Children aged 5–17 years with poorly-controlled asthma should be offered COVID-19 vaccination, according to new study

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The current UK recommendation on COVID-19 vaccination for children aged 12–17 years should be expanded to include children in the 5–17 years age bracket who have been hospitalised with asthma or prescribed two or more courses of oral steroids for asthma within the past two years, according to the findings of a Scottish study published in The Lancet Respiratory Medicine.

The study analysed data from more than 750,000 school-aged children in Scotland who were included in the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) dataset to identify which children with asthma are at increased risk of serious COVID-19 outcomes, and should be prioritised for vaccination.

Between March 1 2020 and July 27 2021, 752,867 children were included in the EAVE II dataset, 63,463 (8.4%) of whom had clinician-diagnosed and recorded asthma. Of these, 4339 (6.8%) had RT-PCR confirmed SARS-CoV-2 infection.

In those with confirmed infection, 67 (1.5%) were admitted to hospital with COVID-19. Among the 689,404 children without asthma, 40,231 (5.8%) had confirmed SARS-CoV-2 infections, of whom 382 (0.9%) were admitted to hospital with COVID-19.

An increased risk of COVID-19 hospital admission

The rate of COVID-19 hospital admission was higher in children with poorly-controlled asthma—defined as previous asthma hospital admission and at least two previous prescriptions for oral corticosteroids within two years of the study start date—than in those with well controlled asthma or without asthma.

When using previous hospital admission as the marker of uncontrolled asthma, the risk of COVID-19 hospitalisation was increased more than six-fold (adjusted HR [aHR] 6.40; 95% confidence interval [CI] 3.27–12.53) for those with poorly-controlled asthma and by more than 30 per cent (aHR 1.36; 95% CI 1.02–1.80) for those with well controlled asthma, compared with those with no asthma.

When using oral corticosteroid prescriptions as the marker of uncontrolled asthma, the aHR for COVID-19-related hospital admission was 3.38 (95% CI 1.84–6.21) for those who had received at least three courses of corticosteroids in the previous two years, and 3.53 (95% CI 1.87–6.67) for those who had been prescribed two courses, compared with those with no asthma. Children who had received one course of corticosteroids had an aHR of 1.52 (95% CI 0.90–2.57) and those with asthma who had not been prescribed a course of oral corticosteroids had an aHR of 1.34 (95% CI 0.98–1.82), compared with children with no asthma.

The findings of the analysis—the first of its kind—suggest that school-aged children with asthma and a recent hospital admission or at least two courses of oral corticosteroids are at markedly increased risk of COVID-19 hospital admission, although it must be noted that the overall risk of admission was low, with one in 380 children with poorly-controlled asthma being admitted.

‘Keeping children’s asthma under control is critical’

Presenting the results, the authors recommend that children aged 5–17 years, with poorly-controlled asthma, should be prioritised for vaccinations. It is estimated that this would translate to approximately 109,448 children across the UK.

Commenting on the research, lead author, Professor Aziz Sheikh, from the University of Edinburgh, explained that ‘understanding which children with asthma are at increased risk of serious COVID-19 outcomes is critical to ongoing policy deliberations on vaccine prioritisation.

‘The key takeaway from this study is that keeping children’s asthma under control is critical as this greatly reduces the risk of COVID-19 hospitalisation. Vaccinating those with poorly-controlled asthma offers an additional important layer of protection from serious COVID-19 outcomes.’

The study findings are limited by a number of factors, however, including the use of surrogate markers of poor asthma control and the omission of some confounding factors, such as tobacco exposure, living conditions, and ethnicity.

This article first appeared on Medscape, part of the Medscape Professional Network.


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