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Age and sex profiles associated with infectious disease contain the signature of transmission dynamics and vulnerabilities to infection, illness and hospitalization. We discuss potential mechanisms that may be associated with these patterns.įrom early in the pandemic, the discrepancy in SARS-CoV-2 outcomes across age was striking evidence for sex differences followed soon afterwards, with male sex identified as a risk factor for severe outcomes. Intriguingly, age-specific sex differences in hospitalizations are largely similar across endemic and emerging infections. By contrast, differences in severe disease risk by age from endemic pathogens are more decoupled from the immune ageing process. The changing distribution of disease risk by age for emerging pathogens appears to broadly track the gradual deterioration of the immune system (immunosenescence), which starts around puberty. Using 60-year-olds as a reference age group, we find that relative rates of hospitalization and mortality associated with the emergent coronaviruses are lower during childhood and start to increase earlier (around puberty) as compared with influenza and seasonal coronaviruses.
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Comparing age and sex differences in SARS-CoV-2 hospitalization and mortality with MERS-CoV, seasonal coronaviruses, influenza and other health outcomes opens the way to generating hypotheses as to underlying mechanisms driving disease risk.