SARS-CoV-2 infection in immunocompromised children
A literature review
DOI:
https://doi.org/10.14528/snr.2026.60.1.3234Keywords:
immunocompromised children, coronavirus disease, course of infectionAbstract
Introduction: Anyone can become infected with the SARS-CoV-2 virus. However, children with weakened immunity are at greater risk of developing various infections, including COVID-19. It is important to treat these children promptly, especially those with additional comorbidities. The aim of this literature review was to investigate the course of COVID-19 in immunocompromised children.
Methods: We employed a descriptive approach to review scientific literature published in English. The literature search was conducted in the PubMed, ScienceDirect, CINAHL, and Google Scholar databases. The review process is illustrated using the PRISMA flow diagram. We present a descriptive summary of the common characteristics of the included studies. The selected articles were analysed and synthesised using a thematic theoretical framework.
Results: A total of 16 articles were included in the final analysis. We identified one main theme: the course of COVID-19 in immunocompromised children; two secondary-level themes: (1) children with weakened immunity and COVID-19, and (2) diagnosis and treatment of COVID-19; as well as five primary-level themes.
Discussion and conclusion: We found that children with weakened immunity mostly experienced a mild course of COVID-19, with limited data indicating a severe course of illness. These findings emphasise the importance of hygiene measures and the need to monitor the health and well-being of at-risk groups.
Downloads
References
Abuhammad, S., Alazzam, M., & Mukattash, T. (2021). The perception of nurses towards their roles during the COVID-19 pandemic. The International Journal of Clinical Practice, 75(4), Article e13919. https://doi.org/10.1111/ijcp.13919 PMID:33296522; PMCID:PMC7883258
Al-Dossary, R., Alamri, M. S., Almazan, J., Albaqawi, H. M., Al Hosis, K., Aljeldah, M., Aljohani, M., Aljohani, K., Almadani, N., Alrasheadi, B. A., & Falatah, R. (2020). Awareness, attitudes, prevention, and perceptions of COVID-19 outbreak among nurses in Saudi Arabia. International Journal of Environmental Research and Public Health, 17(21), Article 8269. https://doi.org/10.3390/ijerph17218269 PMID:33182352; PMCID:PMC7664870
BC Center for Disease Control. (2022, August 2). Children with immune compromise. http://www.bccdc.ca/healthinfo/diseases-conditions/covid-19/covid-19-and-children/children-with-immune-compromise
Bhayana, S., Kalra, M., & Sachdeva, A. (2022). Covid-19 in pediatric hematology-oncology and stem cell transplant patients: The spectrum of illness, complications and comparison of first two waves. Pediatric Hematology Oncology Journal, 7(3), 96–102. https://doi.org/10.1016/j.phoj.2022.05.003 PMCID:PMC9090776
Bisogno, G., Provenzi, M., Zama, D., Tondo, A., Meazza, C., Colombini, A., Galaverna, F., Compagno, F., Carraro, F., De Santis, R., Meneghello, L., Baretta, V., & Cesaro, S. (2020). Clinical characteristics and outcome of severe acute respiratory syndrome coronavirus 2 infection in Italian pediatric oncology patients: A study from the Infectious Diseases Working Group of the Associazione Italiana di Oncologia e Ematologia Pediatrica. Journal of the Pediatric Infectious Diseases Society, 9(5), 530–534. https://doi.org/10.1093/jpids/piaa088 PMID:32652521; PMCID:PMC7454778
Bridger, N. A., & Allen, U. D. (2019). Safe living strategies for the immunocompromised child. Paediatrics & Child Health, 24(4), Article 291. https://doi.org/10.1093/pch/pxz082 PMID:31239819; PMCID:PMC6587416
Cakmak, H. M. (2021). Management of Covid-19 disease in pediatric oncology patients. In V. Kumar (Ed.), SARS-CoV-2 Origin and COVID-19 Pandemic Across the Globe, Article 129. https://www.intechopen.com/chapters/78445
Chowdhoury, S. R., Biswas, H. S., Raut, S., Bhakta, S., Roy, A., Banerjee, S., & Nandi, M. (2021). Pediatric oncology patients and COVID-19: An experience from the tertiary COVID care facility in Eastern India: A prospective observational study. Indian Journal of Medical and Paediatric Oncology, 42(02), 130–134. https://doi.org/10.1055/s-0041-1732814
Čamernik, M. (2014). Imunske bolezni in zaščita otrok z oslabljenim imunskim sistemom pred okužbo. Slovenska Pediatrija, 21(1), 84–90.
De Souza, T. H., Nadal, J. A., Nogueira, R. J., Pereira, R. M., & Brandão, M. B. (2020). Clinical manifestations of children with COVID-19: A systematic review. Pediatric Pulmonology, 55(8), 1892–1899. https://doi.org/10.1002/ppul.24885 PMID:32492251; PMCID:PMC7300659
Dolan, S. A., Mulcahy Levy, J., Moss, A., Pearce, K., Butler, M., Jung, S., Dominguez, S. R., Mwangi, E., Maloney, K., & Rao, S. (2021). SARS-CoV-2 persistence in immunocompromised children. Pediatric Blood & Cancer, 68(12), Article e29277. https://doi.org/10.1002/pbc.29277 PMID:34453477; PMCID:PMC8661864
El Dannan, H., Al Hassani, M., & Ramsi, M. (2020). Clinical course of COVID-19 among immunocompromised children: A clinical case series. BMJ Case Reports CP, 13(10), Article e237804. https://doi.org/10.1136/bcr-2020-237804 PMID:33130585; PMCID:PMC10577704
Esposito, S., Prada, E., Lelii, M., & Castellazzi, L. (2015). Immunization of children with secondary immunodeficiency. Human Vaccines & Immunotherapeutics, 11(11), 2564–2570. https://doi.org/10.1080/21645515.2015.1039208 PMID:26176360; PMCID:PMC4685680
Fawaz, M., Anshasi, H., & Samaha, A. (2020). Nurses at the front line of COVID-19: Roles, responsibilities, risks, and rights. The American Journal of Tropical Medicine and Hygiene, 103(4), 1341–1342. https://doi.org/10.4269/ajtmh.20-0650 PMID:32783796; PMCID:PMC7543802
Filippatos, F., Tatsi, E. B., & Michos, A. (2023). Immunology of multisystem inflammatory syndrome after COVID-19 in children: A review of the current evidence. International Journal of Molecular Sciences, 24(6), Article 5711. https://doi.org/10.3390/ijms24065711 PMID:36982783; PMCID:PMC10057510
Freeman, M. C., Rapsinski, G. J., Zilla, M. L., & Wheeler, S. E. (2021). Immunocompromised seroprevalence and course of illness of SARS-CoV-2 in one pediatric quaternary care center. Journal of the Pediatric Infectious Diseases Society, 10(4), 426–431. https://doi.org/10.1093/jpids/piaa123 PMID:33049042; PMCID:PMC7665604
Gampel, B., Troullioud Lucas, A. G., Broglie, L., Gartrell-Corrado, R. D., Lee, M. T., Levine, J., Orjuela-Grimm, M., Satwani, P., Glade-Bender, J., & Roberts, S. S. (2020). COVID-19 disease in New York City pediatric hematology and oncology patients. Pediatric Blood & Cancer, 67(9), Article e28420. https://doi.org/10.1002/pbc.28420 PMID:32588957; PMCID:PMC7361160
Goss, M. B., Galván, N. T. N., Ruan, W., Munoz, F. M., Brewer, E. D., O’Mahony, C. A., Melicoff-Portillo, E., Sunny, K. S., Wallisch, M. A., Fleseriu, S., Kupfer, J. M., Hornung, B., Mulay, S., & Goss, J. A. (2021). The pediatric solid organ transplant experience with COVID-19: An initial multi-center, multi-organ case series. Pediatric Transplantation, 25(3), Article e13868. https://doi.org/10.1111/petr.13868 PMID:32949098; PMCID:PMC7537006
Goldschmidt, K. (2021). Covid-19 vaccines for children: The essential role of the pediatric nurse. Journal of Pediatric Nursing, 57, Article 96. https://doi.org/10.1016/j.pedn.2020.12.004 PMID:33342640; PMCID:PMC7732219
Götzinger, F., Santiago-García, B., Noguera-Julián, A., Lanaspa, M., Lancella, L., Calò Carducci, F. I. C., Gabrovska, N., Velizarova, S., Prunk, P., Osterman, V., Krivec, U., Lo Vecchio, A., Shingadia, D., Soriano-Arandes, A., Melendo, S., Lanari, M., Pierantoni, L., Wagner, N., L’Huillier, A. G., … Riordan, A. (2020). COVID-19 in children and adolescents in Europe: A multinational, multicentre cohort study. The Lancet Child & Adolescent Health, 4(9), 653–661. https://doi.org/10.1016/S2352-4642(20)30177-2 PMID:32593339
Hammad, M., Shalaby, L., Sidhom, I., Sherief, N., Abdo, I., Soliman, S., Madeny, Y., Hassan, R., Elmeniawy, S., Khamis, N., Zaki, I., Mansour, T., El-Ansary, M. G., Al-Halfawy, A., Abouelnaga, S., & Elhaddad, A. (2021). Management and outcome of coronavirus disease 2019 (COVID-19) in pediatric cancer patients: A single centre experience from a developing country. Clinical Lymphoma Myeloma and Leukemia, 21(11), e853–e864. https://doi.org/10.1016/j.clml.2021.07.025 PMID:34420893; PMCID:PMC8312090
Hassan, S. A., Sheikh, F. N., Jamal, S., Ezeh, J. K., & Akhtar, A. (2020). Coronavirus (COVID-19): A review of clinical features, diagnosis, and treatment. Cureus, 12(3), Article e7355. https://doi.org/10.7759/cureus.7355
Hrusak, O., Kalina, T., Wolf, J., Balduzzi, A., Provenzi, M., Rizzari, C., Rives, S., del Pozo Carlavilla, M., Alonso, M. E. V., Domínguez-Pinilla, N., Bourquin, J. P., Schmiegelow, K., Attarbaschi, A., Grillner, P., Mellgren, K., van der Werff ten Bosch, J., Pieters, R., Brozou, T., Borkhardt, A., … Schrappe, M. (2020). Flash survey on severe acute respiratory syndrome coronavirus-2 infections in paediatric patients on anticancer treatment. European Journal of Cancer, 132, 11–16. https://doi.org/10.1016/j.ejca.2020.03.021 PMID:32305831; PMCID:PMC7141482
Infection Control Today. (2021, April 28). COVID-19 underscores nurses’ role in infection prevention. https://www.infectioncontroltoday.com/view/covid-19-underscores-nurses-role-in-infection-prevention
Kamdar, K. Y., Kim, T. O., Doherty, E. E., Pfeiffer, T. M., Qasim, S. L., Suell, M. N., Yates, A. M., & Blaney, S. M. (2021). COVID-19 outcomes in a large pediatric hematology-oncology center in Houston, Texas. Pediatric Hematology and Oncology, 38(8), 695–706. https://doi.org/10.1080/08880018.2021.1924327 PMID:34032552
Kuczborska, K., & Książyk, J. (2021). Prevalence and course of SARS-CoV-2 infection among immunocompromised children hospitalised in the tertiary referral hospital in Poland. Journal of Clinical Medicine, 10(19), Article 4556. https://doi.org/10.3390/jcm10194556 PMID:34640570; PMCID:PMC8509507
Madhusoodhan, P. P., Pierro, J., Musante, J., Kothari, P., Gampel, B., Appel, B., Levy, A., Tal, A., Hogan, L., Sharma, A., Feinberg, S., Kahn, A., Pinchinat, A., Bhatla, T., Glasser, C. L., Satwani, P., Raetz, E. A., Onel, K., Carroll, W. L., … Parsons, S. K. (2021). Characterization of COVID-19 disease in pediatric oncology patients: The New York-New Jersey regional experience. Pediatric Blood & Cancer, 68(3), Article e28843. https://doi.org/10.1002/pbc.28843 PMID:33338306; PMCID:PMC7883045
Meena, J. P., Kumar Gupta, A., Tanwar, P., Ram Jat, K., Mohan Pandey, R., & Seth, R. (2021). Clinical presentations and outcomes of children with cancer and COVID-19: A systematic review. Pediatric Blood & Cancer, 68(6), Article e29005. https://doi.org/10.1002/pbc.29005 PMID:33719167; PMCID:PMC8251055
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Lippincott Williams & Wilkins.
Millen, G. C., Arnold, R., Cazier, J. B., Curley, H., Feltbower, R. G., Gamble, A., Glaser, A. W., Grundy, R. G., Lee, L. Y. W., McCabe, M. G., Phillips, R. S., Stiller, C. A., Várnai, C., & Kearns, P. R. (2021). Severity of COVID-19 in children with cancer: Report from the United Kingdom Paediatric Coronavirus Cancer Monitoring Project. British Journal of Cancer, 124(4), 754–759. https://doi.org/10.1038/s41416-020-01181-0 PMID:33299130; PMCID:PMC7884399
Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., Stewart, L. A., & PRISMA-P Group. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews, 4(1), Article 1. https://doi.org/10.1186/2046-4053-4-1 PMID:25554246; PMCID:PMC4320440
Mukkada, S., Bhakta, N., Chantada, G. L., Chen, Y., Vedaraju, Y., Faughnan, L., Homsi, M. R., Muniz-Talavera, H., Ranadive, R., Metzger, M., Friedrich, P., Agulnik, A., Jeha, S., Lam, C., Dalvi, R., Hessissen, L., Moreira, D. C., Santana, V. M., Sullivan, M., … Raimbault, S. (2021). Global characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with cancer (GRCCC): A cohort study. The Lancet Oncology, 22(10), 1416–1426. https://doi.org/10.1016/S1470-2045(21)00454-X PMID:34454651
Nearchou, F., & Flinn, C. (2024). The impact of COVID-19 on children and adolescents with chronic illness. In G. J. G. Asmundson, S. Taylor, & B. J. Cox (Eds.), The COVID-19 aftermath (Vol. 1457, pp. 385–399). Springer. https://doi.org/10.1007/978-3-031-61939-7_22
Nikolopoulou, G. B., & Maltezou, H. C. (2021). COVID-19 in children: Where do we stand. Archives of Medical Research, 53(1), 1–8. https://doi.org/10.1016/j.arcmed.2021.07.002 PMID:34311990; PMCID:PMC8257427
Olivé-Cirera, G., Fonseca, E., Cantarín-Extremera, V., Vázquez-López, M., Jiménez-Legido, M., González-Álvarez, V., Ribeiro-Constante, J., Camacho-Salas, A., Martí, I., Cancho-Candela, R., Martínez-González, M. J., Saiz, A., Armangué, T., … Armangué, T. (2022). Impact of COVID-19 in immunosuppressed children with neuroimmunologic disorders. Neurology-Neuroimmunology Neuroinflammation, 9(1), Article e1101. https://doi.org/10.1212/NXI.0000000000001101 PMID:34759018; PMCID:PMC8587734
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, Article n71. https://doi.org/10.1136/bmj.n71 PMID:33782057; PMCID:PMC8005924
Pérez-Martinez, A., Guerra-García, P., Melgosa, M., Frauca, E., Fernandez-Camblor, C., Remesal, A., & Calvo, C. (2021). Clinical outcome of SARS-CoV-2 infection in immunosuppressed children in Spain. European Journal of Pediatrics, 180(3), 967–971. https://doi.org/10.1007/s00431-020-03793-3 PMID:32860101; PMCID:PMC7455510
Pittet, L. F., & Posfay-Barbe, K. M. (2021). Vaccination of immune compromised children: An overview for physicians. European Journal of Pediatrics, 180(7), 2035–2047. https://doi.org/10.1007/s00431-021-03997-1 PMID:33665677; PMCID:PMC8195953
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer Health, Lippincott Williams and Wilkins.
Rao, S. K., Kumar, A., Prasad, R., Gupta, V., & Mishra, O. P. (2021). Clinical profile and outcome of COVID-19 among immunocompromised children. Indian Pediatrics, 58(7), 686–687. https://doi.org/10.1007/s13312-021-2267-6 PMID:34315835; PMCID:PMC8339160
She, J., Liu, L., & Liu, W. (2020). COVID-19 epidemic: Disease characteristics in children. Journal of Medical Virology, 92(7), 747–754. https://doi.org/10.1002/jmv.25807 PMID:32232980; PMCID:PMC7228385
Singer, P. S., Sethna, C., Molmenti, E., Fahmy, A., Grodstein, E., Castellanos-Reyes, L., Fassano, J., & Teperman, L. (2021). COVID-19 infection in a pediatric kidney transplant population: A single-center experience. Pediatric Transplantation, 25(4), Article e14018. https://doi.org/10.1111/petr.14018 PMID:33813782; PMCID:PMC8250351
Sullivan, M., Bouffet, E., Rodriguez-Galindo, C., Luna-Fineman, S., Khan, M. S., Kearns, P., Mechinaud, F., Graeber, A., Kohler, J., Jähnichen, A., Friedrich, P., Ribeiro, R. C., Ribeiro, R. M., Baruchel, A., Voss, S., Gupta, S., Sullivan, N., Schrappe, M., Rennie, K. L., … Heuvel-Eibrink, M. V. D. (2020). The COVID-19 pandemic: A rapid global response for children with cancer from SIOP, COG, SIOP-E, SIOP-PODC, IPSO, PROS, CCI, and St Jude Global. Pediatric Blood & Cancer, 67(7), Article e28409. https://doi.org/10.1002/pbc.28409 PMID:32400924; PMCID:PMC7235469
Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8(1), 1–10. https://doi.org/10.1186/1471-2288-8-45 PMID:18616818; PMCID:PMC2478656
Widiasih, R., Ermiati, Emaliyawati, E., Hendrawati, S., Susanti, R. D., Sutini, T., & Sari, C. W. M. (2021). Nurses’ actions to protect their families from COVID-19: A descriptive qualitative study. Global Qualitative Nursing Research, 8, Article 23333936211014851. https://doi.org/10.1177/23333936211014851 PMID:33997120; PMCID:PMC8110897
Woodruff, R. C., Campbell, A. P., Taylor, C. A., Chai, S. J., Kawasaki, B., Meek, J., & Havers, F. (2022). Risk factors for severe COVID-19 in children. Pediatrics, 149(1), Article e2021053418. https://doi.org/10.1542/peds.2021-053418 PMID:34935038; PMCID:PMC9213563
World Health Organization. (2021, May 13). Coronavirus disease (COVID-19). https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-covid-19
Zehra, C., & Gulendam, K. (2021). Children with chronic disease during COVID-19 pandemic and nurses' roles. International Journal of Caring Sciences, 14(3), 2058–2065. https://www.internationaljournalofcaringsciences.org
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Slovenian Nursing Review
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
As the author undersigned hereby, I transfer, assign, or otherwise convey the following authorship rights as comprised in the Copyright and Related Rights Act (CRRA) to the Slovenian Nursing Review, Ob železnici 30A, 1000 Ljubljana: the right of reproduction - the exclusive right to fix the work in a material medium or in another copy directly or indirectly, temporarily or permanently, by any means and in any digital form, in whole or in part (CRRA, Article 23); the right of distribution (CRRA, Article 24); the right of making a work available and accessible through the internet (CRRA, Article 32a); the right of transformation, especially the exclusive right to translate a pre-existing work (CRRA, Article 33). The transfer of author rights applies to the article in its entirety, including pictorial and/or graphic works and possible supplements. The transfer of rights is exclusive and unlimited in duration or territory.
