SARS-CoV-2 Infections Among Children in the Biospecimens from Respiratory Virus-Exposed Kids (BRAVE Kids) Study

Abstract

BACKGROUND: Children with SARS-CoV-2 infection typically have mild symptoms that do not require medical attention, leaving a gap in our understanding of the spectrum of illnesses that the virus causes in children. METHODS: We conducted a prospective cohort study of children and adolescents (<21 years of age) with a SARS-CoV-2-infected close contact. We collected nasopharyngeal or nasal swabs at enrollment and tested for SARS-CoV-2 using a real-time PCR assay. RESULTS: Of 382 children, 293 (77%) were SARS-CoV-2-infected. SARS-CoV-2-infected children were more likely to be Hispanic (p<0.0001), less likely to have asthma (p=0.005), and more likely to have an infected sibling contact (p=0.001) than uninfected children. Children ages 6-13 years were frequently asymptomatic (39%) and had respiratory symptoms less often than younger children (29% vs. 48%; p=0.01) or adolescents (29% vs. 60%; p<0.0001). Compared to children ages 6-13 years, adolescents more frequently reported influenza-like (61% vs. 39%; p<0.0001), gastrointestinal (27% vs. 9%; p=0.002), and sensory symptoms (42% vs. 9%; p<0.0001), and had more prolonged illnesses [median (IQR) duration: 7 (4, 12) vs. 4 (3, 8) days; p=0.01]. Despite the age-related variability in symptoms, we found no differences in nasopharyngeal viral load by age or between symptomatic and asymptomatic children. CONCLUSIONS: Hispanic ethnicity and an infected sibling close contact are associated with increased SARS-CoV-2 infection risk among children, while asthma is associated with decreased risk. Age-related differences in the clinical manifestations of SARS-CoV-2 infection must be considered when evaluating children for COVID-19 and in developing screening strategies for schools and childcare settings.

Comparison of Upper Respiratory Viral Load Distributions in Asymptomatic and Symptomatic Children Diagnosed with SARS-CoV-2 Infection in Pediatric Hospital Testing Programs

“…Given that asymptomatic patients with a recent known COVID-19 contact were more likely to have higher viral loads in our study, one hypothesis is that the lower median viral loads in the preprocedure/preadmission testing groups reflect that more of those children had remote infection. This suggestion is supported by a recent study of children who were all close contacts of people with SARS-CoV-2 infection; that study found similar viral loads on NP swabs from children with and without symptoms (though all reported viral loads were relatively low) ( 35 ). Unfortunately, there are minimal published data describing results of testing asymptomatic populations with a wider range of potential exposure times.…”

Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents

“…Other studies have suggested that only around 20% 31 -50% 6 of population samples of CYP have symptoms. Findings from the small number of available community samples suggest that lower proportions present with fever (30% 6 32 -40% 33 ) and cough (10% 6 -35% 32 33 ), consistent with a higher proportion who are asymptomatic.…”

Subgenomic RNAs as molecular indicators of asymptomatic SARS-CoV-2 infection

“…Of great importance in the management of the pandemic is the observation that many infected individuals are asymptomatic, ranging from 20-80% 1,2,3 . Asymptomatic patients, while having faster viral clearance [4][5][6][7] , appear to have similar viral loads compared to symptomatic patients 4,5,[8][9][10][11] and, therefore, can effectively transmit the disease. Since viral load is not a reliable predictor of disease severity, we examined the genomic biology of SARS-CoV2 infection in primary patient samples for other correlates of clinical severity.…”