Severe Acute Respiratory Syndrome Coronavirus 2 Infections Among Children in the Biospecimens from Respiratory Virus-Exposed Kids (BRAVE Kids) Study

  1. Jillian H Hurst
  2. Sarah M Heston
  3. Hailey N Chambers
  4. Hannah M Cunningham
  5. Meghan J Price
  6. Lilianna Suarez
  7. Carter G Crew
  8. Shree Bose
  9. Jhoanna N Aquino
  10. Stuart T Carr
  11. S Michelle Griffin
  12. Stephanie H Smith
  13. Kirsten Jenkins
  14. Trevor S Pfeiffer
  15. Javier Rodriguez
  16. C Todd DeMarco
  17. Nicole A De Naeyer
  18. Thaddeus C Gurley
  19. Raul Louzao
  20. Congwen Zhao
  21. Coleen K Cunningham
  22. William J Steinbach
  23. Thomas N Denny
  24. Debra J Lugo
  25. M Anthony Moody
  26. Sallie R Permar
  27. Alexandre T Rotta
  28. Nicholas A Turner
  29. Emmanuel B Walter
  30. Christopher W Woods
  31. Matthew S Kelly

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Abstract

Background

Child with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection typically have mild symptoms that do not require medical attention, leaving a gap in our understanding of the spectrum of SARS-CoV-2-related illnesses that the viruses causes in children.

Methods

We conducted a prospective cohort study of children and adolescents (aged <21 years) with a SARS-CoV-2-infected close contact. We collected nasopharyngeal or nasal swabs at enrollment and tested for SARS-CoV-2 using a real-time polymerase chain reaction assay.

Results

Of 382 children, 293 (77%) were SARS-CoV-2-infected. SARS-CoV-2-infected children were more likely to be Hispanic (P < .0001), less likely to have asthma (P = .005), and more likely to have an infected sibling contact (P = .001) than uninfected children. Children aged 6-13 years were frequently asymptomatic (39%) and had respiratory symptoms less often than younger children (29% vs 48%; P = .01) or adolescents (29% vs 60%; P < .001). Compared with children aged 6-13 years, adolescents more frequently reported influenza-like (61% vs 39%; P < .001) , and gastrointestinal (27% vs 9%; P = .002), and sensory symptoms (42% vs 9%; P < .0001) and had more prolonged illnesses (median [interquartile range] duration: 7 [4-12] vs 4 [3-8] days; P = 0.01). Despite the age-related variability in symptoms, wWe found no difference in nasopharyngeal viral load by age or between symptomatic and asymptomatic children.

Conclusions

Hispanic ethnicity and an infected sibling close contact are associated with increased SARS-CoV-2 infection risk among children, while asthma is associated with decreased risk. Age-related differences in clinical manifestations of SARS-CoV-2 infection must be considered when evaluating children for coronavirus disease 2019 and in developing screening strategies for schools and childcare settings.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.08.18.20166835: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was approved by the DUHS Institutional Review Board.
    Consent: Informed consent was obtained from study participants or their legal guardians; assent was obtained for children 8-17 years of age.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Study data were managed using REDCap electronic data capture tools hosted at Duke University.
    REDCap
    suggested: (REDCap, RRID:SCR_003445)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations. First, study recruitment was influenced by local SARS-CoV-2 testing availability and guidelines, which changed substantially during the study period and may differ from other areas. Given our study design and the relatively high rate of asymptomatic infection among children in our cohort, we were unable to determine the direction of SARS-CoV-2 transmission within households. Nearly one-third (30%) of children in our cohort were tested for SARS-CoV-2 infection at only a single time point, and some children who ultimately developed SARS-CoV-2 infection may have been misclassified as uninfected because of the timing of sample collection. The prevalence of influenza-like and sensory symptoms should be interpreted with caution in children <5 years of age, given that many children in this age group are unable to verbalize these symptoms. Further, viral loads from nasopharyngeal swabs are likely affected by sampling technique. Finally, analyses were limited to detection of viral nucleic acid, although a prior study reported a close correlation between viral load and infectious virus in symptomatic neonates, children, and adolescents.39 In summary, we identify risk factors for SARS-CoV-2 infection among children and present further evidence of probable child-to-child transmission within household settings. Moreover, we demonstrate that the clinical manifestations of SARS-CoV-2 infection among children and adolescents are dependent on age. Finally, w...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1093/cid/ciaa1693
  3. Version published to 10.1101/2020.08.18.20166835 on medRxiv