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.