Association of Vaccinations and Clinical Manifestations in Children with COVID–19

Background: The aim of the present study was to explore the association of vaccinations and clinical manifestations in pediatric patients with Coronavirus Disease 2019 (COVID–19). Methods: Pediatric patients with COVID–19 were recruited from Wuhan Children’s Hospital and Shanghai Children’s Medical Center, including 248 laboratory–confirmed and 56 suspected cases from January 21 to March 12, 2020. Suspected and confirmed cases were diagnosed basing on the Novel Coronavirus 2019 Diagnosis and Treatment Protocol, seventh version. The associations of initial symptoms with age, vaccinations, pathogens, and cytokines were determined via Chi–square tests, Spearman correlations, and logistic regressions. Findings: We assessed 248 (81.58%) laboratory–confirmed cases and 56 (18.42%) suspected cases of COVID–19. The median age of all patients was 6.82 years (interquartile range: 2.08–10.20), and 186 cases (61.18%) were boys; furthermore, 30.26% of all patients were asymptomatic cases. The percentage of asymptomatic cases vaccinated with Bacillus Calmette Guerin (BCG) was not significantly higher than that without BCG vaccination (86/280 [30.71%] vs 6/13 [46.15%], P = 0.203), initial symptoms was not corrected with immunized influenza vaccine ( P = 0.267). Significant correlations were found between age and immunoglobulin (Ig) A (P < 0.001), IgE (P = 0.021), IgG (P < 0.001), complement C4 (P = 0.031), interleukin (IL)–10 (P = 0.003), and tumor necrosis factor (TNF)–α (P = 0.044). Compared to parameters in pediatric patients with normal body temperatures, patients with fever had higher high sensitivity C reactive protein (hs-CRP) (P < 0.001), IL–4 (P = 0.005), IL–10 (P = 0.038), TNF–α (P = 0.004), and TNF–γ (P = 0.036). Interpretation: Pediatric COVID–19 patients with BCG vaccinations exhibit similar clinical manifestations compared to those without BCG vaccinations, and the severity of symptoms in pediatric patients may be related to the maturity of immune function. Funding Statement: This study was partly supported by Top Medical Young Talents of Hubei Province, the National Science Foundation of China [81872637], Shanghai Municipal Commission of Health and Family Planning[201840324], Science and Technology Development Program of Pudong Shanghai New District [PKJ2017–Y01], Shanghai Professional and Technical Services Platform [18DZ2294100], and Shanghai Science and Technology Commission of Shanghai Municipality (17411965300, 17XD1402800,19441904400]. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was approved by the Institutional Review Board of Wuhan Children’s Hospital (IEC–2020R003–E01) and Shanghai Children’s Medical Center (SCMCIRB– K2020019–1).