J Pediatr . Pediatric SARS-CoV-2: Clinical Presentation, Infectivity, and Immune Responses

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J Pediatr


. 2020 Aug 18;S0022-3476(20)31023-4.
doi: 10.1016/j.jpeds.2020.08.037. Online ahead of print.
Pediatric SARS-CoV-2: Clinical Presentation, Infectivity, and Immune Responses


Lael M Yonker ¹ , Anne M Neilan ² , Yannic Bartsch ³ , Ankit B Patel ⁴ , James Regan ⁵ , Puneeta Arya ⁶ , Elizabeth Gootkind ⁷ , Grace Park ⁷ , Margot Hardcastle ⁷ , Anita St John ⁷ , Lori Appleman ⁷ , Michelle L Chiu ⁶ , Allison Fialkowski ⁸ , Denis De la Flor ⁹ , Rosiane Lima ⁹ , Evan A Bordt ⁶ , Laura J Yockey ¹⁰ , Paolo D'Avino ¹¹ , Stephanie Fischinger ¹² , Jessica E Shui ⁶ , Paul H Lerou ⁶ , Joseph V Bonventre ⁴ , Xu G Yu ¹³ , Edward T Ryan ¹⁴ , Ingrid V Bassett ¹⁵ , Daniel Irimia ¹⁶ , Andrea G Edlow ¹⁷ , Galit Alter ¹⁸ , Jonathan Z Li ¹⁹ , Alessio Fasano ²⁰



Affiliations

• PMID: 32827525
• DOI: 10.1016/j.jpeds.2020.08.037

Abstract

Data sharing: The data obtained as part of this study are available from the corresponding author upon reasonable request.
Objectives: As schools plan for re-opening, understanding the potential role children play in the coronavirus infectious disease 2019 (COVID-19) pandemic and the factors that drive severe illness in children is critical.
Study design: Children ages 0-22 years with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presenting to urgent care clinics or being hospitalized for confirmed/suspected SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) at Massachusetts General Hospital (MGH) were offered enrollment in the MGH Pediatric COVID-19 Biorepository. Enrolled children provided nasopharyngeal, oropharyngeal, and/or blood specimens. SARS-CoV-2 viral load, ACE2 RNA levels, and serology for SARS-CoV-2 were quantified.
Results: A total of 192 children (mean age 10.2 +/- 7 years) were enrolled. Forty-nine children (26%) were diagnosed with acute SARS-CoV-2 infection; an additional 18 children (9%) met criteria for MIS-C. Only 25 (51%) of children with acute SARS-CoV-2 infection presented with fever; symptoms of SARS-CoV-2 infection, if present, were non-specific. Nasopharyngeal viral load was highest in children in the first 2 days of symptoms, significantly higher than hospitalized adults with severe disease (P = .002). Age did not impact viral load, but younger children had lower ACE2 expression (P=0.004). IgM and IgG to the receptor binding domain (RBD) of the SARS-CoV-2 spike protein were increased in severe MIS-C (P<0.001), with dysregulated humoral responses observed.
Conclusion: This study reveals that children may be a potential source of contagion in the SARS-CoV-2 pandemic in spite of milder disease or lack of symptoms, and immune dysregulation is implicated in severe post-infectious MIS-C.