Screening of COVID-19 in outpatient children with cancer or solid organ transplantation: preliminary report
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Published on: September 7, 2022
Thaís Lira Cleto-Yamane1,2, Gustavo Rodrigues-Santos3, Maria Clara de Magalhães-Barbosa3
1Department of Kidney Transplant, Hospital Estadual da Criança, Rua Luiz Beltrão, 147, Vila Valqueire, Rio de Janeiro, RJ, 21330-320, Brazil. thaiscleto@yahoo.com.br.
Insights
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, causing coronavirus disease 2019 (COVID-19), is common in immunosuppressed children. Most pediatric patients experience mild or no symptoms, with few developing complications.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Transplantation Medicine
Background:
- The clinical course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pediatric immunosuppressed patients remains largely unknown.
- While emerging data suggest milder COVID-19 in children compared to adults, immunocompromised children may face increased severity risk.
- The number of immunosuppressed patients contracting coronavirus disease 2019 (COVID-19) is rising globally.
Purpose of the Study:
- To determine the seroprevalence of SARS-CoV-2 infection in a cohort of immunosuppressed children and adolescents.
- To describe the clinical features and outcomes of COVID-19 in this vulnerable pediatric population.
Main Methods:
- A prospective cohort study was conducted involving 114 immunosuppressed children and adolescents.
- Participants were categorized into three groups: kidney transplant recipients, liver transplant recipients, and cancer patients.
- Serological testing was used to detect SARS-CoV-2 infection, followed by clinical assessment and a minimum of 30 days of follow-up.
Main Results:
- The seroprevalence of SARS-CoV-2 infection was 30.7% (35 out of 114 patients).
- Among serology-positive patients, 77% were asymptomatic, and 25% reported mild symptoms (diarrhea, fever, cough).
- No patient developed severe coronavirus disease 2019 (COVID-19) complications or multisystem inflammatory syndrome in children (MIS-C) during the follow-up period.
Conclusions:
- SARS-CoV-2 infection is highly prevalent in immunosuppressed pediatric populations.
- Coronavirus disease 2019 (COVID-19) generally presents with a mild or asymptomatic course in these children.
- Immunosuppressed children with COVID-19, including transplant recipients and cancer patients, show a low risk of severe outcomes or MIS-C.
Abstract:
Clinical presentation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pediatric immunosuppressed patients is unknown. Emerging data describe a milder or asymptomatic course in children compared with adults in this scenario. We present the seroprevalence and clinical features of coronavirus disease 2019 in a prospective cohort of 114 immunosuppressed children and adolescents from three groups: kidney transplantation, liver transplantation, and cancer patients. Among the thirty-five (30.7%) patients who had a positive serological test for SARS-CoV-2, 77% did not report previous symptoms and none of them developed any complications of coronavirus disease 2019 (COVID-19) after 30 or more days of follow-up. Among those who were symptomatic, diarrhea, fever, and cough were the most common findings.Conclusion: Seroprevalence of SARS-CoV-2 infection is high among immunosuppressed children and adolescents. COVID-19 has a mild or asymptomatic course in most of these patients. What is Known: • The number of immunosuppressed patients with coronavirus disease 2019 is increasing. • Viral infections have the potential for greater severity in immunocompromised children. What is New: • Seroprevalence for severe acute respiratory syndrome coronavirus 2 in immunocompromised pediatric patients was 31%. • A quarter of the serology-positive patients reported mild symptoms and none of them developed multisystem inflammatory syndrome in children associated with coronavirus disease 2019.
