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Prolonged Fecal Shedding of SARS-CoV-2 in Pediatric Patients: A Quantitative Evidence Synthesis
Victor S Santos1, Ricardo Q Gurgel2,3, Luis E Cuevas4
1Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca.
Insights
Children with novel coronavirus disease 19 (COVID-19) shed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in stools longer than in respiratory samples. This suggests potential fecal-oral transmission routes in pediatric COVID-19 cases.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Public Health
Background:
- The transmission routes of novel coronavirus disease 19 (COVID-19) are still being investigated.
- Understanding viral shedding patterns in children is crucial for public health strategies.
Purpose of the Study:
- To compare the duration and proportion of viral shedding in respiratory versus fecal samples from pediatric COVID-19 patients.
- To analyze the pattern of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding in children.
Main Methods:
- Systematic literature search of PubMed, SCOPUS, Embase, and Web of Science databases.
- Inclusion of four pediatric studies with data from 36 children.
- Meta-analysis using random-effects models to calculate summary estimates.
Main Results:
- A higher proportion of children exhibited viral shedding in stools beyond 14 days post-symptom onset compared to respiratory samples (RR = 3.2).
- Viral RNA shedding persisted approximately 9 days longer in fecal samples than in respiratory samples (MD = 8.6 days).
- Significant heterogeneity was observed in both proportion (I² = 51%) and duration (I² = 77%) analyses.
Conclusions:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding appears to be prolonged in the feces of children compared to their respiratory tract.
- While fecal shedding does not confirm transmissibility, prolonged presence suggests potential alternative transmission routes, contributing to the rapid global spread of COVID-19.
Abstract:
The aim of the study was to investigate differences in viral shedding in respiratory and fecal samples from children with novel coronavirus disease 19. We searched PubMed, SCOPUS, Embase, and Web of Science databases to identify pediatric studies comparing the pattern of fecal and respiratory shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA. Summary estimates were calculated using random-effects models. Four studies reporting data from 36 children were included. A higher proportion of children had viral shedding in stools after 14 days of symptoms onset compared to respiratory samples (risk ratio = 3.2, 95% confidence interval 1.2-8.9, I2 = 51%). Viral RNA shedding was longer in fecal samples with a mean difference of approximately 9 days (mean difference = 8.6, 95% confidence interval 1.7-15.4, I2 = 77%) compared with respiratory samples. SARS-CoV-2 shedding seems to be present in feces for a longer time than in the respiratory tract of children. Although fecal SARS-CoV-2 presence in feces do not confirm its transmissibility, the high and fast spread of the novel coronavirus disease 19 worldwide indicate other transmission routes are also plausible.
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