Severe acute respiratory syndrome among children.
OBJECTIVE
To study the epidemiologic, clinical, laboratory, and radiologic features, prognostic indicators, and short-term to medium-term outcomes for children with severe acute respiratory syndrome (SARS) and to validate the performance characteristics of a clinical case definition, calculated with respect to SARS-associated coronavirus (SARS-CoV) seroconversion.


METHODS
Children <18 years of age, from a single-site outbreak, who satisfied a clinical case definition for SARS, with subsequent serologic confirmation, were treated according to a standard protocol and prospectively monitored.


RESULTS
Forty-four children were included. The median age was 12 years. Forty-two children (95.5%) demonstrated an epidemiologic link. Fever, cough, malaise, coryza, sputum production, headache, myalgia, lymphopenia, and elevated lactate dehydrogenase levels were common presenting features. Radiographic findings were nonspecific, but high-resolution computed tomography of the thorax was an early diagnostic aid. A specific reverse transcription-polymerase chain reaction assay for SARS-CoV yielded positive results for <50% of children. Of 9 children who developed hypoxemia, 8 were treated with methylprednisolone. Of 5 children who received intensive care, 3 required assisted ventilation. All children recovered, and serious adverse events in response to treatment were not observed. The outcomes at 3 to 6 months after disease onset, including exercise tolerance, pulmonary functions, and psychologic status, were favorable. An age of >12 years was associated with methylprednisolone therapy for severe illness. After exclusion of the only infant, an age of >12 years was associated with oxygen requirements. Sore throat, high neutrophil count at presentation, and peak neutrophilia were independent factors predicting severe illness. The clinical case definition demonstrated good sensitivity, specificity, and positive and negative predictive values (97.8%, 92.7%, 88%, and 98.7%, respectively) for diagnostic accuracy.


CONCLUSIONS
Children are susceptible to SARS-CoV infection. Teenagers resemble adults with respect to disease progression and may develop severe illness. The short-term to medium-term outcomes are good. Sore throat and initial and peak neutrophilia seem to be predictors of severe illness. Our clinical case definition performed well in the epidemic.
Leung
Chi-wai
CW
Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Lai Chi Kok, Kowloon, Hong Kong. leungcw@ha.org.hk
Kwan
Yat-wah
YW
Ko
Po-wan
PW
Chiu
Susan S
SS
Loung
Po-yee
PY
Fong
Nai-chung
NC
Lee
Lai-ping
LP
Hui
Yim-wo
YW
Law
Helen K W
HK
Wong
Wilfred H S
WH
Chan
Kwok-hung
KH
Peiris
J S Malik
JS
Lim
Wilina W L
WW
Lau
Yu-lung
YL
Chiu
Man-chun
MC
D000293:Adolescent; D017677:Age Distribution; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006723:Hong Kong; D006801:Humans; D007223:Infant; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D011379:Prognosis; D011859:Radiography; D012307:Risk Factors; D045169:Severe Acute Respiratory Syndrome / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D012720:Severity of Illness Index