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<p>SARS-CoV-2 Omicron variant evolved into multiple sub-lineages, some showing increased transmissibility and immune evasion. Despite decreased risk of severe disease, paediatric hospitalization rose. However, factors influencing clinical outcomes remain unclear. A total of 458 whole-genome Omicron sequences from patients 0–17 years, diagnosed with SARS-CoV-2 at Bambino Gesù Children’s Hospital (January-December 2023) were analysed. Clinical features, disease severity and circulating variants were assessed. Phylogenetic analysis was performed, and logistic regression identified factors associated with hospitalization. Among patients, 249 (54.4%) were male, with median age 0.6 years. Comorbidities were present in 105 (22.9%) patients, mainly immunocompromised (21.0%). Infections were predominantly from XBB (75.0%), JN.1 (12.4%), BA.5 (7.4%) and BA.2 (5.2%) clades. Upper respiratory infections predominated (73.8%), followed by asymptomatic (17.2%) and lower respiratory infections (4.6%), with nine patients having ≥ 1 co-infection. Comorbidities and lower respiratory infections were positively associated with hospitalization, while upper respiratory infections showed a negative association. Given the recent shift to RGN integrin-binding motif in Omicron sub-lineages, leading to altered pathogenesis, its presence was evaluated, revealing a predominance of RGN (<i>N</i> = 378, 84.6%). In conclusion, COVID-19 severity in paediatric patients was primarily driven by comorbidities and co-infections, while milder cases in healthy children may be associated with RGN integrin-binding motif.</p>

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Clinical manifestations and severity of COVID-19 caused by Omicron among paediatric patients aged 0–17 years in Italy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月21日

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  • Rossana Scutari,
  • Valeria Fox,
  • Jennifer L. Nguyen,
  • Luna Colagrossi,
  • Andrea Smarrazzo,
  • Anna Chiara Vittucci,
  • Laura Cursi,
  • Martina Mastropaolo,
  • Lorena Forquè Rodriguez,
  • Carmen D’amore,
  • Luciano Pacelli,
  • Mustapha M. Mustapha,
  • Claudia Alteri,
  • Jingyan Yang,
  • Antonella De Santis,
  • Romina Quercia,
  • Alessandra Pagliaro,
  • Annarita Granaglia,
  • Vanessa Fini,
  • Srinivas R. Valluri,
  • Cristina Russo,
  • Catia Marques,
  • John M. McLaughlin,
  • Laura Lancella,
  • Marta Luisa Ciofi degli Atti,
  • Andrea Campana,
  • Massimiliano Raponi,
  • Alberto Villani,
  • Carlo Federico Perno

摘要

SARS-CoV-2 Omicron variant evolved into multiple sub-lineages, some showing increased transmissibility and immune evasion. Despite decreased risk of severe disease, paediatric hospitalization rose. However, factors influencing clinical outcomes remain unclear. A total of 458 whole-genome Omicron sequences from patients 0–17 years, diagnosed with SARS-CoV-2 at Bambino Gesù Children’s Hospital (January-December 2023) were analysed. Clinical features, disease severity and circulating variants were assessed. Phylogenetic analysis was performed, and logistic regression identified factors associated with hospitalization. Among patients, 249 (54.4%) were male, with median age 0.6 years. Comorbidities were present in 105 (22.9%) patients, mainly immunocompromised (21.0%). Infections were predominantly from XBB (75.0%), JN.1 (12.4%), BA.5 (7.4%) and BA.2 (5.2%) clades. Upper respiratory infections predominated (73.8%), followed by asymptomatic (17.2%) and lower respiratory infections (4.6%), with nine patients having ≥ 1 co-infection. Comorbidities and lower respiratory infections were positively associated with hospitalization, while upper respiratory infections showed a negative association. Given the recent shift to RGN integrin-binding motif in Omicron sub-lineages, leading to altered pathogenesis, its presence was evaluated, revealing a predominance of RGN (N = 378, 84.6%). In conclusion, COVID-19 severity in paediatric patients was primarily driven by comorbidities and co-infections, while milder cases in healthy children may be associated with RGN integrin-binding motif.