Previous videos on children and infection
Pediatric SARS-CoV-2: Clinical Presentation, Infectivity, and Immune Responses
Massachusetts General Hospital
Background
Asymptomatic carriers, including children, can spread infection and carry virus into their household
Objectives
Potential role children play in the coronavirus infectious disease 2019 (COVID-19) pandemic
Factors that drive severe illness in children
Study design
0-22 years
With suspected infection
Presenting to urgent care clinics or being hospitalized
For confirmed/suspected SARS-CoV-2 infection
Or multisystem inflammatory syndrome in children (MIS-C)
Enrolled provided
Nasopharyngeal, oropharyngeal, and/or blood specimens
SARS-CoV-2 viral load
Serology
ACE2 RNA levels
Results
192 children
Forty-nine children (26%) were diagnosed with acute SARS-CoV-2 infection
An additional 18 children (9%) met criteria for MIS-C
Nasopharyngeal viral load was highest in children in the first 2 days of symptoms
Some children carry very high viral loads even before symptoms develop
Viral load in respiratory secretions of children was high, despite mild or absent symptoms
Significantly higher than hospitalized adults with severe disease (P = .002)
Age of child / young person did not impact viral load
Younger children had lower ACE2 expression (P=0.004)
Source of children’s infection
Nine (18%) did not have a known infected household contact
26 (53%) attended grade school.
Presentations
SARS-CoV-2 infection and non-COVID-19-related illnesses presented similarly
In the positive group
25 (51%) presented with fever
Cough 23, (47%)
Congestion 17 (35%)
Rhinorrhea 14, 29%)
Headache 13, 27%)
None of which were significantly different between the two groups
Significant difference
Anosmia 10, 20%
Sore throat 17, 35%
COVID – 19 symptom tracker app
Rash in up to 20% of cases
Conclusion
Children may be a potential source of contagion in the SARS-CoV-2 pandemic
Contradict previous reports, children to be less likely to be the index case within a household
Children with high viral loads and non-specific symptoms including rhinorrhea and cough can likely transmit SARS-CoV-2 as easily as other viral infections spread by respiratory particles
If schools were to re-open fully without necessary precautions, it is likely that children will play a larger role in this pandemic
Potential transmission between children and families should be considered when designing strategies to mitigate the pandemic
In spite of milder disease or lack of symptoms
Immune dysregulation is implicated in severe post-infectious MIS-C
Hypothesis
ACE2 expression in the nasopharynx increases with age
Multisystem inflammatory syndrome (MIS-C)
IgM and IgG to the receptor binding domain spike protein were increased in severe MIS-C (P less than 0.001)
In severe MIS-C, more often a broadly elevated IgG response
To a multitude of respiratory viruses, including;
Other coronaviruses, 229E, NL63, HKU1, and OC43
Respiratory Syncytial Virus
Influenza
Several weeks after possible SARS-CoV-2 infection or exposure
MIS-C presented more often with
Viral load the same as other infected children
Fever
Nausea/vomiting
Rash
Less often with symptoms of an upper respiratory tract infection
Criteria for COVID – 19 MIS-C
Fever more than 38oC for more than 24 hours
Laboratory evidence of inflammation
At least two organs involved
No alternative plausible diagnoses and a
Positive serology or antigen test
Exposure to an individual with COVID-19 within 4 weeks prior to the onset of symptoms
Severe cardiac complications, including hypotension, shock, and acute heart failure
Understanding post-infectious immune responses in pediatric is critical for designing treatment and prevention strategies
