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PEDIATRICS Vol. 113 No. 6 June 2004, pp. e535-e543

ELECTRONIC ARTICLE

Severe Acute Respiratory Syndrome Among Children

Chi-wai Leung, FRCPCH^*, Yat-wah Kwan, MRCP^*, Po-wan Ko, MRCP, Susan S. Chiu, MD, Po-yee Loung, MBChB^*, Nai-chung Fong, MRCP^*, Lai-ping Lee, MRCP^*, Yim-wo Hui, MRCP^*, Helen K.W. Law, PhD, Wilfred H.S. Wong, MSc, Kwok-hung Chan, PhD^||, J.S. Malik Peiris, DPhil^||, Wilina W.L. Lim, FRCPath^¶, Yu-lung Lau, MD, Man-chun Chiu, FRCPCH^*

^* Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong
Department of Paediatrics and Adolescent Medicine, Our Lady of Maryknoll Hospital, Hong Kong
Departments of Paediatrics and Adolescent Medicine
^|| Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong
^¶ Government Virus Unit, Public Health Laboratory Centre, Department of Health, Hong Kong

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.

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Key Words: severe acute respiratory syndrome • SARS • children

Abbreviations: SARS, severe acute respiratory syndrome • SARS-CoV, SARS-associated coronavirus • CXR, chest radiograph • HRCT, high-resolution computed tomography • NPA, nasopharyngeal aspirate • RSV, respiratory syncytial virus • RT-PCR, reverse transcription-polymerase chain reaction • WHO, World Health Organization

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Received for publication Nov 24, 2003; Accepted Jan 21, 2004.

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