Comparison of Clinical and Epidemiological Characteristics of Asymptomatic and Symptomatic SARS-CoV-2 Infection in Children

Abstract

To understand the epidemiological and clinical features of the symptomatic and asymptomatic pediatric cases of COVID-19, we carried out a prospective study in Shanghai during the period of January 19 to April 30, 2020. A total of 49 children (mean age 11.5 ± 5.12 years) confirmed with SARS-CoV-2 infection were enrolled in the study, including 11 (22.4%) domestic cases and 38 (77.6%) imported cases. Nine (81.8%) local cases and 12 (31.6%) imported cases had a definitive epidemiological exposure. Twenty-eight (57.1%) were symptomatic and 21 (42.9%) were asymptomatic. Neither asymptomatic nor symptomatic cases progressed to severe diseases. The mean duration of viral shedding for SARS-CoV-2 in upper respiratory tract was 14.1 ± 6.4 days in asymptomatic cases and 14.8 ± 8.4 days in symptomatic cases ( P > 0.05). Forty-five (91.8%) cases had viral RNA detected in stool. The mean duration of viral shedding in stool was 28.1 ± 13.3 days in asymptomatic cases and 30.8 ± 18.6 days in symptomatic participants ( P > 0.05). Children < 7 years shed viral RNA in stool for a longer duration than school-aged children ( P < 0.05). Forty-three (87.8%) cases had seropositivity for antibodies against SARS-CoV-2 within 1–3 weeks after confirmation with infection. In conclusion, asymptomatic SARS-CoV-2 infection may be common in children in the community during the COVID-19 pandemic wave. Asymptomatic cases shed viral RNA in a similar pattern as symptomatic cases do. It is of particular concern that asymptomatic individuals are potentially seed transmission of SARS-CoV-2 and pose a challenge to disease control.

Prevalence and determinants of symptomatic COVID-19 infection among children and adolescents in Qatar: a cross-sectional analysis of 11 445 individuals

“…The current study indicated approximately two thirds of the children infected had a contact with a COVID-19 confirmed case (66.0%) but very few had visited a health care facility (about 5.0%), which is consistent with several previous studies [27,29,37]. For instance, Qiu et al reported that the majority of the children infected had a history of exposure to a family member with confirmed status of COVID-19 [27].…”

“…Prevailing symptoms in children with symptomatic COVID-19 was topped by fever (73.5%) and was followed by cough (34.8%). This was also consistent with several reports [22][23][24][25][26][27][28][29][30][31][32]. For instance, in a study of 7780 children with COVID-19, fever (59.1%) and cough (55.9%) were the symptoms most frequent reported [23].…”

Coronavirus Disease 2019 (COVID-19) in Neonates and Children From China: A Review

“…Among the previously diagnosed family from Shenzhen, the 10year-old asymptomatic boy was the first child confirmed infected with the virus (6) Later, on January 19, 2020, a 7-year-old boy with a fever and cough was reported in Shanghai after visiting his grandfather in Wuhan (14). The symptoms of COVID-19 appear to be less severe in infants and children than in adult patients, similar to the SARS-CoV infection (15)(16)(17).…”

COVID-19 and the clinical course of rheumatic manifestations

“…Some patients have been found to shed the SARS-CoV-2 virion in their stool for weeks [ 35 ]. Younger children seem to shed the virus for longer periods [ 36 ]. Some patients test positive for SARS-CoV-2 for a long time, making it difficult to distinguish re-infection from virus persistence [ 37 ].…”