Do symptom profiles differ among children with SARS-CoV-2 infection depending on the type of variant?

In a recent study published in JAMA Network is openIn this study, the researchers performed a comparative analysis of symptoms related to SARS-CoV-2 variants in children.

Study: Comparison of symptoms associated with SARS-CoV-2 variants among children in Canada.  Image credit: Dragana Gordic/Shutterstock
Stady: Comparison of symptoms associated with SARS-CoV-2 variants among children in Canada. Image credit: Dragana Gordic/Shutterstock


The emergence of SARS-CoV-2 variants of concern (VoC) with diverse transmission patterns has impacted the evolution of the novel coronavirus 2019 (COVID-19) pandemic. As the virus evolved, so did the symptoms and severity of the disease.

The Omicron variant can infect the upper airways and multiply more rapidly in the bronchi than in the lung parenchyma than other variants. Symptoms of Omicron infection are different from those of delta VOC in adults, and the fatality rate is lower. While Omicron infection among children has been linked to diphtheria as well as upper airway disease, no studies have compared the prevalence of symptoms between the original strain of SARS-CoV-2 and the most recent audible, and the severity of the illness remains poorly understood.

about studying

In the current study, the researchers evaluated Symptoms of COVID-19 diseaseEmergency department (ED) chest radiography, treatments, and outcomes associated with SARS-CoV-2 variants in children.

This cohort observational study enrolled children and adolescents who were tested for severe COVID-19 and visited one of 14 Canadian urban children’s medical centers between August 4, 2020, and February 22, 2022. The team reported data according to the strengthening of reporting on existing studies. On Surveillance in Epidemiology (STROBE) Guidelines.

Participants were under the age of 18 and tested positive for SARS-CoV-2 nucleic acid A test performed on samples taken from the nasopharynx, throat, or nostril. Research assistants contacted all potentially eligible children by telephone, starting with the first child evaluated each day.

The primary outcome of the study included the detection and number of visible symptoms observed between disease onset and enrollment. The team classified symptoms into groups, including gastrointestinal, lower respiratory, hydration, neurological, musculoskeletal, oral changes or rashes, upper respiratory, and systemic symptom clusters. In addition, age or anosmia, cough, fever, and conjunctivitis were assessed separately without pooling for other symptoms.

Secondary outcomes were as follows: (1) detection of symptoms of primary SARS-CoV-2 infection; (2) requirements for performing chest radiography and treatment; and (iii) hospital admissions, admissions to the intensive care unit (ICU), and return visits to any ED or any healthcare provider within 14 days since the indication ED visit.


Approximately 1,440 of the 7,272 eligible individuals have tested positive for SARS-CoV-2 infection. The average age of the 1,440 study participants was 2 years, with 801 males and 639 females participating in the population. A total of 388 subjects were tested for VoC, resulting in the identification of 158 Alpha, 177 Delta, and 46 Omicron VOCs, along with one beta and six gamma VOCs. Associated respiratory viruses are more commonly detected in children with delta. Of the 998 participants who were asked about their children’s COVID-19 vaccination status, 80 were vaccinated with one dose, 816 were not, and 102 were unsure.

Individually, cough, fever, and runny nose were the most common symptoms. Individuals diagnosed with the virus are often shown with the original type Stomach ache, anosmia, aging, and myalgia. Individuals with Alpha had the least sleepiness, conjunctivitis, mouth changes, sore throat, and runny nose. Individuals with Delta usually present with cough, conjunctivitis, and upper respiratory symptoms, while those with Omicron usually experience drowsiness, fever, and shortness of breath. Individuals with the alpha variant reported the fewest symptoms overall. Only 85 of the 237 infected individuals reported at least seven symptoms.

Delta and Omicron infections were associated with cough and fever according to the multivariate model. Omicron infection was associated with lower respiratory tract symptoms in addition to systemic symptoms, whereas delta infection was associated with upper respiratory tract symptoms. In addition, the musculoskeletal symptoms were more closely associated with the virus of the original type than with the other sounds. Age or loss of smell, as well as skin rashes or oral changes, have been associated with infection due to the alpha and Omicron strains to a lesser extent than the original type.

The majority of study participants reported basic COVID-19 symptoms. These symptoms were more common among people with Omicron and less common among those with Omicron. Compared with patients with Alpha and Delta VOCs, Omicron patients were more likely to have chest radiography and to receive intravenous fluids.

Children with Omicron were more likely to be prescribed corticosteroids than those with various other infections. In addition, people with Omicron disease were more likely to visit EDs than those with Delta infection. In total, 164 children were hospitalized, and nine were admitted to the intensive care unit, with no difference between the two groups.


The results of the study showed that children with SARS-CoV-2 Omicron VOC were more likely to have fever, systemic signs, and lower respiratory symptoms than those with earlier variants.

These results emphasized the importance of maintaining vigilance in changing clinical manifestations and evaluating patients when clinically necessary. Notably, although the symptom onset characteristics of COVID-19 changed with the evolution of SARS-CoV-2, the proportion of pediatric COVID-19 patients who tested negative remained constant, in contrast to adults.

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