1/ Remember all the media coverage of #omicron causing so much severe #COVID19 in young kids?

We extended our @UKHSA #COVID19 deaths surveillance in kids & found:

ONE #COVID19 fatality per MILLION #Omicron infections in children aged <20 yrs …🧵

👉 sciencedirect.com/science/articl… 2/ We assessed all fatalities within 30 days of a positive #SARSCoV2 test in <20 year-olds during Jan-Mar 2022 when national testing was still available. We collected detailed clinical data from multiple sources to ascertain cause of death for each child

1/ This is so mportant - thank you @kerpen for tagging me

The US with all its mitigations, vaccine & booster mandates has the same proportion of kids already exposed to #sarscov2 as the UK, which as been accused of “letting the virus rip”

90.3% (US) vs 86.7% (UK)

…🧵

https://twitter.com/kerpen/status/1608611826740396032

2/ In England, among 1-17 year-olds, we recently reported that by Sep 2022

➡️ 86.2% (95%CrL 81.1-91.6) had infection-induced #SARSCoV2 N antibodies

➡️ 97.2% (95% CrI 93.7%–98.9%) had #SARSCoV2 S-antibodies (infection and/or vaccine)

👉 journalofinfection.com/article/S0163-…

1/ Our @UKHSA paper on paediatric #SARSCoV2 antibody prevalence in England is now published

By Sep 2022, 97.2% of 1-17 year-olds had #SARSCoV2 antibodies

Our findings are critical for future #COVID19 vaccine/booster recommendations for kids

…🧵

👉sciencedirect.com/science/articl… 2/ Methods: We used residual samples from kids aged 1–17 years having a blood test as part of their clinical management in 44 hospital trusts in England. Samples were processed using Roche Elecsys assays for i) nucleocapsid (N) antibodies and ii) spike RBD (S) antibodies

1/ Our latest paper on longitudinal follow-up of teens with long covid (CLoCk) is a game changer:

Different teens report the same post-covid symptoms at 0, 6m & 12m after their #SARSCoV2 PCR , irrespective of whether they tested + or - for the virus

👉 sciencedirect.com/science/articl… 2/ Method: we followed up 11-17y with a PCR-positive #SARSCoV2 test compared with matched PCR-negative controls for 12 months after their test. The final cohort included 2,909 cases and 2,177 controls

1/ It’s really sad that, when we report that a disease (eg. #covid19) is more severe or fatal in kids with underlying conditions (eg neurodisabilities, immunocompromised), this is taken to mean that such kids are less valued

The truth is exactly the opposite…🧵 2/ It is really important that we identify kids at increased risk of severe outcomes after any condition (eg #COVID19) so we can raise awareness among clinicians, parents & policymakers to be extra vigilant & implement additional strategies protect them 👉journals.plos.org/plosmedicine/a…

Remember that recent US paper on #covid19 vaccination for 5-11y?

We didn’t agree with the conclusions (h/t @ProfAsmaKhalil)

So, we wrote to @NEJM to explain why US data do NOT support BOOSTERS for kids irrespective of their previous infection status

👉 nejm.org/doi/full/10.10… 2/ We pointed out that there was very little difference in protection against omicron infection between vaccinated & previously infected 5-11y, while infection plus 2 vaccine doses might provide slightly better protection after 4 months (79.4% vs 62.9%)

👉nejm.org/doi/full/10.10…

1/ Our national surveillance study on childhood #COVID19 deaths in the first 2 pandemic years in England is now peer-reviewed & published in @PLOSMedicine

Here are the main findings …🧵

👉 journals.plos.org/plosmedicine/a… 2/ There were 185 deaths within 100 days of a positive test and 81 (44%) were due to #covid19

That’s an infection fatality rate of 0.70/100,000 SARS-CoV-2 infections = 0.0007% fatality after infection

#SARSCoV2 was responsible for 1.2% (81/6,790) of all deaths in <20 year-olds

1/ Another study on #COVID19 #vaccine effectiveness in kids & teens published in @NEJM

Here are the 3 main findings, followed by an honest conclusion by the authors - compare this to conclusions of US authors in a study with similar findings … 🧵

👉 nejm.org/doi/full/10.10… 2/ In 5-11 year-olds in Qatar, overall #COVID19 vaccine effectiveness against omicron was 25.7% (95%CI, 10.0-38.6)

Vaccine effectiveness decreased with time, from 49.6% (95%CI, 28.5-64.5) right after dose 2 to 11.0% (95%CI, −26.8 to 37.5) by the third month after second dose

1/ So, here’s some really exciting news:

The hyper-inflammatory heart condition linked with #COVID19 (MIS-C/PIMS-TS) in kids has now virtually disappeared - despite large waves of community #SARSCoV2 infections with omicron & it’s subvariants …🧵

👉 journalofinfection.com/article/S0163-… 2/ We developed a real-time model to predict MIS-C cases based on local & national #SARSCoV2 infection rates. The model was very accurate in predicting cases during the Alpha variant wave but cases were >50% lower than predicted during the Delta wave

👉 papers.ssrn.com/sol3/papers.cf…

1/ I was asked to write an editorial on face masks for kids in educational settings

My conclusion?

We need to stop masking children in educational settings because, after nearly 3 years of the pandemic, there is no robust evidence of benefit

Short🧵

👉 sciencedirect.com/science/articl… 2/ My editorial accompanies a study that re-analyses a recent US CDC study and finds no benefit of masking kids against #covid19 when the analysis was extended to a larger more representative geographical region & over a longer time period

👉 journalofinfection.com/article/S0163-…

1/ Our new preprint on Long Covid & Kids:

TOPLINE: Teenagers who had parents with long covid were significantly more likely to report long covid symptoms at 6 months after a positive OR negative SARS-CoV-2 PCR-test (CLoCK study)

Surprised?…🧵

👉 papers.ssrn.com/sol3/papers.cf… 2/ We have been following up a national cohort of 11-17 yr-olds with PCR-confirmed #SARSCoV2 infection alongside teens with a negative PCR-test matched by age, sex, geographical area & month of test since Sep 2020 as part of the CLoCk study in England

👉 bmjopen.bmj.com/content/11/8/e…

1/ Our preprint on immune responses of kids to #SARSCoV2 #Omicron is online

Top line: Primary Omicron infection induces poor antibody responses in unvaccinated kids, but robust T cell responses which will protect against severe #COVID19 in the future🧵

👉biorxiv.org/content/10.110… 2/ We determined the variant-specific antibody and cellular immune response following Omicron infection in children aged 6-14 years and related this to prior SARS-CoV-2 infection and vaccination status.

1/ Many parents are still concerned about long covid in kids:

If you want to know where we really are with long covid in kids then take a few mins to read this short, honest, down-to-earth editorial by a Danish paediatrician in @LancetChildAdol …🧵

👉 thelancet.com/journals/lanch… 2/ Early in the pandemic, following long covid reports in adults, studies focused on asking parents & their kids about symptoms experienced after #COVID19. Most kids had common, non-specific symptoms that commonly come and go over time, often nothing to do with covid

1/ I was asked by @TheLancet to write an editorial on #COVID19 vaccines for 5-11 year-olds: 6 months on, what have we learnt?

Importantly, what is the endgame?
Preventing infections? Severe disease? Long covid? And at what cost?

My tuppence worth …🧵

👉thelancet.com/journals/lance… 2/ My editorial was based on an Italian study on #COVID19 vaccines for 5-11y during Jan-Apr 2022:

VE ⬇️ from 65% (95% CI 62–68) in the 2 weeks after 2 doses to 12% (8–16) by 28-34 days

VE against hospitalisation was 41·1% (22·2–55·4) after 2 doses

👉 thelancet.com/journals/lance…

1/ Our preprint on #COVID19 & childhood deaths during the first 2 pandemic years in England 👉papers.ssrn.com/sol3/papers.cf…

Top line: Among ~12 million <20 year-olds, there were 81 #covid deaths (infection fatality rate, 0.70/100,000 infections) - that’s less than 1 in 100,000 …🧵 2/ We followed up all deaths within 100 days of confirmed #SARSCoV2 infection in children & young people (CYP) aged <20 years in England during 2021 & 2022, using national databases, surveillance questionnaires, post-mortem reports and clinician interviews

1/ Unlike adults, the majority of kids hospitalised with #SARSCoV2 do *not* have severe #Covid

In London we found only 10% of kids hospitalised with a +ve #sarscov2 PCR-test had severe #COVID19, mainly during the alpha wave

Here’s our preprint…🧵

👉 papers.ssrn.com/sol3/papers.cf… 2/ We reviewed medical records of 0-18 year-old admitted to a large London teaching hospital over 14 months, covering alpha, delta & omicron waves. PIMS-TS excluded because diagnosis does not require positive virus test. There were 150 kids hospitalised between 01Dec20 & 31Jan22

1/ Back when #SARSCoV2 Delta variant emerged & there were reports of increased severity in adults & then in US kids, we tried to reassure parents with indirect data that delta was not more severe than alpha in kids. Here finally is our evidence …🧵

👉 thelancet.com/journals/lanch… 2/ We compared hospitalizations in kids with alpha or delta variant in England. Between Nov 1 2020 & Sept 13, 2021 (before COVID-19 vaccine for 12–15y in the UK), there were 759 307 SARS-CoV-2 infections in kids; 156 031 were sequenced/genotyped: 31 182 were alpha & 115 795 delta

1/ Please BEWARE this pre-print from Hong Kong claiming that the Omicron BA.2 variant is not mild in kids. Basic epidemiology will tell you that the methodology is flawed & the conclusions go against everything we know about the Omicron variants

👉 papers.ssrn.com/sol3/papers.cf… 2/ This preprints compares 1,147 kids (0-11y) who were hospitalized with BA.2 in Feb 2022 (at the peak of their latest pandemic wave) with 737 kids hospitalised with any of the past #SARSCoV2 variants since the start of the pandemic (over 20 months) - but here’s the problem…

1/ Our latest analysis from the UK School Infection Survey (SIS2) is now online @UKHSA @ONS @LSHTM

Here are some interesting findings from the autumn term (Sep-Dec 2021) in primary and secondary schools … 🧵

👉 ons.gov.uk/peoplepopulati… 2/ Unlike autumn 2020, the highest infection rates in autumn 2021 were in kids in least deprived areas (20.1% primary & 27.9% secondary pupils in least deprived vs 9.4% primary & 15.3% secondary pupils in most deprived) - likely because they had avoided infection previously

1/ In England, ONS recruited nationally representative schools in Nov 2021 & found only 1.0% of kids in primary (4-11y) & 2.7% in secondary (11-17y) schools fulfilled Long COVID criteria *since March 2020* - only loss of taste/smell was significant…🧵

👉ons.gov.uk/peoplepopulati… 2/ The survey used Delphi criteria developed from the CLoCk study to define long COVID, which included:
1. Positive viral test
2. Symptoms for 12 weeks or more
3. Everyday life affected by these symptoms

👉 bmjopen.bmj.com/content/11/8/e…

1/ In other news, England is seeing an ⬆️ in invasive pneumococcal disease in young kids this winter, higher than pre-pandemic years, likely because of immunity debt from earlier lockdowns. Fortunately, total cases still 50% ⬇️ @MartaBertran9 @acciochoc 👉 papers.ssrn.com/sol3/papers.cf… 2/ We recently also reported a small ⬆️ in meningococcal group B infections (meningitis, septicaemia) in university-aged students (the main age group that carries meningococcal bacteria at the back of their nose/throat) - higher than pre-pandemic numbers 👉papers.ssrn.com/sol3/papers.cf…