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Published on: November 10, 2023
Epidemiological features and viral shedding in children with SARS-CoV-2 infection
Chun-Zhen Hua1, Zi-Ping Miao2, Ji-Shan Zheng3
1Department of Infectious Diseases, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Insights
Children infected with SARS-CoV-2 show lower susceptibility and longer incubation periods. Fecal viral shedding can exceed 70 days, but does not increase transmission risk within families.
Area of Science:
- Virology
- Epidemiology
- Pediatrics
Background:
- Limited epidemiological data and viral shedding information exist for pediatric SARS-CoV-2 infections during the pandemic.
- Understanding transmission dynamics and clinical characteristics in children is crucial for public health strategies.
Purpose of the Study:
- To investigate the epidemiological characteristics of SARS-CoV-2 infection in children within infected families.
- To compare infection incidence between child and adult close contacts.
- To evaluate viral shedding, particularly fecal excretion, and the effect of antiviral therapy in pediatric cases.
Main Methods:
- Retrospective, multicenter study of children from families with confirmed SARS-CoV-2 infections in Zhejiang Province, China.
- Real-time reverse transcription PCR (RT-PCR) for SARS-CoV-2 RNA confirmation.
- Comparison of epidemiological data, analysis of incubation periods, symptom presentation, fecal viral RNA detection, and viral clearance times; Kaplan-Meier plot used for fecal-viral excretion analysis.
Main Results:
- Lower infection incidence in child close contacts (13.2%) compared to adult contacts (21.2%).
- Mean incubation period of 9.1 days in 43 pediatric cases (mean age 8.2 years), with 93% being family clusters.
- Fecal SARS-CoV-2 RNA detected in 91.4% of cases; prolonged fecal viral excretion (over 70 days) observed, with no difference in clearance time across antiviral regimens. No secondary infections from fecal-viral-excreting children were noted.
Conclusions:
- Children exhibit lower susceptibility to SARS-CoV-2 infection, longer incubation periods, and extended fecal viral excretion.
- Fecal SARS-CoV-2 RNA positivity did not necessitate hospitalization or quarantine.
- Antiviral regimens did not significantly alter viral clearance times in pediatric cases.
Abstract:
A pandemic of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection broke out all over the world; however, epidemiological data and viral shedding in pediatric patients are limited. We conducted a retrospective, multicenter study, and followed-up with all children from the families with SARS-CoV-2 infected members in Zhejiang Province, China. All infections were confirmed by testing the SARS-CoV-2 RNA with real-time reverse transcription PCR method, and epidemiological data between children and adults in the same families were compared. Effect of antiviral therapy was evaluated observationally and fecal-viral excretion times among groups with different antiviral regiments were compared with Kaplan-Meier plot. By 29 February 2020, 1298 cases from 883 families were confirmed with SARS-CoV-2 infection and 314 of which were families with children. Incidence of infection in child close contacts was significantly lower than that in adult contacts (13.2% vs 21.2%). The mean age of 43 pediatric cases was 8.2 years and mean incubation period was 9.1 days. Forty (93.0%) were family clustering. Thirty-three children had coronavirus disease 2019 (20 pneumonia) with mild symptoms and 10 were asymptomatic. Fecal SARS-CoV-2 RNA detection was positive in 91.4% (32/35) cases and some children had viral excretion time over 70 days. Viral clearance time was not different among the groups treated with different antiviral regiments. No subsequent infection was observed in family contacts of fecal-viral-excreting children. Children have lower susceptibility of SARS-CoV-2 infection, longer incubation, and fecal-viral excretion time. Positive results of fecal SARS-CoV-2 RNA detection were not used as indication for hospitalization or quarantine.
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