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Hidden SARS-CoV-2 Omicron Infections in Young Children: What Routine Tests Do Not Tell
Stijn Bogaert1, Hannah Lukasik2, Panagiotis Georgiou3
1Department of Otorhinolaryngology - Head and Neck Surgery, Saint Elisabeth Hospital, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany.
Insights
Routine PCR tests for COVID-19 in young children show low sensitivity, missing many infections. This challenges current screening protocols for asymptomatic children, especially those recently recovered from SARS-CoV-2.
Area of Science:
- Pediatric Infectious Diseases
- Diagnostic Accuracy
- Epidemiology
Background:
- The COVID-19 pandemic necessitated varied screening protocols, complicated by different variants and challenging implementation in young children.
- Routine polymerase chain reaction (PCR) testing is a primary screening method, but its accuracy in pediatric populations requires evaluation.
Purpose of the Study:
- To assess the diagnostic accuracy of routine PCR testing for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in young children.
- To identify SARS-CoV-2 Omicron infections missed by routine PCR and compare multiple testing modalities.
Main Methods:
- A prospective cohort study involving 55 children aged ≤ 6 years undergoing adenoidectomy/tonsillotomy.
- Comparison of preoperative PCR with intraoperative rapid antigen tests, separate naso/oropharyngeal PCR swabs, tissue PCR, and serological tests.
Main Results:
- Routine preoperative PCR had a sensitivity of only 20% compared to tissue PCR.
- Intraoperative PCR screening achieved 79% sensitivity, detecting SARS-CoV-2 in 51% of all children and 43% of those without recent infection.
- Nasopharyngeal PCR outperformed oropharyngeal swabs in detecting SARS-CoV-2.
Conclusions:
- Routine PCR testing in infants demonstrates low sensitivity and a high false-negative rate.
- Current preoperative screening protocols for asymptomatic children, particularly those with recent SARS-CoV-2 recovery, may need re-evaluation due to potential inaccuracies.
Introduction:
The coronavirus disease 2019 (COVID-19) pandemic caused a global emergency. Screening protocols vary regarding the epidemiological situation and the dominant virus variant. Implementing these protocols can be particularly challenging in young children.
Objective:
To evaluate the diagnostic accuracy of routine polymerase chain reaction (PCR) testing in small children. Furthermore, hidden severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) Omicron infections, missed by routine PCR testing, were intraoperatively analyzed, and multiple testing methods were compared.
Methods:
The present prospective cohort study was performed between March and May 2022. All children aged ≤ 6 years who were admitted for adenoidectomy and/or tonsillotomy to the Department of Otorhinolaryngology - Head and Neck Surgery of the Saint Elisabeth Hospital, in Bochum, Germany, were included. Routine PCR swabs were performed ≤ 24 hours before surgery. Intraoperatively, rapid antigen tests, separate naso- and oropharyngeal PCR swabs, adenoid and/or tonsillar tissue for PCR analysis, and serological tests were collected.
Results:
We included 55 children with negative preoperative PCR tests. Intraoperatively, SARS-CoV-2 particles were detected in 51% of the sample. Among children without a history of SARS-CoV-2 infection within 90 days before surgery, the prevalence was 43%. Compared with the PCR results regarding tissue, the preoperative PCR screening had a sensitivity of 20%, and, in the intraoperative PCR screening, the optimally performed swabs had a sensitivity of 79%. In total, 29% of the positive cases had a cycle threshold (Ct) value < 30. Nasopharyngeal PCR tests detected significantly more SARS-CoV-2 infections than oropharyngeal swabs.
Conclusion:
Routine PCR tests in infants may present a high rate of false-negative results and a low sensitivity. These findings question preoperative screening protocols that include testing asymptomatic children who have recovered from a recent SARS-CoV-2 infection.
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