CHILDREN with a history of severe asthma are up to six times more likely to be hospitalised with Covid and should be prioritised for vaccination, scientists have said.
The findings emerged in a major study of Scottish patients aged five to 17 requested by the Joint Committee on Vaccination and Immunisation (JCVI).
It is the first time that the associated risk of Covid and asthma has been analysed nationally for school-age children.
The study compared Covid hospitalisation rates from March 2020 to the end of July 2021 in children and teenagers with "poorly controlled" asthma against those without the respiratory condition and those whose asthma was "well-controlled".
Over the 17 month period, 4,339 asthmatic children had a confirmed Covid infection, with 67 being admitted to hospital within 14 days of testing positive and nine leading to intensive care admissions or deaths.
This compared to 40,231 Covid cases and 382 hospitalisations in children without asthma.
Researchers used anonymised health records to identify youngsters with "poorly controlled" asthma - defined as either having been hospitalised with asthma or prescribed one to two courses of oral steroids, to treat inflammation caused by asthma attacks, over the two years prior to the study.
These children were found to have a Covid hospitalisation rate of 548 per 100,000, compared to 55 for those without asthma and 94 per 100,000 for those whose asthma was well-controlled.
Once these figures had been adjusted for variables including age, sex, socioeconomic status, and medical history, children who had recently been hospitalised with asthma were were found to be six times more likely to be admitted to hospital with Covid than those without asthma, while children who had recently been prescribed oral steroids had a three-fold increased risk.
The numbers for severe outcomes - intensive care admission or death - were too small to derive a detailed evaluation, and the researchers note that there was also a lack of reliable information in relation to other factors - such as tobacco exposure, ethnicity, and housing conditions - which can affect asthma.
However, they said the findings, published in the journal Lancet Respiratory Medicine, indicate that Covid vaccinations currently available to all over 12s should be prioritised to children aged five and over with poorly-controlled asthma.
In Scotland, that would equate to around 6,300 children aged five to 11 becoming eligible.
European regulators approved the Pfizer vaccine last week for all children aged five to 11, but no decision has yet been taken in the UK.
Lead author of the study, Professor Aziz Sheikh, of Edinburgh University, said the results "underscore the importance of maintaining good asthma control in children, particularly during the pandemic".
He added: “Emerging evidence from children aged five and older suggests that Covid-19 vaccines are overall well-tolerated by the vast majority of children. It is now for policymakers to decide how to act on these data.”
Co-author Professor Chris Robertson, of Public Health Scotland, added: “We hope the findings can assist the JCVI with its efforts to identify those who should be eligible for the vaccine and further extend the offer of protection to those most vulnerable to the virus.
“Covid vaccines are already available for children aged 12-17 years and I would encourage those who have not yet been vaccinated to consider this option, particularly those who have experienced issues with asthma.”
In a linked comment piece, Rachel Harwood - a paediatric clinician who was not involved in the study - stressed that the overall Covid risk for children with asthma "remains very low", adding: "A balance between the risk of hospitalisation from SARS-CoV-2 and the low risk of vaccination side-effects needs to be carefully considered before vaccination is contemplated.”
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