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COVID-19 in Cuban Children and Adolescents. Fifth Report. Epidemiological Weeks from 7 to 17. from February 14 to May 1, 2021

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COVID-19 in Cuban Children and Adolescents. Fifth Report. Epidemiological Weeks from 7 to 17. from February 14 to May 1, 2021 COVID-19 in Cuban children and adolescents. Fifth report. Epidemiological weeks from 7 to 17. From February 14 to May 1, 2021. Luisa Íñiguez Rojas FLACSO-Cuba. University of Havana Edgar Figueroa Fernández CEPDE-ONEI Angel Miguel Germán Almeida IPK-MINSAP Lissette del Rosario López González Head of the National Pediatrics Group of MINSAP Lorenzo Somarriba López Head of Health Watch and of the Management Center, MINSAP, Cuba ÍNDICE 1.1. Evolution and general characteristics of COVID-19 in children and adolescents. Weeks from 7 to 17, 2021 | 03 1.2. Distribution by province of children and adolescents (from 0 to 18 years) confirmed with COVID-19 | 06 1.3. Distribution by municipality of children and adolescents (from 0 to 18 years) confirmed with COVID-19 | 08 1.4. Incidence of COVID-19 in children under one year | 12 Summary and reflections | 16 Bibliography | 18 The previous report, on the evolution of COVID-19 until epidemiological week 6, showed an increase of the virus’s transmission in the population under 18 years of age, and its relation with the rise in case detection in the popula- tion over 18 from the first epidemiological week of the current year. The descriptive cross-sectional study referred to in this report shows particularities of the propagation of CO- VID-19 from February 14 to May 1 (epidemiological weeks 7-17 of 2021), according to individual characteristics such as the sex and age of the infected children and adolescents, as well as the incidence by province and municipality, with an emphasis in the territorial spreading of cases. Due to its relevance, the fifth report on epidemiological characteristics and spatial dissemination of infection in Cuban children and adolescents includes a subsection on its incidence in children under one year of age. As in previous reports, the main sources for the study are the database of the Health Watch Office of the Minis- try of Public Health, other databases of the National Statistics and Information Office (ONEI), as well as cartogra- phic resources from the GeoCuba Business Group. Again, the data used may have been modified or updated after the date of this report. 1.1 Evolution and general characteristics of COVID-19 in children and adolescents. Weeks from 7 to 17, 2021. As described in the fourth report in this series, from the last week of the year case detection in the country rose, which marked the beginning of a third epidemic wave, with an evident reflection in case detection in children and adolescents. In the eleven weeks referred to in this report, a new increase in detection is observed, with between more than 600 and up to 800 weekly cases recorded until week 12. From that moment, detection rises to more than 1,000 weekly cases. In correspondence with the increase in cases, the detection rates show values close to or above 3 in 10,000 children and adolescents until week 12, and rise to more than 4 in 10,000 in the following weeks of the study. Figure 1a. Thus, the evolution of case detection in children and adolescents throughout all epidemiological weeks since the beginning of the pandemic in Cuba, demonstrates that the most intense transmission of SARS-CoV-2 has occurred in what is considered a third epidemic wave. This intensified in the last five weeks of the study. Figure 1b. a) Cases Rate per 10 000 b) Cases 1200 6 1200 1000 5 1000 800 4 800 600 3 600 400 2 400 200 1 0 0 200 78910 11 12 13 14 15 16 17 0 Epidemiological weeks 12/2020 17/2021 Cases Rate per 10 000 Epidemiological weeks Figure 1. (a) Cuba. Confirmed cases and incidence rates of COVID-19 in children and adolescents (Weeks 7-17/2021) (b) Reported cases throughout the totality of epidemiological weeks (12/2020 to 17/2021). Source: Daily MINSAP reports. Database of the Health Watch Office. -3- LA COVID-19 EN NIÑOS Y ADOLESCENTES CUBANOS. QUINTO REPORTE. SEMANAS EPIDEMIOLÓGICAS.... As in the previous report, imported cases, which totaled 97 between weeks 1 and 6, are not included in this in- crease. Between weeks 7 and 17, 37 imported cases were confirmed, which came mostly from Russia (17), and other countries like the United States (6), Mexico (5) and Spain (4). Imported cases had dropped to 3% between weeks 1 and 6. Between weeks 7 and 17, they represent 0.4% of confirmed cases, the majority of them being Cuban nationals residing in the country, concentrated in the provinces of La Habana, Ciego de Ávila and Camagüey. Figure 2. Between weeks 1 and 6, which showed a notable increase of transmission in the country, the detection of cases in children and adolescents was slightly more than 11% of total confirmed cases. In all of the weeks analyzed in this report, the proportion of cases from 0 to 18 years is above 12% and reaches values close to 15% in the last weeks of the study (Weeks 13, 14, 17). Figure 3. Provinces % Pinar del Río 16 Artemisa La Habana 14 Mayabeque Matanzas 12 Villa Clara 10 Cienfuegos Sancti Spíritus 8 Ciego de Ávila Camagüey 6 Las Tunas Holguín 4 Granma Santiago de Cuba 2 Guantánamo 0 015 0215 0325 0 Cases 132 4 57689110 1112 3 14 15 16 17 Weeks 1-6 Weeks 7-17 Epidemiological weeks Figure 2.Imported COVID-19 cases detected in children Figure 3. Percentage of cases detected in children and and adolescents, by province. Weeks 1-6 and 7-17 of adolescents from the total confirmed cases in the country 2021. by epidemiological weeks (EW 1-7/2021). Source: Daily MINSAP reports. Database of the Health Watch Source: Daily MINSAP reports. Database of the Health Watch Office. Office. Como regularidad de la epidemia se mantiene que las diferencias por sexo no son significativas. En el periodo que se analiza, se aprecia un incremento en la detección en el sexo femenino, entre las semanas 14 a la 16. Figure 4. Cases 600 500 400 300 200 100 0 135724689110 1112 3 14 15 16 17 Epidemiological weeks Female Male Figure 4. COVID-19 cases in children and adolescents by sex and epidemiological weeks (7 to 17/2021). Source: Daily MINSAP reports. Database of the Health Watch Office. The 12-to-18-years age group remains the one with more detected cases from the total in children and adolescents. Nevertheless, in the previous report this age group represented 49.29% of total cases from 0 to 18 years, a value that drops to 44.8% between weeks 7 and 17. This happens due to the increase of the percentage of detected cases in the 0-to-5-years age group, which rises from 24.40% to 27.78% in this period. -4- LA COVID-19 EN NIÑOS Y ADOLESCENTES CUBANOS. QUINTO REPORTE. SEMANAS EPIDEMIOLÓGICAS.... Case detection in children from 0 to 5 years and from 6 to 11 remains, as in previous reports, below the propor- tion these groups represent of the country’s total 0-to-18-years population. Nevertheless, in the 0-to-5-years group, the increase in detected cases brings it closer to matching the proportion of the country’s total population of chil- dren and adolescents this group represents. The 12-to-18-years group, with 37.32% of this population, concentrates 44.8% of the cases, which maintains its overrepresentation in the incidence of COVID-19 in the country. Figure 5. a) % b) % 50 1200 40 1000 30 800 600 20 400 10 200 0 From From From 0 0 to 5 years 6 to 11 years 12 to 18 years 78910 11 12 13 14 15 16 17 Age range Epidemiological weeks % of cases from 0 to 18 years From 0 to 5 years % of population from 0 to 18 years From 6 to 11 years From 12 to 18 years Figure 5. (a) Cases by age groups as percentage of total cases from 0 to 18 years (b) Confirmed cases by age groups and epidemiological weeks. Source: Daily MINSAP reports. Database of the Health Watch Office. A more detailed look to the 0-to-5-years group by weeks produces alarming information, when it reaches 30% of total detected cases in children and adolescents by week 17. This value is similar to the 30.73% this age group repre- sents in the structure of the population from 0 to 18 years of age. Figure 6. Should this trend continue, the 0-to-5-years group may get to be overrepresented in the incidence of the epide- mic in the country. And although the mass media have been making multiple appeals for several months to family and household members, unquestionably the ones responsible for the protection of children, it seems these have not had an impact so far in the reduction of the virus’s transmission in this age group. Such a trend would merit more detailed analyses of the behavior of household members, and perhaps even new measures for control and support of mothers or guardians with no other family support, single mothers, or mothers who continue to attend their workplaces. Cases % 350 35 300 30 250 25 200 20 150 15 100 10 50 5 0 0 12345687 91011121314151617 Epidemiological weeks Cases from 0 to 5 years% of total from 0 to 18 years Exponential (% of total from 0 to 18 years) Figure 6. Cases in children from 0 to 5 years, percentage of the total from 0 to 18 years and growth trend. Source: Daily MINSAP reports. Database of the Health Watch Office.
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