Respiratory viral coinfections in pediatric patients in the primary care setting: a multicenter prospective study within the COPEDICAT network.

Acute respiratory viral infections pose a significant healthcare burden on the pediatric population globally, but data on the dissemination pattern in the community due to the COVID-19 pandemic are scarce. We conducted a two-year prospective multicenter study in Catalonia (Spain) that examined the prevalence and coinfection dynamics of respiratory viruses among 1276 pediatric patients from different age groups attending primary care. Coinfection analysis demonstrated complex patterns and revealed a coinfection rate of 23.8% for SARS-CoV-2, often in association with rhinovirus or influenza A. This study provides valuable data to understand post-pandemic viral interactions, which is imperative for public health interventions.

Multisystem inflammatory syndrome in children and SARS-CoV-2 variants: a two-year ambispective multicentric cohort study in Catalonia, Spain.

Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe disease temporarily related to SARS-CoV-2. We aimed to describe the epidemiological, clinical, and laboratory findings of all MIS-C cases diagnosed in children < 18 years old in Catalonia (Spain) to study their trend throughout the pandemic. This was a multicenter ambispective observational cohort study (April 2020-April 2022). Data were obtained from the COVID-19 Catalan surveillance system and from all hospitals in Catalonia. We analyzed MIS-C cases regarding SARS-CoV-2 variants for demographics, symptoms, severity, monthly MIS-C incidence, ratio between MIS-C and accumulated COVID-19 cases, and associated rate ratios (RR). Among 555,848 SARS-CoV-2 infections, 152 children were diagnosed with MIS-C. The monthly MIS-C incidence was 4.1 (95% CI: 3.4-4.8) per 1,000,000 people, and 273 (95% CI: 230-316) per 1,000,000 SARS-CoV-2 infections (i.e., one case per 3,700 SARS-CoV-2 infections). During the Omicron period, the MIS-C RR was 8.2 (95% CI: 5.7-11.7) per 1,000,000 SARS-CoV-2 infections, which was significantly lower (p < 0.001) than that for previous variant periods in all age groups. The median [IQR] age of MIS-C was 8 [4-11] years, 62.5% male, and 80.2% without comorbidities. Common symptoms were gastrointestinal findings (88.2%) and fever > 39 °C (81.6%); nearly 40% had an abnormal echocardiography, and 7% had coronary aneurysm. Clinical manifestations and laboratory data were not different throughout the variant periods (p > 0.05).  Conclusion: The RR between MIS-C cases and SARS-CoV-2 infections was significantly lower in the Omicron period for all age groups, including those not vaccinated, suggesting that the variant could be the main factor for this shift in the MISC trend. Regardless of variant type, the patients had similar phenotypes and severity throughout the pandemic. What is Known: • Before our study, only two publications investigated the incidence of MIS-C regarding SARS-CoV-2 variants in Europe, one from Southeast England and another from Denmark. What is New: • To our knowledge, this is the first study investigating MIS-C incidence in Southern Europe, with the ability to recruit all MIS-C cases in a determined area and analyze the rate ratio for MIS-C among SARS-CoV-2 infections throughout variant periods. • We found a lower rate ratio of MISC/infections with SARS-CoV-2 in the Omicron period for all age groups, including those not eligible for vaccination, suggesting that the variant could be the main factor for this shift in the MISC trend.

Household Severe Acute Respiratory Syndrome Coronavirus 2 Transmission and Children: A Network Prospective Study.

BACKGROUND: The role of children in household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unclear. We describe the epidemiological and clinical characteristics of children with coronavirus disease 2019 (COVID-19) in Catalonia, Spain, and investigate the household transmission dynamics. METHODS: A prospective, observational, multicenter study was performed during summer and school periods (1 July 2020-31 October 2020) to analyze epidemiological and clinical features and viral household transmission dynamics in COVID-19 patients aged <16 years. A pediatric index case was established when a child was the first individual infected. Secondary cases were defined when another household member tested positive for SARS-CoV-2 before the child. The secondary attack rate (SAR) was calculated, and logistic regression was used to assess associations between transmission risk factors and SARS-CoV-2 infection. RESULTS: The study included 1040 COVID-19 patients. Almost half (47.2%) were asymptomatic, 10.8% had comorbidities, and 2.6% required hospitalization. No deaths were reported. Viral transmission was common among household members (62.3%). More than 70% (756/1040) of pediatric cases were secondary to an adult, whereas 7.7% (80/1040) were index cases. The SAR was significantly lower in households with COVID-19 pediatric index cases during the school period relative to summer (P = .02) and compared to adults (P = .006). No individual or environmental risk factors associated with the SAR. CONCLUSIONS: Children are unlikely to cause household COVID-19 clusters or be major drivers of the pandemic, even if attending school. Interventions aimed at children are expected to have a small impact on reducing SARS-CoV-2 transmission.

Prevalence, Clinical Characteristics and Risk Factors of Post-COVID-19 Condition in a Multicenter Pediatric Primary and Hospital Care Cohort.

The prevalence of post-COVID-19 condition is not well defined. We describe a cohort of 244 children diagnosed with COVID-19 and followed up for 6 months, in which 4.9% of patients had persistent symptoms at 12 weeks. Anosmia was the most frequent symptom. Being female and having more than 3 symptoms in acute infection were associated with an increased risk of post-COVID.

Unravelling the role of the mandatory use of face covering masks for the control of SARS-CoV-2 in schools: a quasi-experimental study nested in a population-based cohort in Catalonia (Spain).

OBJECTIVE: To assess the effectiveness of mandatory use of face covering masks (FCMs) in schools during the first term of the 2021-2022 academic year. DESIGN: A retrospective population-based study. SETTING: Schools in Catalonia (Spain). POPULATION: 599 314 children aged 3-11 years attending preschool (3-5 years, without FCM mandate) and primary education (6-11 years, with FCM mandate). STUDY PERIOD: From 13 September to 22 December 2021 (before Omicron variant). INTERVENTIONS: A quasi-experimental comparison between children in the last grade of preschool (5 years old), as a control group, and children in year 1 of primary education (6 years old), as an interventional group. MAIN OUTCOME MEASURES: Incidence of SARS-CoV-2, secondary attack rates (SARs) and effective reproductive number (R*). RESULTS: SARS-CoV-2 incidence was significantly lower in preschool than in primary education, and an increasing trend with age was observed. Six-year-old children showed higher incidence than 5 year olds (3.54% vs 3.1%; OR 1.15 (95% CI 1.08 to 1.22)) and slightly lower but not statistically significant SAR (4.36% vs 4.59%; incidence risk ratio 0.96 (95% CI 0.82 to 1.11)) and R* (0.9 vs 0.93; OR 0.96 (95% CI 0.87 to 1.09)). Results remained consistent using a regression discontinuity design and linear regression extrapolation approaches. CONCLUSIONS: We found no significant differences in SARS-CoV-2 transmission due to FCM mandates in Catalonian schools. Instead, age was the most important factor in explaining the transmission risk for children attending school.

Symptom-Based Predictive Model of COVID-19 Disease in Children.

BACKGROUND: Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is neither always accessible nor easy to perform in children. We aimed to propose a machine learning model to assess the need for a SARS-CoV-2 test in children (<16 years old), depending on their clinical symptoms. METHODS: Epidemiological and clinical data were obtained from the REDCap® registry. Overall, 4434 SARS-CoV-2 tests were performed in symptomatic children between 1 November 2020 and 31 March 2021, 784 were positive (17.68%). We pre-processed the data to be suitable for a machine learning (ML) algorithm, balancing the positive-negative rate and preparing subsets of data by age. We trained several models and chose those with the best performance for each subset. RESULTS: The use of ML demonstrated an AUROC of 0.65 to predict a COVID-19 diagnosis in children. The absence of high-grade fever was the major predictor of COVID-19 in younger children, whereas loss of taste or smell was the most determinant symptom in older children. CONCLUSIONS: Although the accuracy of the models was lower than expected, they can be used to provide a diagnosis when epidemiological data on the risk of exposure to COVID-19 is unknown.

Age-dependency of the Propagation Rate of Coronavirus Disease 2019 Inside School Bubble Groups in Catalonia, Spain.

BACKGROUND: We analyzed contagions of coronavirus disease 2019 inside school bubble groups in Catalonia, Spain, in the presence of strong nonpharmaceutical interventions from September to December 2020. More than 1 million students were organized in bubble groups and monitored and analyzed by the Health and the Educational departments. METHODS: We had access to 2 data sources, and both were employed for the analysis, one is the Catalan school surveillance system and the other of the educational department. As soon as a positive index case is detected by the health system, isolation is required for all members of the bubble group, in addition to a mandatory proactive systematic screening of each individual. All infected cases are reported. It permits the calculation of the average reproductive number (R*), corresponding to the average number of infected individuals per index case. RESULTS: We found that propagation inside of the bubble group was small. Among 75% index cases, there was no transmission to other members in the classroom, with an average R* across all ages inside the bubble of R* = 0.4. We found a significant age trend in the secondary attack rates, with the R* going from 0.2 in preschool to 0.6 in high school youth. CONCLUSIONS: The secondary attack rate depends on the school level and therefore on the age. Super-spreading events (outbreaks of 5 cases or more) in childhood were rare, only occurring in 2.5% of all infections triggered from a pediatric index case.

Schools as a Framework for COVID-19 Epidemiological Surveillance of Children in Catalonia, Spain: A Population-Based Study.

Objective: We describe and analyze the childhood (<18 years) COVID-19 incidence in Catalonia, Spain, during the first 36 weeks of the 2020-2021 school-year and to compare it with the incidence in adults. Methods: Data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests were obtained from the Catalan Agency for Quality and Health Assessment. Overall, 7,203,663 SARS-CoV-2 tests were performed, of which 491,819 were positive (6.8%). We collected epidemiological data including age-group incidence, diagnostic effort, and positivity rate per 100,000 population to analyze the relative results for these epidemiological characteristics. Results: Despite a great diagnostic effort among children, with a difference of 1,154 tests per 100,000 population in relation to adults, the relative incidence of SARS-CoV-2 for <18 years was slightly lower than for the general population, and it increased with the age of the children. Additionally, positivity of SARS-CoV-2 in children (5.7%) was lower than in adults (7.2%), especially outside vacation periods, when children were attending school (4.9%). Conclusions: A great diagnostic effort, including mass screening and systematic whole-group contact tracing when a positive was detected in the class group, was associated with childhood SARS-CoV-2 incidence and lower positivity rate in the 2020-2021 school year. Schools have been a key tool in epidemiological surveillance rather than being drivers of SARS-CoV-2 incidence in Catalonia, Spain.

COPEDI-CAT: estrategia de calidad para la investigación en covid-19 pediátrica en Cataluña / COPEDI-CAT: estratègia de qualitat per a la recerca en covid-19 pediàtrica a Catalunya / COPEDI-CAT: quality strategy for pediatric covid-19 research in Cataloni

Fundamento. El estallido brusco de la pandemia de la covid-19suposo la necesidad de iniciar proyectos de investigación coordinados. La creación del grupo COPEDI-CAT (julio 2020; más de170 profesionales) para estudiar la covid-19 pediátrica en Cataluña es un buen ejemplo de ello.Objetivo. Dar a conocer los resultados del grupo COPEDI-CAT, paramostrar la viabilidad de una estrategia de investigación multidisciplinaria de calidad con amplia participación de la atención primaria (AP).Método. Recogida de la producción científica del grupo COPEDICAT, resultado del trabajo multidisciplinario a partir de una extensa base de datos. En el grupo se revisan los estudios en cursoy los datos recogidos, se proponen nuevos proyectos, se realizanintervenciones de profesionales expertos (locales y de otros ámbitos y países) y se genera un espacio de debate y seguimiento de lapandemia.Resultados. Se han respondido las principales cuestiones sobre clínica, transmisibilidad, gravedad y principales complicaciones dela covid-19 en pediatría (síndrome pediátrico inflamatorio multisistémico y covid-19 persistente). Esta investigación ha generadocomunicaciones en congresos nacionales e internacionales, publicaciones científicas de alto impacto, la guía clínica de recomendaciones para el manejo de la covid-19 persistente, modelos depredicción clínica, becas de investigación (beca Prandi y MaratóTV3) y la participación en el proyecto «Escoles Sentinella».Conclusiones. La pandemia de covid-19 ha representado una oportunidad única para realizar investigación multidisciplinaria de calidad en pediatría de AP. COPEDI-CAT puede ser un modelo parala investigación futura de las patologías que afectan a los niños y adolescentes de nuestro país.

Background. The sudden outbreak of the covid-19 pandemic resulted in a need to start coordinated research projects on the disease. The creation of the COPEDI-CAT group (July 2020; more than 170professionals) to study pediatric covid-19 in Catalonia representsa good example of this effort.Objective. To disseminate the results of the COPEDI-CAT group toshow the feasibility of a quality multidisciplinary research strategywith wide participation of primary care (PC).Method. Review of the scientific production of the COPEDI-CATgroup generated by a multidisciplinary team. The group reviewedongoing studies and collected data, proposed new projects, implemented interventions recommended by expert professionals (local,national, and international), and created a space for debate andmonitoring of the pandemic.Results. The main questions about the symptoms, transmissibility,severity, and main complications of covid-19 in pediatrics (multisystem inflammatory syndrome and long covid-19) have beenaddressed. This research has generated papers at national andinternational conferences, high-impact scientific publications,recommended clinical guidelines for the management of longcovid-19, clinical prediction models, research grants (Prandi andMarató TV3 scholarship) and the participation in the «Escoles Sentinella» project.Conclusions. The covid-19 pandemic has represented a unique opportunity to carry out quality multidisciplinary research in pediatrics at PC. COPEDI-CAT can be a model for future research ondiseases that affect children and adolescents in our country. (AU)

Fonament. L’esclat brusc de la pandèmia va comportar la necessitat d’iniciar projectes de recerca coordinats. La creació del grup COPEDI-CAT (juliol 2020; més de 170 professionals) per estudiar la covid-19 pediàtrica a Catalunya n’és un bon exemple. Objectiu. Donar a conèixer els resultats del grup COPEDICAT, per mostrar la viabilitat d’una estratègia d’investigació multidisciplinària de qualitat amb àmplia participació de l’atenció primària (AP). Mètode. Recollida de la producció científica del grup COPEDI-CAT, resultat del treball multidisciplinari a partir d’una extensa base de dades. Al grup es revisen els estudis en curs i les dades recollides, es proposen nous projectes, es fan intervencions de professionals experts (locals i d’altres àmbits i països) i es genera un espai de debat i seguiment de la pandèmia. Resultats. S’han respost les principals qüestions sobre clínica, transmissibilitat, gravetat i principals complicacions de la covid-19 pediàtrica (síndrome pediàtrica multisistèmica i covid-19 persistent). Aquesta recerca ha generat comunicacions a congressos nacionals i internacionals, publicacions científiques d’alt impacte, la guia clínica de recomanacions pel maneig de la covid-19 persistent, models de predicció clínica, beques d’investigació (beca Prandi i Marató TV3) i la participació al projecte «Escoles Sentinella». Conclusions. La pandèmia de covid-19 ha representat una oportunitat única per fer investigació multidisciplinària de qualitat en pediatria d’AP. COPEDI-CAT pot ser un model per a la recerca futura de les patologies que afecten els infants i adolescents del nostre país. (AU)

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