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Viral Dynamics of the SARS-CoV-2 Omicron Variant in Pediatric Patients: A Prospective Cohort Study

Michelle Science1,2,3, Julia Orkin3,4,5, Bryan Maguire6

  • 1Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|December 12, 2023
PubMed

Insights

Children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) often reach non-infectious viral load levels the day after symptom resolution. Rapid antigen tests (RATs) may be unreliable early in illness, underscoring the need for further research into pediatric SARS-CoV-2 dynamics.

Area of Science:

  • Pediatric Infectious Diseases
  • Virology
  • Epidemiology

Background:

  • Limited data exist on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral dynamics in children.
  • Understanding viral load and shedding in pediatric populations is crucial for infection control and public health strategies.

Purpose of the Study:

  • To investigate viral dynamics, including viral load and shedding duration, in children with SARS-CoV-2.
  • To inform public health and infection-control decisions regarding pediatric SARS-CoV-2 transmission.

Main Methods:

  • Prospective cohort study of 101 children (aged 2-17 years) with PCR-confirmed SARS-CoV-2.
  • Daily viral load testing for 10 days, with a subset completing daily rapid antigen tests (RATs).
  • Analysis of viral RNA trajectories relative to symptom onset and resolution using Cox proportional hazards models.

Main Results:

  • Median time to non-infectious viral load was 5 days post-symptom onset; 75% achieved this by 7 days.
  • 49% and 60% met non-infectious thresholds on the day of and day after symptom resolution, respectively.
  • Rapid antigen tests (RATs) showed variable positivity, with 61% positive on the first day of non-infectious viral load.

Conclusions:

  • Children with SARS-CoV-2 frequently reach non-infectious viral load thresholds shortly after symptom resolution.
  • Rapid antigen tests (RATs) may yield false negatives early in illness and should not be solely relied upon to rule out infection.
  • Further research is needed to fully elucidate pediatric SARS-CoV-2 viral dynamics and optimize diagnostic and control measures.
Abstract

Keywords:
SARS-CoV-2childrenviral dynamicsviral load

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