The findings also indicate that the risk of severe disease may be highest in children with CF who have poorer lung function or a low body mass index (BMI).
The study, “Clinical characteristics of SARS-CoV-2 infection in children with cystic fibrosis: An international observational study,” was published in the Journal of Cystic Fibrosis.
Since the start of the COVID-19 pandemic, there has been a concerted effort by scientists around the world to better understand the novel coronavirus and its effects on the human body. Early data indicated that people with pre-existing lung conditions, like CF, could be at increased risk from COVID-19.
Now, an international research team has reported the outcomes of SARS-CoV-2 infection in 105 children with CF across 13 countries: the U.K., the U.S., Argentina, Brazil, Chile, France, Germany, Italy, Russia, South Africa, Spain, Sweden, and Switzerland.
“In a ground-breaking collaborative effort from the worldwide cystic fibrosis community, we collected vital data from around the world during a global pandemic,” Rebecca Cosgriff, study co-author and director of data of quality and improvement at the U.K. Cystic Fibrosis Trust, said in a press release.
“This global project helps shine a light on the outcomes of people with cystic fibrosis after having COVID-19, gathering much needed evidence, and helping people make informed choices based on the best available advice,” added Robbie Bain, study co-author from Newcastle University, U.K.
The median age of the children analyzed was 10 years and 54% were male. None of the children were actively waiting a transplant, though two had received transplants (one lung and one liver). Also of note, 50 of the children were being treated with CFTR modulators (a class of medications that work to correct the underlying molecular defects that cause CF).
In about a quarter of the children, SARS-CoV-2 infection was asymptomatic, meaning there were no detectable symptoms of the infection.
Among the children who did develop symptoms, the most common were fever (73%) and altered cough (72%). About 23% of symptomatic children had gastrointestinal symptoms. Other, less-frequent, symptoms included headache, fatigue, loss of sense of smell, and runny nose.
These symptoms are “similar to those reported in other paediatric, non-CF, cohort studies,” the researchers wrote.
Most (71%) of the children were managed in their community; the rest required hospitalization. Hospitalization was used “as the best available surrogate of disease severity in our dataset,” the researchers wrote.
Six hospitalized children required supplemental oxygen and three needed some form of ventilation.
None of the children received experimental treatments for COVID-19.
“Our findings from our global study of 13 countries across the world reassuringly show that very few children were seriously unwell after developing COVID-19,” said Malcolm Brodlie, study co-author from Newcastle University.
“We hope this provides reassurance to the community and we will continue to monitor new data and learn more information about COVID-19 and cystic fibrosis,” Cosgriff added.
Using statistical analyses, the researchers looked for differences between children who were hospitalized from those who were not. Hospitalized children had significantly poorer lung function (as assessed by forced expiratory volume) and significantly lower BMI (a ratio of body weight to height).
Significantly fewer children being treated with CFTR modulators were admitted to the hospital — though the researchers urged caution in interpreting these findings, since children in different countries in the study would have different access to these medications.
“Importantly, these comparisons were performed with caution and are exploratory,” the researchers wrote, adding that there is an “important caveat that some children were likely to have been tested for SARS-CoV-2 in association with a hospital admission for other reasons.”
No deaths in the study were attributed to COVID-19. There was one on-study death, but it was attributed to other health conditions. All but two of the remaining cases have resolved as of the writing of the study.
Collectively, the “findings suggest that SARS-CoV-2 infection in children with CF is usually associated with a mild illness in those who do not have pre-existing severe lung disease,” the researchers concluded.
“We are highly encouraged by these findings on the impact of COVID-19 in children with CF,” Bruce Marshall, MD, study co-author and chief medical officer of the Cystic Fibrosis Foundation, said in a separate press release.
“However, further studies are needed to fully understand the impacts of this novel disease,” Marshall added. “We continue to urge all people living with CF to continue to take precautions to avoid exposure to COVID-19 and to work directly with their care teams to assess their personal risk during this time.”
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