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