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Risk factors linked to severe pediatric COVID-19

Two recent studies in Pediatrics look at risk factors for severe pediatric COVID-19 and COVID deaths in those younger than 21 years of age.

The first study, which was published in the October print issue, involved 2,293 US children hospitalized for COVID-19 across 14 states from March 2020 to May 2021. About 30% had severe COVID-19, and 0.5% died. Increased risk factors for severe COVID-19 were stratified across two-age groups: those less than 2 years (32.5% of the cohort) and those who were 2 to 17 years (67.5%).

The younger group had increased risk associated with chronic lung disease (adjusted risk ratio [aRR], 2.2.), neurologic disorders (aRR, 2.0), cardiovascular disease (aRR, 1.7), prematurity (aRR, 1.6), and airway abnormality (aRR, 1.6), while severe COVID-19 was linked to feeding tube dependence (aRR, 2.0), diabetes (aRR, 1.9), and obesity (aRR, 1.2) in the older group.

Overall, 12.0 children among 100,000 had severe COVID-19, with the highest instances among infants, Hispanic children, and Black children. Children with at least one underlying medical condition had an aRR of 1.5, although severe disease was significantly less likely in those younger than 6 months (aRR, 0.7).
Oct 21 Pediatr study

The second study looked specifically at 112 COVID-19 deaths in those younger than 21 and found that they mostly occurred in older adolescents (median age, 17 years), males (63%), Black people (28%), or Hispanic people (46%). About 86% of the patients had underlying health issues, and the most common were obesity (42%), asthma (29%), and developmental disorders (22%).

Multi-inflammatory syndrome in children received its Centers for Disease Control and Prevention case definition on May 14, 2020, and the researchers found that those with MIS-C were more likely to not have underlying health conditions. However, they add, the MIS-C criteria at the time of the study included severe illness requiring hospitalization, which may have affected the death rate of MIS-C patients.

The researchers created the cohort using reports submitted by 25 of 55 US jurisdictions from Feb 12 to Jul 31, 2020.
Oct 22 Pediatr study


COVID-19 vaccine mandates increase uptake, study says

Vaccine mandates increase uptake, according to a study published in Scientific Reports yesterday. The researchers ran four small experiments looking at vaccine mandate/normalization scenarios, attitudes, and current behavior toward the COVID-19 vaccine in winter and spring 2021.

The first involved 299 people who were asked if they would get the COVID-19 vaccine if it were required for work, travel, or school, and then if they would get it today if it were free. Overall, 86% said they would get it if it were mandated, but only 68% said they would receive the vaccine today. After stratifying the data by race—105 White, 95 Black, and 89 Hispanic people—the gaps between mandate prediction and current behavior ranged from 14 to 24 percentage points, with the mandate resulting in higher uptake in every instance.

The second study involved 359 people who were presented with a hypothetical new employer’s attitudes or mandates regarding a vaccine against a new disease, while the third study looked at how 357 people behaved under free choice and mandated scenarios in relation to vaccination norms (eg, population uptake). Results from both suggested that mandates resulted in equal or stronger vaccine uptake, even when people reacted negatively to the mandate.

The last study involved 606 people representative of the US population. Examining vaccination intention, perceived benefits, perceived norms, perceived fairness, and perceived obligation, the researchers found that vaccination mandates resulted in stronger intentions to vaccinate (M = 3.59, SE = 0.07) compared with describing it as a free choice (M = 3.36, SE = 0.07), with similar results observed regardless of any negative psychological reaction to the mandate. Among those who did react negatively to mandates, the researchers note their opinions on the vaccine’s benefits did not change, and they felt less moral obligation.

“Our experiments show very clearly that these requirements do not have any negative effects on vaccination intentions,” said lead author Dolores Albarracín, PhD, in a University of Pennsylvania press release. “Actually, they have positive effects across various ethnic groups and for people who have a tendency to oppose anything seemingly forced on them.”
Oct 21 Scientific Reports study
Oct 21 University of Pennsylvania
press release

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