Characteristics and clinical features of SARS-CoV-2 infections among ambulatory and hospitalized children and adolescents in an integrated health care system in Tennessee

  1. Leigh M. Howard
  2. Kathryn Garguilo
  3. Jessica Gillon
  4. Adam C. Seegmiller
  5. Jonathan E. Schmitz
  6. Steven A. Webber
  7. Natasha B. Halasa
  8. Ritu Banerjee

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Abstract

Background

Little is known regarding the full spectrum of illness among children with SARS-CoV-2 infection across ambulatory and inpatient settings.

Methods

Active surveillance was performed for SARS-CoV-2 by polymerase chain reaction among asymptomatic and symptomatic individuals in a quaternary care academic hospital laboratory in Tennessee from March 12-July 17, 2020. For symptomatic patients ≤18 years of age, we performed phone follow-up and medical record review to obtain sociodemographic and clinical data on days 2, 7, and 30 after diagnosis and on day 30 for asymptomatic patients ≤18 years. Daily and 7-day average test positivity frequencies were calculated for children and adults beginning April 26, 2020.

Results

SARS-CoV-2 was detected in 531/10327 (5.1%) specimens from patients ≤18 years, including 46/5752 (0.8%) asymptomatic and 485/4575 (10.6%) specimens from 459 unique symptomatic children. Cough (51%), fever (42%), and headache (41%) were the most common symptoms associated with SARS-CoV-2 infection. SARS-CoV-2-related hospitalization was uncommon (18/459 children; 4%); no children with SARS-CoV-2 infection during the study period required intensive care unit admission. Symptom resolution occurred by follow-up day 2 in 192/459 (42%), by day 7 in 332/459 (72%), and by day 30 in 373/396 (94%). The number of cases and percent positivity rose in late June and July in all ages.

Conclusions

In an integrated healthcare network, most pediatric SARS-CoV-2 infections were mild, brief, and rarely required hospital admission, despite increasing cases as community response measures were relaxed.

Key points

In an integrated healthcare network in the Southeastern United States, symptomatic SARS-CoV-2 infection in children was generally mild, resolved rapidly, and rarely required hospitalization. Cases increased in children and adults as community mitigation measures became less restrictive.

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  1. ScreenIT

    SciScore for 10.1101/2020.10.08.20208751: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was reviewed and approved by the VUMC Institutional Review Board.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableRoutine screening of all pregnant women admitted to the Labor and Delivery unit began on April 22, 2020.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis: Descriptive analyses were conducted using STATA/SE 14.2 (StataCorp LP, College Station, TX).
    STATA/SE
    suggested: None
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    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 is also subject to some limitations. Our cohort is limited to patients who visited one of our network’s testing sites for assessment. Due to limited testing capacity, especially earlier in the study period, testing was recommended only for individuals with new-onset respiratory symptoms, fever, or a known SARS-CoV-2-positive contact; thus, providers were discouraged from sending SARS-CoV-2 testing on patients with other symptoms, such as gastrointestinal or general symptoms alone, which introduced sampling bias. Real-time monitoring of testing indications was impractical and testing practices may have varied by provider. In summary, symptomatic SARS-CoV-2 infections among individuals ≤18 years were generally associated with respiratory symptoms, mild illness that usually resolved within a week, and rarely required hospitalization. Cases increased in our community in both children and adults as local businesses reopened, highlighting the importance of community mitigation strategies in reducing SARS-CoV-2 transmission.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    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 10.1101/2020.10.08.20208751 on medRxiv