Differentiating COVID-19 vs. Flu Symptoms in Children

Children admitted to Children’s National Hospital in Washington, DC, for COVID-19 were not more likely to suffer serious complications than children admitted with seasonal influenza, according to a retrospective study.

Among some 1,700 pediatric patients with respiratory viral illness, there were no significant differences in children diagnosed with COVID-19 versus influenza A or B in hospitalization rate (17% vs 21%, P= 0.15), admission to the intensive care unit (6% vs 7%, P= 0.42), or the use of mechanical ventilation (3% vs 2%, P= 0.17), reported Xiaoyan Song, PhD, MSc, Children’s National Hospital, and colleagues, in JAMA network open.

However, the following symptoms were significantly more common in children with COVID-19 at the time of diagnosis than in children with influenza:

• Fever (76% vs 55%, P= 0.005)
• Diarrhea or vomiting (26% vs 12%, P= 0.01)
• Headache (11% vs 3%, P= 0.01)
• Body aches or myalgia (22% vs 7%, P= 0.001)
• Chest pain (11% vs 3%, P= 0.01)

Two children with influenza A died and no children with COVID-19 died. But no patients were diagnosed with influenza and COVID-19, Song and co-authors reported.

“Until we have more data … [frontline providers] you should be aware when encountering children with respiratory viral infections and consider testing patients for common respiratory viruses such as influenza and also COVID-19, “Song said. MedPage today.

Previously, a CDC analysis of 500 patients in the COVID-19 Associated Hospitalization Surveillance Network (COVID-NET) found a much higher ICU admission rate among children, at 33%. However, the rate of mechanical ventilation use of 6% was similar to that found in the current study.

Song and his colleagues also found that influenza hospitalizations dropped dramatically in the spring, only one case between March 22 and June 6, presumably due to stay-at-home orders and school closings, the authors noted, although the influenza activity would normally decrease. anyway during this period.

With influenza and SARS-CoV-2 circulating this fall, the American Academy of Pediatrics on Monday urged that all children 6 months and older receive the influenza vaccine as soon as possible, ideally before the end of October.

“During a pandemic, we can work together to reduce the risks of infection and of spreading the disease to others,” said co-author Flor Munoz, MD, of the AAP Committee on Infectious Diseases, adding that children and families should continue washing the hands. distance yourself and cover your face to prevent the spread of disease.

The study by Song and his colleagues involved 315 children with confirmed COVID-19 who were admitted from March 25 to May 15 of this year, and 1,402 children with confirmed influenza through molecular trials from October 1, 2019 to May. June 6, 2020. Asymptomatic children who tested positive during a pre-admission screening test were excluded.

Both cohorts were 52% male, but children hospitalized with COVID-19 tended to be older than those hospitalized with influenza (median age 9.7 vs 4.2, P> 0.001). Children with COVID-19 were also more likely to have underlying medical conditions compared to children hospitalized with influenza (65% vs 42%, P= 0.002), the researchers reported.

The prevalence of cough and shortness of breath was numerically higher among those with COVID-19, but the differences were not statistically significant.

Viral infections were detected using different testing methods, which is a limitation, the authors noted. The sample size was also too small to perform a subgroup analysis of patients admitted to the ICU, including how many patients were obese.