Immunocompromised Children and Young People Are at No Increased Risk of Severe COVID-19

Background: The risk of SARS-CoV-2 infection to immunocompromised children and young people remains of concern to parents and clinicians despite little data suggesting increased morbidity or mortality. We aimed to prospectively describe the incidence and clinical spectrum of SARS-CoV-2 infection in immunocompromised paediatric patients in the UK. Methods: From March 2020 – 2021 weekly questionnaires were sent to immunocompromised paediatric patients or their parents. Information, including symptom presentation and SARS-CoV-2 PCR test results, was collected from 1527 participants from 46 hospitals. Cross-sectional serology was investigated in February and March 2021. Findings: Until the end of September 2020 no cases were reported. From September 28th 2020 through March 2021 a total of 38 PCR-detected SARS-CoV-2 infections were reported. Of these, four children were admitted to hospital but none had acute severe COVID-19. Increasing age in association with immunodeficiency increased reporting of SARS-CoV-2 infection. Worsening of fever, cough, and sore throat were associated with participants reporting SARS-CoV-2 infection. Serology data included 452 unvaccinated participants. In those reporting prior positive SARS-CoV-2 PCR, there were detectable antibodies in 9 of 18 (50%). In those with no prior report of infection, antibodies were detected in 32 of 434 (7·4%). Interpretation: This study shows SARS-CoV-2 infections have occurred in immunocompromised children and young people with no increased risk of severe disease. No children died. Funding Information: British Paediatric Allergy, Immunity and Infection Group. Southampton Rheumatology Trust. NIHR Senior Investigator award to SNF. Declaration of Interests: All authors have completed ICMJE disclosure forms. HdG received grant funding from the BPAIIG for the submitted work; there are no other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: The study gained ethical approval from the Yorkshire and the Humber – Leeds West NHS Research Ethics Committee (IRAS 281544).