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. Children with DS should be prioritised for COVID-19 vaccination as part of children’s vaccination programmes.