Differences in SARS-CoV-2 Clinical Manifestations and Disease Severity in Children and Adolescents by Infecting Variant

Figure 1. Shifts in the circulating SARS-CoV-2 variants identified at Nationwide Children’s Hospital, Columbus, Ohio, USA, by percentage of total cases irrespective of patient age, January 2021–January 2022. The others category comprises Beta (n = 12), Iota (n = 9), Zeta (n = 7), Eta (n = 2), Epsilon (n = 3), and Mu (n = 2) variants, as well as variants under investigation (n = 2). The black dotted line represents the rate of positive tests by month.

Figure 2. Flow diagram of sample and patient selection for SARS CoV-2 variant screening of nasopharyngeal samples at Nationwide Children’s Hospital, Columbus, Ohio, USA, during January 1, 2021–January 15, 2022. After excluding patients >22 years of age and duplicate entries, 676 patients with positive SARS-CoV-2 tests during January 1–September 19, 2021, and December 15, 2021–January 15, 2022 were included in the clinical analyses. Other variants were Beta, Iota, Zeta, Eta, Epsilon, Gamma, Mu, and other variants under investigation.

Figure 3. Distribution of SARS-CoV-2 variants pediatric and adolescent patients included in a clinical cohort (n = 676) at Nationwide Children’s Hospital, Columbus, Ohio, USA, by age group. Bars represent the percentage of each SARS-CoV-2–specific variant in the different age groups.

Figure 4. SARS-CoV-2 viral loads and viral co-infections among children and adolescents with COVID-19 at Nationwide Children’s Hospital, Columbus, Ohio, USA, by the infecting SARS-CoV-2 variant, January 1, 2021–January 15, 2022. A) Nasopharyngeal SARS-CoV-2 viral loads expressed as Ct values according to the infecting SARS-CoV-2 variant in the clinical cohort (n = 676). Percentage of total infections for each variant is below each bar. B) Viral co-infections by SARS-CoV-2 variant during the study period in patients that underwent multiplex viral testing. Twelve patients with other variants tested negative for viral co-infections (not shown). Percentage of total co-infections is above each bar. p value was determined by χ2 test. C) Nasopharyngeal SARS-CoV-2 Ct values by infecting SARS-CoV-2 variant among inpatients with acute COVID-19, excluding patients with MIS-C, SARS-CoV-2 detected by screening in inpatients, and those infected with uncommon SARS-CoV-2 strains. p value at bottom right represents the overall Kruskal-Wallis p value; values above bars indicate ad hoc pairwise comparisons by Dunn multiple test correction. For box plots in panels A and C, horizontal lines within boxes…