Screening for COVID-19 in Children Undergoing Elective Invasive Procedures

Abstract

Objective To report the frequency of asymptomatic infection with SARS-CoV-2 in pediatric patients undergoing invasive medical procedures in a tertiary pediatric hospital. Methods From June to October 2020, a SARS-CoV-2 real-time reverse-transcription polymerase chain reaction (rRT-PCR) test was performed for all pediatric patients scheduled to undergo an elective invasive procedure. None of the patients was symptomatic. The cycle threshold (Ct) values of the ORF1ab gene were recorded for all patients. Results A total of 700 patients were screened for SARS-CoV-2 infection. The median age was 5.7 y old. In total, 46.6% (n = 326) of the patients were male, and 53.4% (n = 374) were female. The most common underlying diseases were hematooncological (25.3%), gastrointestinal (24.9%), and genitourinary (10.3%). The main scheduled surgical-medical procedures were surgical treatment for acquired congenital diseases, biopsy sampling, local therapy administration, organ transplantation, and the placement of central venous catheters, among others. The SARS-CoV-2 rRT-PCR test was positive in 9.4% (66), and the median Ct value was 35.8. None of the patients developed COVID-19. Conclusions The frequency of asymptomatic SARS-CoV-2 infection was detected in less than 10% of pediatric patients scheduled to undergo an elective invasive procedure in a tertiary hospital. This frequency is higher than those in reports from different countries.

Is There a Need to Screen Children for COVID-19 for Elective Procedures?

“…A cross-sectional study from Mexico to report the frequency of asymptomatic infection with SARS-CoV-2 in children undergoing invasive medical procedures warrants attention [ 1 ]. The SARS-CoV-2 RT-PCR test was positive in 9.4% of 700 tested individuals; none of these patients was symptomatic of COVID-19 [ 2 ].…”

“…The study [ 1 ] was done during prevaccine era and effects of vaccine on positivity rate and risk of transmission needs to be evaluated.…”

“…When population subgroups were analyzed, the asymptomatic transmission rate among familial clusters, adults, children, and healthcare workers was 15.72%, 29.48%, 24.09%, and 0%, respectively [ 3 ]. The study in question suggested that a tenth of all patients undergoing medical procedures may silently harbor infection with SARS-CoV-2 [ 1 ]. This is a considerable proportion as these patients may potentially transmit the virus to other patients and healthcare personnel.…”

“…The authors reported average cycle threshold (Ct) value as 35.8 (range 31.9 to 37.8) in their asymptomatic positive cases [ 1 ]. The higher Ct value suggest lower viral load and initial reports suggested very low/no risk of transmission, if Ct value was > 30, but later on, studies reported positive virus culture in up to 50% cases of Ct values > 30, suggesting infectivity [ 4 ].…”