Department of Epidemiology, Regional Public Health Laboratory Kennemerland, Haarlem, The Netherlands.
Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp/Haarlem, The Netherlands.
Int J Epidemiol. 2022 Jan 6;50(6):1795-1803. doi: 10.1093/ije/dyab145. Epub 2021 Sep 8.
Describing the SARS-CoV-2 viral-load distribution in different patient groups and age categories.
All results from first nasopharyngeal (NP) and oropharyngeal (OP) swabs from unique patients tested via SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) collected between 1 January and 1 December 2020 predominantly in the Public Health Services regions Kennemerland and Hollands Noorden, province of North Holland, the Netherlands, were included in this study. SARS-CoV-2 PCR crossing-point (Cp)-values were used to estimate viral loads.
In total, 278 455 unique patients were tested, of whom 9.1% (n = 25.374) were SARS-CoV-2-positive. PCRs performed by Public Health Services (n = 211 914), in which sampling and inclusion were uniform, revealed a clear relation between age and SARS-CoV-2 viral load, with especially children aged <12 years showing lower viral loads than adults (β: -0.03, 95% confidence interval: -0.03 to -0.02, p < 0.001), independently of sex and/or symptom duration. Interestingly, the median Cp-values between the >79- and <12-year-old populations differed by more than four PCR cycles, suggesting an ∼16-fold difference in viral load. In addition, the proportion of children aged <12 years with a low load (Cp-value >30) was higher compared with other patients (31.1% vs 17.2%, p-value < 0.001).
In patients tested by Public Health Services, SARS-CoV-2 viral load increases with age. Further studies should elucidate whether the lower viral load in children is indeed related to their suggested limited role in SARS-CoV-2 transmission. Moreover, as rapid antigen tests are less sensitive than PCR, these results suggest that SARS-CoV-2 antigen tests have lower sensitivity in children than in adults.
描述不同患者群体和年龄类别的 SARS-CoV-2 病毒载量分布。
本研究纳入了 2020 年 1 月 1 日至 12 月 1 日期间，主要在荷兰北荷兰省肯默兰和霍兰北部公共卫生服务地区，通过 SARS-CoV-2 逆转录酶聚合酶链反应（RT-PCR）对来自独特患者的首次鼻咽（NP）和口咽（OP）拭子的所有结果。使用 SARS-CoV-2 PCR 交叉点（Cp）值来估计病毒载量。
共有 278455 名独特患者接受了检测，其中 9.1%（n=25374）为 SARS-CoV-2 阳性。公共卫生服务机构进行的 PCR（n=211914）显示，年龄与 SARS-CoV-2 病毒载量之间存在明显的关系，特别是年龄<12 岁的儿童的病毒载量低于成年人（β：-0.03，95%置信区间：-0.03 至-0.02，p<0.001），与性别和/或症状持续时间无关。有趣的是，>79 岁和<12 岁人群之间的中位 Cp 值相差超过四个 PCR 循环，表明病毒载量差异约为 16 倍。此外，与其他患者相比，年龄<12 岁的儿童低载量（Cp 值>30）的比例更高（31.1%比 17.2%，p 值<0.001）。
在公共卫生服务机构接受检测的患者中，SARS-CoV-2 病毒载量随年龄增长而增加。进一步的研究应该阐明儿童病毒载量较低是否确实与他们在 SARS-CoV-2 传播中作用有限有关。此外，由于快速抗原检测比 PCR 检测的灵敏度低，这些结果表明 SARS-CoV-2 抗原检测在儿童中的灵敏度低于成人。
