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Comparison of Clinical Features of COVID-19 vs Seasonal Influenza A and B in US Children

Educational Objective
To understand the differences between COVID-19 and Seasonal Influenza A and B in US Children
1 Credit CME
Key Points

Question  What are the similarities and differences in clinical features between coronavirus disease 2019 (COVID-19) and seasonal influenza in US children?

Findings  In this cohort study of 315 children with COVID-19 and 1402 children with seasonal influenza, there were no statistically significant differences in the rates of hospitalization, admission to the intensive care unit, and mechanical ventilator use between the 2 groups. More patients with COVID-19 than with seasonal influenza reported fever, diarrhea or vomiting, headache, body ache, or chest pain at the time of diagnosis.

Meaning  The findings suggest that prevention of both COVID-19 and seasonal influenza in US children is prudent and urgent for the well-being of this population.

Abstract

Importance  Compared with seasonal influenza, the clinical features and epidemiologic characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus 2019 (COVID-19) in US children remain largely unknown.

Objective  To describe the similarities and differences in clinical features between COVID-19 and seasonal influenza in US children.

Design, Setting, and Participants  This retrospective cohort study included children who were diagnosed with laboratory-confirmed COVID-19 between March 25 and May 15, 2020, and children diagnosed with seasonal influenza between October 1, 2019, and June 6, 2020, at Children’s National Hospital in the District of Columbia.

Exposures  COVID-19 or influenza A or B.

Main Outcomes and Measures  Rates of hospitalization, admission to the intensive care unit, and mechanical ventilator use and the association between underlying medical conditions, clinical symptoms, and COVID-19 vs seasonal influenza.

Results  The study included 315 patients diagnosed with COVID-19 (164 [52%] male; median age, 8.3 years [range, 0.03-35.6 years]) and 1402 patients diagnosed with seasonal influenza (743 [53%] male; median age, 3.9 years [range, 0.04-40.4 years]). Patients with COVID-19 and those with seasonal influenza had a similar hospitalization rate (54 [17%] vs 291 [21%], P = .15), intensive care unit admission rate (18 [6%] vs 98 [7%], P = .42), and use of mechanical ventilators (10 [3%] vs 27 [2%], P = .17). More patients hospitalized with COVID-19 than with seasonal influenza reported fever (41 [76%] vs 159 [55%], P = .005), diarrhea or vomiting (14 [26%] vs 36 [12%], P = .01), headache (6 [11%] vs 9 [3%], P = .01), body ache or myalgia (12 [22%] vs 20 [7%], P = .001), and chest pain (6 [11%] vs 9 [3%], P = .01). Differences between patients hospitalized with COVID-19 vs influenza who reported cough (24 [48%] vs 90 [31%], P = .05) and shortness of breath (16 [30%] vs 59 [20%], P = .13) were not statistically significant.

Conclusions and Relevance  In this cohort study of US children with COVID-19 or seasonal influenza, there was no difference in hospitalization rates, intensive care unit admission rates, and mechanical ventilator use between the 2 groups. More patients hospitalized with COVID-19 than with seasonal influenza reported clinical symptoms at the time of diagnosis.

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Article Information

Accepted for Publication: August 1, 2020.

Published: September 8, 2020. doi:10.1001/jamanetworkopen.2020.20495

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Song X et al. JAMA Network Open.

Corresponding Author: Xiaoyan Song, PhD, MBBS, CIC, Office of Infection Control and Epidemiology, Children’s National Hospital, 111 Michigan Ave, NW, Washington, DC 20010 (xsong@cnmc.org).

Author Contributions: Dr Song had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Song, Delaney, Wessel, DeBiasi.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Song, DeBiasi.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Song.

Administrative, technical, or material support: Delaney, Shah, Campos, DeBiasi.

Supervision: Shah, Wessel, DeBiasi.

Conflict of Interest Disclosures: None reported.

Additional Contributions: Jeffrey Li, River Hill High School, Clarksville, Maryland, provided editing assistance and was not compensated for his help.

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