Symptomatic infection tied to extended viral shedding in children with COVID-19

Symptomatic infections, including fever, pneumonia, and lymphocyte count <2.0 × 10⁹/L, are associated with prolonged duration of viral shedding in children with coronavirus disease 2019 (COVID-19), according to a recent study. Additionally, younger age, increased hypersensitive C-reactive protein (hs-CRP), and pneumonia are independent risk factor for symptomatic infection in this population.

“Our results suggested that the clinical presentation was associated with the duration of viral shedding in children with COVID-19,” the researchers said.

A retrospective analysis was carried out on clinical and laboratory information of 110 children with COVID-19 (median age, 6 years) at Wuhan Children’s Hospital in Wuhan, China, from 30 January to 10 March 2020.

The median period of viral shedding, as measured from illness onset to discharge, was 15 days (interquartile range, 11–20 days), and such period was shorter in asymptomatic patients (26.4 percent; 11 days) compared with symptomatic ones (73.6 percent; 17 days). The most common symptoms in symptomatic patients were cough and dyspnoea (51.8 percent), followed by fever (50.9 percent). Digestive symptoms were present in 26 children (23.6 percent). [Pediatr Infect Dis J 2020;39:e95-e99]

On multivariable regression analysis, age <6 years (odds ratio [OR], 8.94, 95 percent confidence interval [CI], 2.55–31.35; p=0.001), hs-CRP >3.0 mg/L (OR, 4.89, 95 percent CI, 1.10–21.75; p=0.037), and presenting pneumonia in chest radiologic findings (OR, 8.45, 95 percent CI, 2.69–26.61; p<0.001) correlated with a higher risk of symptomatic infection.

Furthermore, Kaplan-Meier analysis revealed that prolonged duration of viral shedding in children with COVID-19 was associated with symptomatic infection (p<0.001), as well as fever (p=0.006), pneumonia (p=0.003), and lymphocyte counts <2.0 × 10⁹/L (p=0.008).

“[A]ll the asymptomatic children at admission were mild or ordinary COVID-19, which is consistent with asymptomatic adults,” the researchers said. “The duration of viral shedding in symptomatic children was significantly longer than in asymptomatic cases, which indicated that symptomatic patients had much more transmission potential and may need to be isolated.” [J Infect Dis 2020;pii:jiaa119]

Of note, symptomatic infection was more common in younger children. The researchers stressed the importance of performing throat or nasopharyngeal swabs on young children who had an exposure history and presented fever to confirm infection with SARS-CoV-2, the causative agent of COVID-19.

“It is worth noting that digestive symptoms such as diarrhoea, vomiting, poor feeding, and abdominal pain were not rare in children with COVID-19, which should not be ignored by parents and doctors,” the researchers said. 

Moreover, “[c]hildren with COVID-19 experienced a milder clinical course than adults, and the majority of children recovered with interferon-α nebulization, similar to children with SARS,” they added. [Pediatrics 2003;112:e261; Pediatrics 2004;113:e7-e14]

The current study had certain limitations, such as its retrospective design and small sample size. In addition, not all tests were performed and monitored during hospitalization in all patients, and other specimens, such as faeces and urine, were not monitored for SARS-CoV-2.