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Epidemiology of SARS-CoV-2 infection and SARS-CoV-2 positive hospital admissions among children in South Africa
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  • Tendesayi Kufa,
  • Waasila Jassat ,
  • Cheryl Cohen,
  • Stefano Tempia,
  • Maureen Masha ,
  • Nicole Wolter,
  • Sibongile Walaza,
  • Anne von Gottberg,
  • Nelesh Govender ,
  • Gillian Hunt,
  • Andronica Shonhiwa,
  • Joy Ebonwu,
  • Genevie M. Ntshoe,
  • Wellington Maruma ,
  • Poncho Bapela ,
  • Nomathamsanqa Ndhlovu,
  • Hlengani Mathema,
  • Motshabi Modise ,
  • Liliwe Shuping,
  • Pinky Manana,
  • David Moore ,
  • Ziyaad Dangoor,
  • Charl Verwey,
  • Shabir Madhi,
  • Haroon Saloojee,
  • Heather J. Zar,
  • Lucille Blumberg
Tendesayi Kufa
National Institute for Communicable Diseases
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Waasila Jassat
National Institute for Communicable Diseases
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Cheryl Cohen
National Institute for Communicable Diseases
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Stefano Tempia
National Institute for Communicable Diseases
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Maureen Masha
National Institute for Communicable Diseases
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Nicole Wolter
National Institute for Communicable Diseases
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Sibongile Walaza
National Institute for Communicable Diseases
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Anne von Gottberg
National Institute for Communicable Diseases
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Nelesh Govender
National Institute for Communicable Diseases
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Gillian Hunt
National Institute for Communicable Diseases
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Andronica Shonhiwa
National Institute for Communicable Diseases
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Joy Ebonwu
National Institute for Communicable Diseases
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Genevie M. Ntshoe
National Institute for Communicable Diseases
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Wellington Maruma
National Institute for Communicable Diseases
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Poncho Bapela
National Institute for Communicable Diseases
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Nomathamsanqa Ndhlovu
National Institute for Communicable Diseases
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Hlengani Mathema
National Institute for Communicable Diseases
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Motshabi Modise
National Institute for Communicable Diseases
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Liliwe Shuping
National Institute for Communicable Diseases
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Pinky Manana
National Institute for Communicable Diseases
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David Moore
University of the Witwatersrand Faculty of Health Sciences
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Ziyaad Dangoor
University of the Witwatersrand Faculty of Health Sciences
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Charl Verwey
University of the Witwatersrand Faculty of Health Sciences
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Shabir Madhi
University of the Witwatersrand Faculty of Health Sciences
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Haroon Saloojee
University of the Witwatersrand Faculty of Health Sciences
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Heather J. Zar
University of Cape Town Faculty of Health Sciences
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Lucille Blumberg
National Institute for Communicable Diseases
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Abstract

Introduction: We describe epidemiology and outcomes of confirmed SARS-CoV-2 infection and admissions among children <18 years in South Africa, an upper-middle income setting with high inequality. Methods: Laboratory and hospital COVID-19 surveillance data, 28 January - 19 September 2020 was used. Testing rates were calculated as number of tested for SARS-CoV-2 divided by population at risk; test positivity rates were calculated as positive tests divided by total number of tests. In-hospital case fatality ratio (CFR) was calculated based on hospitalized positive admissions with outcome data who died in-hospital and death was judged SARS-CoV-2 related by attending physician. Findings: 315,570 children aged <18 years were tested for SARS-CoV-2; representing 8.9% of all 3,548,738 tests and 1.6% of all children in the country. Of children tested, 46,137 (14.6%) were positive. Children made up 2.9% (n=2,007) of all SARS-CoV-2 positive admissions to sentinel hospitals. Among children, 47 died (2.6% case-fatality). In-hospital deaths were associated with male sex [adjusted odds ratio (aOR) 2.18 (95% confidence intervals (CI) 1.08 - 4.40)] vs female; age <1 year [aOR 4.11 (95% CI 1.08-15.54)], age 10-14 years [aOR 4.20 (95% CI1.07-16.44)], age 15-17 years [aOR 4.86 (95% 1.28 -18.51)] vs age 1-4 years; admission to a public hospital [aOR 5.07(95% 2.01 -12.76)] vs private hospital and ≥1 underlying conditions [aOR 12.09 (95% CI 4.19-34.89)] vs none Conclusions: Children with underlying conditions were at greater risk of severe SARS-CoV-2 outcomes. Children > 10 years and those with underlying conditions should be considered for increased testing and vaccination.
14 Sep 2021Submitted to Influenza and other respiratory viruses
15 Sep 2021Assigned to Editor
15 Sep 2021Submission Checks Completed
15 Sep 2021Editorial Decision: Accept
18 Nov 2021Published in Influenza and Other Respiratory Viruses. 10.1111/irv.12916