Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지
DOI QR코드

DOI QR Code

Viral load and rebound in children with coronavirus disease 2019 during the first outbreak in Daegu city

  • Chu, Mi Ae (Department of Pediatrics, Keimyung University Daegu Dongsan Hospital) ;
  • Jang, Yoon Young (Department of Pediatrics, School of Medicine, Daegu Catholic University) ;
  • Lee, Dong Won (Department of Pediatrics, Daegu Fatima Hospital) ;
  • Kim, Sung Hoon (Department of Nuclear Medicine, Keimyung University Daegu Dongsan Hospital) ;
  • Ryoo, Namhee (Department of Laboratory Medicine, Keimyung University School of Medicine) ;
  • Park, Sunggyun (Department of Laboratory Medicine, Keimyung University School of Medicine) ;
  • Lee, Jae Hee (Department of Laboratory Medicine, Keimyung University Daegu Dongsan Hospital) ;
  • Chung, Hai Lee (Department of Pediatrics, School of Medicine, Daegu Catholic University)
  • 투고 : 2020.12.13
  • 심사 : 2021.09.28
  • 발행 : 2021.12.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Viral load and shedding duration are highly associated with the transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. However, limited studies have reported on viral load or shedding in children and adolescents infected with sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Purpose: This study aimed to investigate the natural course of viral load in asymptomatic or mild pediatric cases. Methods: Thirty-one children (<18 years) with confirmed SARS-CoV-2 infection were hospitalized and enrolled in this study. Viral loads were evaluated in nasopharyngeal swab samples using real-time reverse transcription polymerase chain reaction (E, RdRp, N genes). cycle threshold (Ct) values were measured when patients met the clinical criteria to be released from quarantine. Results: The mean age of the patients was 9.8 years, 18 (58%) had mild disease, and 13 (42%) were asymptomatic. Most children were infected by adult family members, most commonly by their mothers. The most common symptoms were fever and sputum (26%), followed by cough and runny nose. Nine patients (29%) had a high or intermediate viral load (Ct value≤30) when they had no clinical symptoms. Viral load showed no difference between symptomatic and asymptomatic patients. Viral rebounds were found in 15 cases (48%), which contributed to prolonged viral detection. The mean duration of viral detection was 25.6 days. Viral loads were significantly lower in patients with viral rebounds than in those with no rebound (E, P=0.003; RdRp, P=0.01; N, P=0.02). Conclusion: Our study showed that many pediatric patients with coronavirus disease 2019 (COVID-19) experienced viral rebound and showed viral detection for more than 3 weeks. Further studies are needed to investigate the relationship between viral rebound and infectiousness in COVID-19.

키워드

참고문헌

  1. Song Z, Xu Y, Bao L, Zhang L, Yu P, Qu Y, et al. From SARS to MERS, thrusting coronaviruses into the spotlight. Viruses 2019;11:59. https://doi.org/10.3390/v11010059
  2. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020;395:514-23. https://doi.org/10.1016/s0140-6736(20)30154-9
  3. Zimmermann P, Curtis N. Coronavirus infections in children including COVID-19: an overview of the epidemiology, clinical features, diagnosis, treatment and prevention options in children. Pediatr Infect Dis J 2020;39:355-68. https://doi.org/10.1097/INF.0000000000002660
  4. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 among children in China. Pediatrics 2020;145:e20200702. https://doi.org/10.1542/peds.2020-0702
  5. Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. SARS-CoV-2 infection in children. N Engl J Med 2020;382:1663-5. https://doi.org/10.1056/NEJMc2005073
  6. Coronavirus disease 2019 in children - United States, February 12-April 2, 2020. Morb Mortal Wkly Rep 2020;69:422-6. https://doi.org/10.15585/mmwr.mm6914e4
  7. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239-42. https://doi.org/10.1001/jama.2020.2648
  8. Han MS, Choi EH, Chang SH, Jin BL, Lee EJ, Kim BN, et al. Clinical characteristics and viral RNA detection in children with coronavirus disease 2019 in the Republic of Korea. JAMA Pediatr 2021;175:73-80. https://doi.org/10.1001/jamapediatrics.2020.3988
  9. Walsh KA, Jordan K, Clyne B, Rohde D, Drummond L, Byrne P, et al. SARS-CoV-2 detection, viral load and infectivity over the course of an infection. J Infect 2020;81:357-71. https://doi.org/10.1016/j.jinf.2020.06.067
  10. Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DK, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill 2020;25:2000045.
  11. Lalueza A, Folgueira D, Munoz-Gallego I, Trujillo H, Laureiro J, Hernandez-Jimenez P, et al. Influence of viral load in the outcome of hospitalized patients with influenza virus infection. Eur J Clin Microbiol Infect Dis 2019;38:667-73. https://doi.org/10.1007/s10096-019-03514-1
  12. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis 2020;20:689-96. https://doi.org/10.1016/s1473-3099(20)30198-5
  13. Lazzerini M, Sforzi I, Trapani S, Biban P, Silvagni D, Villa G, et al. Characteristics and risk factors for SARS-CoV-2 in children tested in the early phase of the pandemic: a cross-sectional study, Italy, 23 February to 24 May 2020. Euro Surveill 2021;26:2001248.
  14. COVID-19 National Emergency Response Center, Epidemiology and Case Management Team, Korea Centers for Disease Control and Prevention. Coronavirus disease-19: the first 7,755 cases in the Republic of Korea. Osong Public Health Res Perspect 2020;11:85-90. https://doi.org/10.24171/j.phrp.2020.11.2.05
  15. Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol 2020;277:2251-61. https://doi.org/10.1007/s00405-020-05965-1
  16. Kam KQ, Yung CF, Cui L, Tzer Pin Lin R, Mak TM, Maiwald M, et al. A well infant with coronavirus disease 2019 with high viral load. Clin Infect Dis 2020;71:847-9. https://doi.org/10.1093/cid/ciaa201
  17. Patel PA, Chandrakasan S, Mickells GE, Yildirim I, Kao CM, Bennett CM. Severe pediatric COVID-19 presenting with respiratory failure and severe thrombocytopenia. Pediatrics 2020;146:e20201437. https://doi.org/10.1542/peds.2020-1437
  18. Pan Y, Zhang D, Yang P, Poon LLM, Wang Q. Viral load of SARS-CoV-2 in clinical samples. Lancet Infect Dis 2020;20:411-2. https://doi.org/10.1016/s1473-3099(20)30113-4
  19. Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med 2020;382:1177-9. https://doi.org/10.1056/NEJMc2001737
  20. Lombardi A, Bozzi G, Mangioni D, Muscatello A, Peri AM, Taramasso L, et al. Duration of quarantine in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: a question needing an answer. J Hosp Infect 2020;105:404-5. https://doi.org/10.1016/j.jhin.2020.03.003
  21. Madera S, Crawford E, Langelier C, Tran NK, Thornborrow E, Miller S, et al. Nasopharyngeal SARS-CoV-2 viral loads in young children do not differ significantly from those in older children and adults. Sci Rep 2021;11:3044. https://doi.org/10.1038/s41598-021-81934-w
  22. Aykac K, Cura Yayla BC, Ozsurekci Y, Evren K, Oygar PD, Gurlevik SL, et al. The association of viral load and disease severity in children with COVID-19. J Med Virol 2021;93:3077-83. https://doi.org/10.1002/jmv.26853
  23. Zheng S, Fan J, Yu F, Feng B, Lou B, Zou Q, et al. Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study. BMJ 2020;369:m1443.
  24. Heald-Sargent T, Muller WJ, Zheng X, Rippe J, Patel AB, Kociolek LK. Age-related differences in nasopharyngeal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) levels in patients with mild to moderate coronavirus disease 2019 (COVID-19). JAMA Pediatr 2020;174:902-3. https://doi.org/10.1001/jamapediatrics.2020.3651
  25. Lu Y, Li Y, Deng W, Liu M, He Y, Huang L, et al. Symptomatic infection is associated with prolonged duration of viral shedding in mild coronavirus disease 2019: a retrospective study of 110 children in Wuhan. Pediatr Infect Dis J 2020;39:e95-9. https://doi.org/10.1097/INF.0000000000002729
  26. Uhm JS, Ahn JY, Hyun J, Sohn Y, Kim JH, Jeong SJ, et al. Patterns of viral clearance in the natural course of asymptomatic COVID-19: comparison with symptomatic non-severe COVID-19. Int J Infect Dis 2020;99:279-85. https://doi.org/10.1016/j.ijid.2020.07.070
  27. Cento V, Colagrossi L, Nava A, Lamberti A, Senatore S, Travi G, et al. Persistent positivity and fluctuations of SARS-CoV-2 RNA in clinically-recovered COVID-19 patients. J Infect 2020;81:e90-2. https://doi.org/10.1016/j.jinf.2020.06.024
  28. Gao C, Zhu L, Jin CC, Tong YX, Xiao AT, Zhang S. Prevalence and impact factors of recurrent positive SARS-CoV-2 detection in 599 hospitalized COVID-19 patients. Clin Microbiol Infect 2021;27:785.e1-785.e7. https://doi.org/10.1016/j.cmi.2021.01.028
  29. Song W, Li J, Zou N, Guan W, Pan J, Xu W. Clinical features of pediatric patients with coronavirus disease (COVID-19). J Clin Virol 2020;127:104377. https://doi.org/10.1016/j.jcv.2020.104377
  30. Su L, Ma X, Yu H, Zhang Z, Bian P, Han Y, et al. The different clinical characteristics of corona virus disease cases between children and their families in China - the character of children with COVID-19. Emerg Microbes Infect 2020;9:707-13. https://doi.org/10.1080/22221751.2020.1744483
  31. Lin J, Duan J, Tan T, Fu Z, Dai J. The isolation period should be longer: lesson from a child infected with SARS-CoV-2 in Chongqing, China. Pediatr Pulmonol 2020;55:E6-9. https://doi.org/10.1002/ppul.24763
  32. Xing YH, Ni W, Wu Q, Li WJ, Li GJ, Wang WD, et al. Prolonged viral shedding in feces of pediatric patients with coronavirus disease 2019. J Microbiol Immunol Infect 2020;53:473-80. https://doi.org/10.1016/j.jmii.2020.03.021
  33. Wang D, Ju XL, Xie F, Lu Y, Li FY, Huang HH, et al. Clinical analysis of 31 cases of 2019 novel coronavirus infection in children from six provinces (autonomous region) of northern China. Zhonghua Er Ke Za Zhi 2020;58:269-74.
  34. Liu W, Zhang Q, Chen J, Xiang R, Song H, Shu S, et al. Detection of Covid-19 in Children in Early January 2020 in Wuhan, China. N Engl J Med 2020;382:1370-1. https://doi.org/10.1056/NEJMc2003717
  35. Chiotos K, Hayes M, Kimberlin DW, Jones SB, James SH, Pinninti SG, et al. Multicenter initial guidance on use of antivirals for children with coronavirus disease 2019/severe acute respiratory syndrome coronavirus 2. J Pediatric Infect Dis Soc 2020;9:701-15. https://doi.org/10.1093/jpids/piaa045
  36. Shen K, Yang Y, Wang T, Zhao D, Jiang Y, Jin R, et al. Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts' consensus statement. World J Pediatr 2020;16:223-31. https://doi.org/10.1007/s12519-020-00343-7
  37. He X, Lau EHY, Wu P, Deng X, Wang J, Hao X, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med 2020;26:672-5. https://doi.org/10.1038/s41591-020-0869-5