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Incidence of SARS-CoV-2 reinfection in a paediatric cohort in Kuwait
Fatemah Alhaddad1, Ali Abdulkareem1, Danah Alsharrah1
1Department of Pediatrics, Farwaniya Hospital, Farwaniya, Kuwait.
Insights
SARS-CoV-2 reinfection is rare in children, with a low incidence rate observed. Subsequent infections in pediatric patients tend to be less severe, often asymptomatic.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Epidemiology
Background:
- Limited data exists on subsequent protection from SARS-CoV-2 infection in pediatric populations.
- Understanding SARS-CoV-2 reinfection dynamics in children is crucial for public health strategies.
Purpose of the Study:
- To describe the clinical characteristics and dynamics of SARS-CoV-2 PCR positivity in children.
- To estimate the rate of SARS-CoV-2 reinfection in pediatric patients.
- To determine the average time interval between initial and subsequent SARS-CoV-2 infections.
Main Methods:
- Population-level retrospective cohort study utilizing national electronic COVID-19 databases in Kuwait.
- Inclusion of children aged 12 years and younger diagnosed between February 2020 and March 2021.
- Definition of reinfection as two or more positive SARS-CoV-2 PCR tests at least 45 days apart; incidence-sensitivity analysis for 60- and 90-day intervals.
Main Results:
- Thirty pediatric patients experienced SARS-CoV-2 reinfection, with an incidence of 1.02 per 100,000 person-days; median time to reinfection was 83 days.
- Reinfection incidence decreased with longer intervals (0.78 at 60 days, 0.47 at 90 days).
- The majority of reinfections (55.2%) were asymptomatic; fever was the most common symptom in symptomatic cases. Mean age of reinfected children was 8.5 years, with 70% being girls.
Conclusions:
- SARS-CoV-2 reinfection is uncommon in the pediatric population.
- Prior COVID-19 infection appears to confer milder subsequent infections in children.
Objective:
Subsequent protection from SARS-CoV-2 infection in paediatrics is not well reported in the literature. We aimed to describe the clinical characteristics and dynamics of SARS-CoV-2 PCR repositivity in children.
Design:
This is a population-level retrospective cohort study.
Setting:
Patients were identified through multiple national-level electronic COVID-19 databases that cover all primary, secondary and tertiary centres in Kuwait.
Participants:
The study included children 12 years and younger between 28 February 2020 and 6 March 2021. SARS-CoV-2 reinfection was defined as having two or more positive SARS-CoV-2 PCR tests done on a respiratory sample, at least 45 days apart. Clinical data were obtained from the Pediatric COVID-19 Registry in Kuwait.
Primary And Secondary Outcome Measures:
The primary measure is to estimate SARS-CoV-2 PCR repositivity rate. The secondary objective was to establish average duration between first and subsequent SARS-CoV-2 infection. Descriptive statistics were used to present clinical data for each infection episode. Also, incidence-sensitivity analysis was performed to evaluate 60-day and 90-day PCR repositivity intervals.
Results:
Thirty paediatric patients with COVID-19 had SARS-CoV-2 reinfection at an incidence of 1.02 (95% CI 0.71 to 1.45) infection per 100 000 person-days and a median time to reinfection of 83 (IQR 62-128.75) days. The incidence of reinfection decreased to 0.78 (95% CI 0.52 to 1.17) and 0.47 (95% CI 0.28 to 0.79) per person-day when the minimum interval between PCR repositivity was increased to 60 and 90 days, respectively. The mean age of reinfected subjects was 8.5 (IQR 3.7-10.3) years and the majority (70%) were girls. Most children (55.2%) had asymptomatic reinfection. Fever was the most common presentation in symptomatic patients. One immunocompromised experienced two reinfection episodes.
Conclusion:
SARS-CoV-2 reinfection is uncommon in children. Previous confirmed COVID-19 in children seems to result in a milder reinfection.
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