January 3, 2024

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COVID: Children and other Vulnerable Populations

Characteristics and Clinical Outcomes of Vaccine-Eligible US Children Under-5 Years Hospitalized for Acute COVID-19 in a National Network
Investigators enrolled inpatients aged 8 months to <5 years with acute community-acquired COVID-19 across 28 U.S. pediatric hospitals from September 20, 2022 to May 31, 2023. They assessed demographic and clinical factors, including the highest level of respiratory support, and vaccination status defined as unvaccinated, incomplete, or complete primary series [at least 2 (Moderna) or 3 (Pfizer-BioNTech) mRNA vaccine doses ≥14 days before hospitalization]. Among 597 children, 174 (29.1%) patients were admitted to the intensive care unit and 75 (12.6%) had a life-threatening illness, including 51 (8.5%) requiring invasive mechanical ventilation. Children with underlying respiratory and neurologic/neuromuscular conditions more frequently received higher respiratory support. Only 4.5% of children hospitalized for COVID-19 (n = 27) had completed their primary COVID-19 vaccination series and 7.0% (n = 42) of children initiated but did not complete their primary series. Among 528 unvaccinated children, nearly half (n = 251) were previously healthy, three of them required extracorporeal membrane oxygenation for acute COVID-19 and one died. Completion of the vaccine series was low in all regions but highest in the Northeast (12.2%) and lowest in the South (1.5%).
SARS-CoV-2 Perinatal Transmission and Neonatal Outcomes across Four Different Waves of COVID-19 Pandemic: A Nationwide Prospective Cohort Study from the Italian Society of Neonatology
These results are from a large prospective nationwide cohort study collecting maternal and neonatal data in case of maternal peripartum SARS-CoV-2 infection between February, 2020 and March, 2022. Data were stratified across the four observed pandemic waves. Among 5,201 positive mothers, the risk of being symptomatic at delivery was significantly higher in the first and third waves (20.8%-20.8%) than in the second and fourth (13.2%-12.2%). Among mothers with symptomatic infections, the rates of severe infection were significantly higher in the first (21.4%) and third (27.4%) waves compared with the second (9.3%) and fourth (5.6%) waves (P < .005). Overall, death during hospitalization occurred in 0.2% of all SARS-CoV-2-positive mothers, with no significant differences observed across the periods. Among their 5,284 neonates, the risk of prematurity (gestational age < 37 weeks) was significantly higher in the first and third waves (15.6%-12.5%). The risk of postnatal transmission during rooming-in was higher and peaked to 4.5% during the fourth wave. Eighty percent of positive neonates were asymptomatic.

COVID: The Late Phase/PASC/Long COVID

Corticosteroids for COVID-19-induced Olfactory Dysfunction: A Comprehensive Systematic Review and Meta-analysis of Randomized Controlled Trials
Here seven randomized controlled trials with 999 participants were included in the meta-analysis. Compared with the control group, corticosteroid treatment resulted in a statistically significant improvement in olfactory score with a standardized mean difference of 0.55 (95% CI: 0.15 to 0.95). Topical corticosteroids were found to be effective, but systemic corticosteroids were not. In addition, longer durations and higher dosages of corticosteroids treatment may also be associated with significant improvements in olfactory scores. No significant effect was observed on the duration or recovery rate of olfactory dysfunction.
COVID-19 Convalescent Plasma Therapy: Long-term Implications
The CONTAIN-Extend study examined 281 participants from the original CONTAIN COVID-19 trial (CONTAIN-RCT, NCT04364737) at 18 months post-hospitalization for acute COVID-19. Symptom surveys, global health assessments, and biospecimen collection was performed from November 2021 to October 2022. Multivariable logistic and linear regression estimated associations between the randomization arms and self-reported symptoms and PROMIS scores, adjusted for covariables, including age, sex, race/ethnicity, disease severity, and CONTAIN enrollment quarter and sites. PROMIS stands for Patient-Reported Outcomes Measurement Information System. While some previous studies have shown benefits in certain populations if given at the right time, looking at longer-term outcomes, there were no differences in symptoms or PROMIS scores between CCP and placebo (adjusted odds ratio of general symptoms, 0.95; 95% confidence intervals, 0.54, 1.67). CCP demonstrated no lasting effect on PASC symptoms or overall health in comparison to the placebo.