Abstract
Objective
To study the clinical and laboratory profile and to assess period for viral clearance in COVID 19 children.
Methods
We reviewed hospital records of children (<18 years) admitted from 1 April to 31 May, 2020 at a tertiary-care public hospital and identified those positive for severe acute respiratory syndrome corona virus (SARS-CoV-2) by RT-PCR of respiratory secretions.
Results
81.2% of the 85 children studied were asymptomatic and 3 (8.5%) died. Severe lymphopenia (43.8%), raised C-reactive protein (93.8%), raised erythrocyte sedimentation rate (75%) and high (>500ng/mL) levels of D-dimer (37.5%) were common. Median (IQR) duration of viral shedding was 7 (5–10) days, with range of 2 to 45 days; 96.3% had viral clearance within 14 days.
Conclusions
Majority of children aged <18 years with SARS-CoV-2 infection had viral clearance within 14 days.
Keywords: COVID-19, Management, Outcome, Viral shedding
Contributors
MLG, RKG, RBS: concept and design; SG, JSM, PKS, DD: data collection, review of literature; SG, RKG, JSM, PKS, DD: drafting of manuscript, SG, DKG: data analysis, statistics and data interpretation. MLG, RBS, RKG, SG: intellectual input, critical revision and finalization of manuscript. All authors provided final approval of version to be published.
Funding
None
Ethics clearance: Institutional ethics committee of SMS Medical College; No. 423/MC/2020 dated 27 June, 2020.
Competing interest: None stated.
References
- 1.Meena J, Yadav J, Saini L, Yadav A, Kumar J. Clinical features and outcome of SARS-CoV-2 infection in children: A systematic review and meta-analysis. Indian Pediatr. 2020;57:820–26. doi: 10.1007/s13312-020-1961-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Sarangi B, Reddy VS, Oswal JS, et al. Epidemiological and clinical characteristics of COVID-19 in Indian children in the initial phase of the pandemic. Indian Pediatr. 2020;57:914–17. doi: 10.1007/s13312-020-1994-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Indian Council of Medical Research. Revised Strategy of COVID19 testing in India (version 3, dated 20.03.20). Assessed September 08, 2020. Available from: https://icmr.nic.in/sites/default/files/uploaddocuments/2020-3-20covid19testv3.pdf/www.mohfw.gov.in
- 4.Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020;e20200702.
- 5.Hoang A, Chorath K, Moreira A, et al. COVID-19 in 7780 pediatric patients: A systematic review [published online ahead of print, 2020 Jun 26]. E Clinical Medicine. 2020; 100433. [DOI] [PMC free article] [PubMed]
- 6.Agha R, Kojaoghlanian T, Avner JR. Initial observations of COVID-19 in US children. Hosp Pediatr. 2020;10:902–5. doi: 10.1542/hpeds.2020-000257. [DOI] [PubMed] [Google Scholar]
- 7.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. doi: 10.1016/S1473-3099(20)30198-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Jingjing H, Guo Y, Mao R, Zhang J. Proportion of asymptomatic coronavirus disease 2019: A systematic review and metaanalysis. J Med Virol. 2020;1–11. [DOI] [PMC free article] [PubMed]
- 9.Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109:1088–95. doi: 10.1111/apa.15270. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective observational study. Lancet Respir Med. 2020;8:475–81. doi: 10.1016/S2213-2600(20)30079-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Zhang L, Peres T, Silva M, Camargos P. What we know so far about coronavirus disease 2019 in children: A meta-analysis of 551 laboratory-confirmed cases. Pediatr Pulmonol. 2020;55:2115–17. doi: 10.1002/ppul.24869. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Mak PQ, Chung KS, Wong JS, Shek CC, Kwan MY. Anosmia and ageusia: Not an uncommon presentation of COVID-19 infection in children and adolescents. Pediatr Infec Dis J. 2020;39:e199–e200. doi: 10.1097/INF.0000000000002718. [DOI] [PubMed] [Google Scholar]
- 13.Yasuhara J, Kuno T, Takagi H, Sumitomo N. Clinical characteristics of COVID 19 in children: A systematic review. Pediatr Pulmonol. 2020;1–11. [DOI] [PubMed]
- 14.Kumar J, Meena J, Yadav A, Yadav J. Radiological findings of COVID-19 in children: A systematic review and meta-analysis. J Trop Pediat. 2020:fmaa045 [published online 21 July, 2020]. [DOI] [PMC free article] [PubMed]
- 15.Wu Z, Mc Googan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72/314 cases from the Chinese center for disease control and prevention. JAMA. 2020;323:1239–42. doi: 10.1001/jama.2020.2648. [DOI] [PubMed] [Google Scholar]
- 16.Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020;323:1775–76. doi: 10.1001/jama.2020.4683. [DOI] [PubMed] [Google Scholar]
- 17.Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: Early experience and forecast during an emergency response. JAMA. 2020;323:1545–6. doi: 10.1001/jama.2020.4031. [DOI] [PubMed] [Google Scholar]
- 18.Xu K, Chen Y, Yuan J, et al. Factors associated with prolonged viral RNA shedding in patients with coronavirus disease 2019 (COVID-19) Clin Infect Dis. 2020;71:799–06. doi: 10.1093/cid/ciaa351. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Zhang W, Du RH, Li B, et al. Molecular and serological investigation of 2019- nCoVinfected patients: Implication of multiple shedding routes. Emerg Microbes Infect. 2020;9:1. doi: 10.1080/22221751.2019.1699450. [DOI] [PMC free article] [PubMed] [Google Scholar]