Severe Acute Respiratory Syndrome in Children

Lauren J. Stockman, MPH*†; Mehran S. Massoudi, PhD, MPH*; Rita Helfand, MD*; Dean Erdman, DrPH*; Alison M. Siwek, MPH*†; Larry J. Anderson, MD*; Umesh D. Parashar, MD, MPH*

Disclosures

Pediatr Infect Dis J. 2007;26(1):68-74. 

In This Article

Abstract and Introduction

Background: Severe acute respiratory syndrome (SARS) is a febrile, respiratory tract illness caused by infection with the newly identified SARS-associated coronavirus. A notable feature of the 2003 global SARS outbreak was the relative paucity of cases reported among children. We reviewed the epidemiologic and clinical features of SARS in children and discuss implications of these findings for diagnosis, treatment and prevention of SARS.
Methods: We performed a literature search to identify reports of pediatric (younger than 18 years of age) patients meeting the World Health Organization case definitions for SARS and abstracted relevant clinical and epidemiologic information.
Results: We identified 6 case series reporting 135 pediatric SARS patients (80 laboratory-confirmed, 27 probable and 28 suspect) from Canada, Hong Kong, Taiwan and Singapore. Among laboratory-confirmed and probable SARS cases, the most common symptoms included fever (98%), cough (60%) and nausea or vomiting (41%); 97% had radiographic abnormalities. The clinical presentation of SARS in patients older than 12 years of age was similar to that in adults. However, patients 12 years of age or younger had milder disease and were less likely than older children to be admitted to an intensive care unit, receive supplemental oxygen or be treated with methylprednisolone. No deaths were reported among children or adolescents with SARS, and at 6 months after illness only mild residual changes were reported in exercise tolerance and pulmonary function. There is only 1 published report of transmission of SARS virus from a pediatric patient.
Conclusions: Children and adolescents are susceptible to SARS-associated coronavirus infection, although the clinical course and outcome are more favorable in children younger than 12 years of age compared with adolescents and adults. Transmission of SARS from pediatric patients appears to be uncommon but is possible.

Severe acute respiratory syndrome (SARS) is a febrile, respiratory tract illness that is caused by infection with a novel coronavirus (CoV), the SARS-associated CoV (SARS-CoV).[1,2,3] The disease first came to international attention in March 2003 following global dissemination of the outbreak by people infected from a single patient at a hotel and subsequently in a hospital in Hong Kong.[4] The earliest SARS cases likely occurred in the southern part of China in November 2002.[5,6] The disease rapidly spread throughout the world before it was controlled with an intense global response. By July 2003, when the World Health Organization (WHO) declared the outbreak to be contained, 8098 cases and 774 SARS-related deaths had been reported to WHO from 29 countries.[7]

A notable feature of the global SARS outbreak was the relative paucity of cases reported among children. When pediatric cases of SARS did occur, the general perception was that children had a much milder and shorter course of illness than adults.[8,9,10] We review the epidemiologic and clinical features of SARS in children and adolescents from published case reports and discuss the implications of these findings for diagnosis, treatment and prevention of SARS.

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