Pandemic News - Why We Need To Help Poor Countries Get Vaccinated and Have Access to Effective Treatment

Nadia Sam-Agudu, MD, lead author of the study.

2022 News - Multi-Country African Research Reports High Rates of COVID-19-Related Deaths Among Hospitalized Children and Adolescents | University of Maryland School of Medicine

An open access paper published recently in JAMA Pediatrics shows that African children and adolescents hospitalized with COVID-19 experience much higher mortality rates than Europeans or North Americans of the same age.

The study, led by Associate Professor Nadia Sam-Agudu, MD, of Maryland University School of Medicine (MUSOM), entitled, Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized with COVID-19 in six Sub-Saharan African Countries, was conducted by a collaboration under AFREhealth (the African Forum for Research and Education in Health), a consortium of cross-disciplinary health personnel across Africa.

According to information supplied by the University of Maryland School of Medicine:

This study provides important information about COVID-19 among African children, which was not previously available at this scale. We now have evidence from multiple countries to show that African children also experience severe COVID-19; they experience multisystem inflammatory syndrome; some require intensive care; some also die, and at much higher rates than outside Africa.

[Policy makers in Nigeria and other African countries are urged] to protect children by expanding vaccine approvals and procurements for children specifically, as the variants emerging since our study’s completion have either caused more severe disease and/or more cases overall. We cannot leave children behind in the pandemic response.

Nadia Sam-Agudu, MD, co-first author
Associate Professor of Pediatrics
Institute of Human Virology
University of Maryland School of Medicine, Maryland, USA
And Senior Technical Advisor for Pediatric and Adolescent HIV
Institute of Human Virology
Nigeria

African children and adolescents hospitalized with COVID-19 experience much higher mortality rates than Europeans or North Americans of the same age, according to a recently published study conducted by researchers from the Institute of Human Virology (IHV) at the University of Maryland School of Medicine (UMSOM) and the Institute of Human Virology Nigeria (IHVN). Both organizations are members of the Global Virus Network (GVN).

The study, titled, “Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized with COVID-19 in six Sub-Saharan African Countries,” was conducted by a collaboration under AFREhealth (the African Forum for Research and Education in Health), a consortium of cross-disciplinary health personnel across Africa. The research was published on January 19 in JAMA Pediatrics, the highest-ranked pediatrics journal in the world.

The AFREhealth study collected data from 25 health facilities across Nigeria, Ghana, Democratic Republic of the Congo, Kenya, South Africa, and Uganda. The study included 469 African children and adolescents aged three months to 19 years hospitalized with COVID-19 between March and December 2020. The team reported a high overall mortality rate of 8.3%, compared with 1% or less totaled from Europe and North America. Furthermore, African children less than a year old and with pre-existing, non-communicable diseases were more likely to have poorer outcomes, such as requiring intensive care, and death.

Eighteen participants had suspected or confirmed multisystem inflammatory syndrome (also known as MIS-C), and four of these children died.

Patrick Dakum, MBBS, MPH

"This data from Dr. Sam-Agudu and AFREhealth collaborators puts science from Nigeria and the rest of Africa squarely on the map for pandemic-responsive research, particularly for young populations. We will continually work towards contributing to research discoveries in Nigeria, West Africa and beyond."

Alash’le Abimiku, PhD

"The high impact pediatric COVID-19 findings of this collaborative research underscores the value of sustained investments in strong research institutions, collaborations, and leadership in Nigeria and across Africa. We can generate rigorous local data to guide local, regional, and international health policy and practice."

Robert Gallo, MD

“I am pleased to see our team of researchers continue to build upon the Institute’s eighteen years of work in African nations, particularly Nigeria, and successfully advance a study across varying nations to garner much needed data as this pandemic continues to evolve. Africa is the epicenter of many epidemics, and an important partner in researching viral threats. ‘Pan’ means all, and we must all work together to combat viral threats against mankind.”

Dean E. Albert Reece, MD, PhD, MBA

“Studies like this are essential to ensure that no one country or region is suffering any unneeded hardship. As a result, policy makers and world leaders can better allocate resources to those people and places who need them most.”

The teams findings are published open access in JAMA Pediatrics:

Abstract

Importance Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent.

Objective To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa.

Design, Setting, and Participants This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection.

Exposures Age, sex, preexisting comorbidities, and region of residence.

Main Outcomes and Measures An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay.

Results Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge.

Conclusions and Relevance In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.

Nachega JB, Sam-Agudu NA, Machekano RN, et al.
Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries.
JAMA Pediatrics Pubblished online January 19, 2022. doi:10.1001/jamapediatrics.2021.6436

Copyright: © 2022 The authors. Published by The American Medical Association
Open access
Reprinted under a Creative Commons Attribution 4.0 International license (CC BY 4.0)

The arguments in favour of the wealthy countries providing aid to third-world countries and emerging economies in the form of finance, vaccines, medical expertise and therapeutic drugs are now overwhelming:

1. Humanitarian grounds. As this report shows, African's and in particular African children are many times more likely to require hospitalisation and several time more likely to die of COVID-19 for multiple reasons:
   • Other endemic diseases make them more vulnerable to COVID-19, especially if they are already immune-compromised
   • Because of difficulties in supplying the vaccines to remote areas as well as their general availability in places like Africa, they may not have been vaccinated.
   • If they do fall ill, the medical facilities, expertise and therapeutic drugs may not be available to treat them effectively.
2. Practical grounds. A vulnerable, unprotected population can act as a development ground for new and more virulent variants of the SARS-CoV-2 virus. It is probably no coincident that the last two major waves have been the delta variant, which is believed to have arisen in India, and the currently predominant omicron variant, which appears to have arisen in Africa. This is especially true of a population in which many are immune-compromise, and HIV has been endemic to Africa for many years now. Additionally, many of the parasitic worms endemic to Africa and other poor countries also suppress the immune system as part of their own evolved survival strategy.

If we are to finally put an end to these regular waves of new COVID-19 infections, re-infections and even infections that can escape any immunity we now have, it is vital that we protect as many people in Africa and other poor countries as quickly and effectively as possible, and that means funding organisations such as the WHO so they can mount effective education, vaccination and maybe even eradication campaigns.

If we can't beat it, at least we can reduce the chances of new, even more deadly variants arising so frequently.

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