Symptomatic and Asymptomatic Viral Shedding in Pediatric Patients Infected With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Under the Surface | Infectious Diseases | JAMA Pediatrics | JAMA Network
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Editorial
August 28, 2020

Symptomatic and Asymptomatic Viral Shedding in Pediatric Patients Infected With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Under the Surface

Author Affiliations
  • 1Division of Pediatric Infectious Diseases, Children’s National Hospital and Research Institute, Washington, DC
  • 2Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
  • 3Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
  • 4Division of Laboratory Medicine and Pathology, Children’s National Hospital and Research Institute, Washington, DC
  • 5Department of Pathology, The George Washington University School of Medicine and Health Sciences, Washington, DC
JAMA Pediatr. 2021;175(1):16-18. doi:10.1001/jamapediatrics.2020.3996

Since the global emergence and spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), initial attention appropriately focused on severely affected adults, who represent the highest proportion of symptomatic infections.1 However, as the pandemic has evolved, a significant effect on children has also become evident.2 Data from multiple affected countries have corroborated that children are clearly susceptible to infection and may develop severe primary and unique secondary inflammatory complications of infection, including multisystem inflammatory syndrome of children.3-5 However, the vast majority of infected children have mild or unrecognized disease, and this population may play important epidemiologic roles by potentiating spread of infection through communities6 and/or boosting herd immunity. Only small numbers of children have been included in prior studies focused on kinetics of viral shedding in the setting of symptomatic or asymptomatic SARS-CoV-2 infection.7-12 To our knowledge, no prior studies have systematically focused on the frequency of asymptomatic infection in children or the duration of symptoms and viral shedding in both asymptomatic and symptomatic children.

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    1 Comment for this article
    EXPAND ALL
    Epidemiologic importance of children as undisputed vectors of SARS-CoV-2
    Liz Jenny-Avital, MD | Jacobi Medical Center; Bronx NY
    The epidemiologic consequences of SARS-CoV-2 in children seem to be much greater than the clinical consequences.

    New York City syndromic surveillance for influenza-like illness (ILI) showed a rise in ILI starting at the beginning of March 2020, which in retrospect clearly reflected the onset of the COVID epidemic (1). Notably, the rise in ILI in children ages 0-17 paralleled the rise for adults--but the rate in children was about 3 fold higher than for adults. Anecdotally, my teacher friend told me that student absentee rates were notably higher during the first two weeks
    in March before the public schools were closed on Mar 15. As such, the observations by Han et al should be sobering as we prepare for partial opening of our NYC schools. 

    Reference

    1. https://www1.nyc.gov/site/doh/covid/covid-19-data.pageschools.
    CONFLICT OF INTEREST: None Reported
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