Pediatric SARS-CoV-2: Clinical Presentation, Infectivity, and Immune Responses

Details

• Alternative Title:
  J Pediatr
• Personal Author:
  Yonker, Lael M. ; Neilan, Anne M. ; Bartsch, Yannic ; Patel, Ankit B. ; Regan, James ; Arya, Puneeta ; Gootkind, Elizabeth ; Park, Grace ; Hardcastle, Margot ; John, Anita St. ; Appleman, Lori ; Chiu, Michelle L. ; Fialkowski, Allison ; De la Flor, Denis ; Lima, Rosiane ; Bordt, Evan A. ; Yockey, Laura J. ; D’Avino, Paolo ; Fischinger, Stephanie ; Shui, Jessica E. ; Lerou, Paul H. ; Bonventre, Joseph V. ; Yu, Xu G. ; Ryan, Edward T. ; Bassett, Ingrid V. ; Irimia, Daniel ; Edlow, Andrea G. ; Alter, Galit ; Li, Jonathan Z. ; Fasano, Alessio
• Description:
  Objectives:
  
  As schools plan for re-opening, understanding the potential role children play in the coronavirus infectious disease 2019 (COVID-19) pandemic and the factors that drive severe illness in children is critical.
  
  Study design:
  
  Children ages 0-22 years with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presenting to urgent care clinics or being hospitalized for confirmed/suspected SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) at Massachusetts General Hospital (MGH) were offered enrollment in the MGH Pediatric COVID-19 Biorepository. Enrolled children provided nasopharyngeal, oropharyngeal, and/or blood specimens. SARS-CoV-2 viral load, ACE2 RNA levels, and serology for SARS-CoV-2 were quantified.
  
  Results:
  
  A total of 192 children (mean age 10.2 +/− 7 years) were enrolled. Forty-nine children (26%) were diagnosed with acute SARS-CoV-2 infection; an additional 18 children (9%) met criteria for MIS-C. Only 25 (51%) of children with acute SARS-CoV-2 infection presented with fever; symptoms of SARS-CoV-2 infection, if present, were non-specific. Nasopharyngeal viral load was highest in children in the first 2 days of symptoms, significantly higher than hospitalized adults with severe disease (P = .002). Age did not impact viral load, but younger children had lower ACE2 expression (P=0.004). IgM and IgG to the receptor binding domain (RBD) of the SARS-CoV-2 spike protein were increased in severe MIS-C (P<0.001), with dysregulated humoral responses observed.
  
  Conclusion:
  
  This study reveals that children may be a potential source of contagion in the SARS-CoV-2 pandemic in spite of milder disease or lack of symptoms, and immune dysregulation is implicated in severe post-infectious MIS-C.
  
  
• Subjects:
  Adolescent Age Factors Child Child, Preschool Comorbidity COVID-19 COVID-19 Testing Female Humans Infant Infant, Newborn Male Massachusetts Pandemics Severity Of Illness Index Viral Load Young Adult

  More +
• Source:
  J Pediatr. 227:45-52.e5
• Pubmed ID:
  32827525
• Pubmed Central ID:
  PMC7438214
• Document Type:
  Journal Article
• Funding:
  R01 HD100022/HD/NICHD NIH HHSUnited States/ ; R37 DK039773/DK/NIDDK NIH HHSUnited States/ ; R01 DK104344/DK/NIDDK NIH HHSUnited States/ ; R01 DK072381/DK/NIDDK NIH HHSUnited States/ ; U01 CK000490/CK/NCEZID CDC HHSUnited States/ ; K24 AI141036/AI/NIAID NIH HHSUnited States/ ; R01 GM092804/GM/NIGMS NIH HHSUnited States/ ; R01 DK039773/DK/NIDDK NIH HHSUnited States/ ; K08 HL143183/HL/NHLBI NIH HHSUnited States/ ; U01CK000490/ACL/ACL HHSUnited States/ ; K08 HD094638/HD/NICHD NIH HHSUnited States/
• Volume:
  227
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:70d08253c8bd1218df05e97599fc2eda61937097c03981317ed5eed7a6c3064ef8d151ef284664ad8783b5761e2e5df8a144294e2c9d3fa7969638e400b127a8
• Download URL:
  https://stacks.cdc.gov/view/cdc/112435/cdc_112435_DS1.pdf
• File Type:
  [PDF - 1.24 MB ]