Lin Qiu-Yu, Lin Guo-Tian, Zhang Fan, Xiang Xia-Yu, Zhang Yue-Hua, Wang Jia-Chong, Jin Yu-Ming, Hai Yuan-Ping, Lv Zhi-Yue, Xiang Wei
Hainan Women and Children's Medical Center, Children's Hospital of Fudan University at Hainan, Children's Hospital of Hainan Medical University, Haikou, 570311 China.
Laboratory of Tropical Environment and Health, School of Public Health, Hainan Medical University, No. 3, Chengxi Xue yuan Road, Longhua District, Haikou, 571199 China.
Health Inf Sci Syst. 2022 Aug 24;10(1):18. doi: 10.1007/s13755-022-00188-6. eCollection 2022 Dec.
To investigate the case of a child infected with coronavirus disease 2019 (COVID-19) who had subsequent viral reactivation.
We retrospectively analyzed the clinical manifestations, epidemiological data, laboratory and imaging examinations, treatment, and follow-up of the child. And then, we searched related literature using PubMed.
The 9-year-old boy was exposed to COVID-19 in Malawi and tested positive for NAT in Haikou, China. He was asymptomatic and admitted to our hospital. After six negative NATs, he was discharged from the hospital and quarantined in a hotel. His infection was reactivated again after 22 days (interval between first and last positive NATs). The cycle threshold (Ct) values of positive tests were 25 and 31, and the gene sequencing viral loads were very low. The viral strain Kenya/P2601/2020, a variant of the hCoV-19/Wuhan/IVDC-HB-01/2019 genome (GISAID accession IL: EPI_ISL_402119), was found when polymerase chain reaction enrichment was used to sequence the virus. However, people around him tested negative for COVID-19.
First, we confirmed the reactivation of COVID-19 in a child. The risk of recurrent infection with SARS-CoV-2 was low, and the policy of strictly isolating patients carrying long-term viral ribonucleic acid should be reconsidered. The interval positivity was most likely due to incorrect sampling and/or testing methods. SGS and aB testing are recommended for children with viral reactivation. Second, SARS-CoV-2 viral reactivation cannot be ruled out. The possible mechanisms, such as prolonged infection and viral latent reactivation, need further investigation.
调查一名感染新型冠状病毒肺炎（COVID-19）后出现病毒再激活的儿童病例。
我们回顾性分析了该儿童的临床表现、流行病学数据、实验室及影像学检查、治疗及随访情况。然后，我们使用PubMed检索了相关文献。
这名9岁男孩在马拉维接触了COVID-19，在中国海口核酸检测呈阳性。他无症状，入住我院。经过6次核酸检测阴性后，他出院并在酒店进行隔离。22天后（首次和最后一次核酸检测阳性之间的间隔），他的感染再次被激活。阳性检测的循环阈值（Ct）值分别为25和31，基因测序病毒载量非常低。当使用聚合酶链反应富集对病毒进行测序时，发现病毒株为肯尼亚/P2601/2020，是hCoV-19/武汉/IVDC-HB-01/2019基因组的一个变体（GISAID登录号IL：EPI_ISL_402119）。然而，他周围的人COVID-19检测均为阴性。
首先，我们证实了一名儿童中COVID-19的再激活。SARS-CoV-2再次感染的风险较低，应重新考虑对长期携带病毒核糖核酸的患者进行严格隔离的政策。间隔期阳性很可能是由于采样和/或检测方法不正确所致。对于病毒再激活的儿童，建议进行SGS和aB检测。其次，不能排除SARS-CoV-2病毒再激活。其可能的机制，如长期感染和病毒潜伏再激活，需要进一步研究。
