Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding

Xu, Yi; Li, Xufang; Zhu, Bing; Liang, Huiying; Fang, Chunxiao; Gong, Yu; Guo, Qiaoru; Sun, Xin; Zhao, Danyang; Shen, Jun; Zhang, Huayan; Liu, Huan; Xia, Huimin; Tang, Jin‐Ling; Zhang, Kang; Gong, Sitang

doi:10.1038/s41591-020-0817-4

Cited by 1,401 publications

(1,584 citation statements)

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“…While we were closely monitoring the dynamic changes of fecal SARS-CoV-2 in our patients, a study conducted in Guangzhou, Guangdong Province, China, reported eight out of ten pediatric patients of COVID-19 had prolonged presence of viral RNA in rectal swabs after showing negative in nasopharyngeal swabs. 12 The researchers also found that viral load of SARS-CoV-2 in the gastrointestinal tract might be greater and last longer than that in the respiratory system, a finding also in line with our study. Xiao and colleagues demonstrated that about a quarter of COVID-19 patients had SARS-CoV-2 RNA detectable in feces after + MODEL viral clearance in respiratory tract.…”

Section: Discussionsupporting

confidence: 92%

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Prolonged viral shedding in feces of pediatric patients with coronavirus disease 2019

Xing

et al. 2020

Journal of Microbiology, Immunology and Infection

295

296

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Objective: To determine the dynamic changes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in respiratory and fecal specimens in children with coronavirus disease 2019 . Methods: From January 17, 2020 to February 23, 2020, three paediatric cases of COVID-19 were reported in Qingdao, Shandong Province, China. Epidemiological, clinical, laboratory, and radiological characteristics and treatment data were collected. Patients were followed up to March 10, 2020, and dynamic profiles of nucleic acid testing results in throat swabs and fecal specimens were closely monitored. Results: Clearance of SARS-CoV-2 in respiratory tract occurred within two weeks after abatement of fever, whereas viral RNA remained detectable in stools of pediatric patients for longer than 4 weeks. Two children had fecal SARS-CoV-2 undetectable 20 days after throat swabs showing negative, while that of another child lagged behind for 8 days.Conclusions: SARS-CoV-2 may exist in children's gastrointestinal tract for a longer time than respiratory system. Persistent shedding of SARS-CoV-2 in stools of infected children raises the possibility that the virus might be transmitted through contaminated fomites. Massive efforts should be made at all levels to prevent spreading of the infection among children after reopening of kindergartens and schools.

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Section: Discussionsupporting

confidence: 92%

“…Ct values were used to approximately reflect the viral load (inversely related to Ct value) in respiratory tract and digestive system, a method suggested in recent studies on a similar topic. 2,12…”

Section: Sample Collection and Detection Of Sars-cov-2mentioning

confidence: 99%

Prolonged viral shedding in feces of pediatric patients with coronavirus disease 2019

Xing

et al. 2020

Journal of Microbiology, Immunology and Infection

295

296

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“…We demonstrated that SARS-CoV-2-infected ferrets showed high virus titers in upper respiratory tracts (nasal washes) and consequently transmitted to naive ferrets by direct contact at high efficiency, suggesting that SARS-CoV-2 ferret model recapitulates aspects of human infection and transmission. Further, as suspected in recent COVID-19 patients Xu et al, 2020), we detected the infectious viruses in urine and fecal specimens of virus-infected ferrets. However, there are also limitations in the SARS-CoV-2 ferret model, as SARS-CoV-2 infected ferrets showed only mild clinical symptoms and relatively lower virus titers in lungs of infected animals than SARS-CoV-1-infected or MERS-CoV-infected hACE2 or hDPP4 transgenic mice (Glass et al, 2004 andLi et al, 2017).…”

Section: Routementioning

confidence: 79%

Infection and Rapid Transmission of SARS-CoV-2 in Ferrets

Kim

et al. 2020

Cell Host & Microbe

902

1,047

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“…There are a few limitations of this study; for example, testing was confirmed using pharyngeal, nasal, blood, or respiratory tract samples; anal swabs were not obtained, though viral fecal shedding has also been reported. 7,8 The testing methods used confirmed that children may be asymptomatic carriers of the virus, though it was unclear if these asymptomatic children were identified because of history of exposure, or residence in the Hubei province through universal screening processes. It is additionally unclear if suspected patients had negative testing, or if suspected patients were not tested because of limitations in testing supplies, or testing abilities in the pediatric population.…”

Section: Critical Appraisalmentioning

confidence: 99%