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Children with poorly controlled asthma should be vaccinated to cut COVID risk, say experts

Children with poorly controlled asthma are up to six times more likely to be hospitalised with COVID-19 than those without the condition, a study conducted in Scotland suggests.

The study was launched following a request by the UK’s Joint Committee on Vaccination and Immunisation to investigate the risk of hospitalisation for those in school whose condition has required previous interventions.

About 1.1 million children in the UK are thought to have asthma, and researchers concluded that 5- to 17-year-olds, whose condition has previously required interventions, should be considered a priority for vaccination to reduce the risk of infection and the spread of the coronavirus in schools and households.

Researchers used the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) project, jointly funded by NIHR and UK Research and Innovation (UKRI), which uses anonymised linked patient data to track the pandemic and covers 99% of the Scottish population.

Analysing the data 

The team from the universities of Edinburgh, Aberdeen, Glasgow, Strathclyde and St Andrews, as well as Public Health Scotland, analysed de-identified health records for children of school age across Scotland, which included 63,463 diagnosed with asthma.

In the context of the study, an indicator of poorly controlled asthma was having been prescribed at least two courses of oral steroids in the previous two years.

Applying this yardstick, the results showed 255 per 100,000 of children with poorly controlled asthma were hospitalised for COVID-19 compared with 54 per 100,000 of children without asthma and 91 per 100,000 of children with well controlled asthma.

The findings, published in The Lancet Respiratory Medicine, also highlight the importance of careful monitoring of children with poorly controlled asthma if they become infected with COVID-19.

Vaccination priority

Among children with asthma, there were 4,339 confirmed coronavirus cases between 1 March 2020 and 27 July 2021 and - of these - 67 children were admitted to hospital. By comparison there were 40,231 confirmed cases of COVID-19 in children without asthma, of whom 382 were hospitalised.

Within Scotland, it is believed vaccination could benefit about 9,000 children with poorly controlled asthma issues, while more than 100,000 would be helped by adopting the advice across the UK.

Professor Aziz Sheikh, Director of the University of Edinburgh’s Usher Institute and EAVE II study lead, said: “Asthma is one of the commonest chronic disorders affecting children in the UK. Our national analysis has found that children with poorly controlled asthma are at much higher risk of COVID-19 hospitalisation. They should therefore be considered a priority for COVID-19 vaccination alongside other high-risk children.”

He added: “These data also underscore the importance of maintaining good asthma control in children, particularly during the pandemic.”

Previous studies using EAVE II have shown that vaccines greatly reduce the mortality risk of the COVID-19 Delta variant and also led to a substantial reduction in Scottish hospital admissions.