Introduction:
The coronavirus-19 (COVID-19) pandemic to date has accounted for over
6.9 million deaths and 530 million cases1. Most
children have asymptomatic or mild symptoms of SARS-CoV-2 infection
comparative to adults, with lower rates of
hospitalization2-4. Hospitalization rates have been
quoted between 0.04-1.26%4-6
Approximately 4-6% of children admitted to hospital develop severe
disease4, 6 with risk factors for severe disease being
any pre-existing medical conditions2, 6 (particularly
chronic lung disease, cardiovascular disease, airway
abnormality6, 7) male sex2, 6, age
less than 1 month2, viral
coinfection2 and obesity7. Increased
incidence of severe disease has been noted in adults on
immunosuppressive medications, proton pump inhibitors8and famotidine8, however these relationships are less
clear in children9, 10
Knowledge of patients at risk for increased mortality and morbidity is
essential to inform public health measures, clinical decision making and
recommendations for vaccination.
Esophageal atresia-Tracheoesophageal fistula (EA-TEF) is one of the most
common congenital malformations of the aerodigestive tract affecting 1
in 2500 to 1 in 4500 live births11, 12. Improved
operative and perioperative care has resulted in survival rates between
90-100%13, with management of EA-TEF patients now
focused on improving management of associated symptoms and
complications. Children with EA-TEF are at increased risk of respiratory
infections due to airway abnormalities (tracheomalacia, impaired airway
clearance and aspiration from impaired swallow and gastro-esophageal
reflux)14, with recurrent respiratory tract infections
increase the risk of chronic lung disease. Half of EA-TEF patients have
an underlying syndrome, such as VACTERL, CHARGE syndrome and chromosomal
abnormalities and there is an frequency of congenital cardiovascular
disease14. Finally, EA-TEF patients are often on acid
suppressing medications. These comorbidities and treatments may
potentially increase these patient’s risk of severe SARS-CoV-2 infection
and epidemiological data is required to inform medical care.