Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy.
Microbiology and Immunology Diagnostics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Pediatr Res. 2023 Mar;93(4):897-904. doi: 10.1038/s41390-022-02293-4. Epub 2022 Sep 7.
The purpose of this study is to evaluate the association between SARS-CoV-2 viral load in respiratory secretions of infected children and signs/symptoms of COVID-19.
We reported the clinical characteristics of SARS-CoV-2-infected children during the study period. We compared viral load for several clinical variables, performed a predictive linear regression analysis to identify signs and symptoms significantly associated with viral load, and searched for discriminant viral load thresholds for symptomatic versus asymptomatic infections based on receiver-operating characteristics.
A total of 570 patients were included. The median age was 4.75 years. Comparison of CT values by dichotomous variable showed higher viral loads in children with fever, respiratory symptoms, and previous exposure to SARS-CoV-2. The linear regression analysis confirmed a significant relationship between the CT value with these variables and with age, other symptoms, and asymptomaticity. In particular, infants with fever and SARS-CoV-2 exposure had higher viral loads. No viral load cut-offs were found to distinguish symptomatic from asymptomatic patients.
Our study shows that fever, SARS-CoV-2 exposure, and respiratory symptoms are associated with higher viral load in children, especially infants, while age, presence of nonrespiratory symptoms, or absence of any symptoms are associated with lower viral load.
Key message: the clinical variables that best predict viral load in infected children are history of previous exposure to a SARS-CoV-2-infected person and presence of fever and respiratory symptoms (higher viral load). Added value to the current literature: this is the first article to prove this point.
SARS-CoV-2 viral load should not be used as a measure of clinical severity of COVID-19 in the pediatric population; however, lower viral load appears to be associated with asymptomatic COVID-19 in older children.
本研究旨在评估感染儿童呼吸道分泌物中的 SARS-CoV-2 病毒载量与 COVID-19 症状/体征之间的关联。
我们报告了研究期间 SARS-CoV-2 感染儿童的临床特征。我们比较了几种临床变量的病毒载量，进行了预测线性回归分析，以确定与病毒载量显著相关的症状和体征，并根据接收者操作特征搜索有症状与无症状感染之间的区分病毒载量阈值。
共纳入 570 例患者。中位年龄为 4.75 岁。通过二项变量比较 CT 值显示，有发热、呼吸道症状和 SARS-CoV-2 既往暴露的儿童病毒载量更高。线性回归分析证实 CT 值与这些变量以及与年龄、其他症状和无症状性之间存在显著关系。特别是有发热和 SARS-CoV-2 暴露的婴儿病毒载量更高。未发现病毒载量截止值可区分有症状与无症状患者。
我们的研究表明，发热、SARS-CoV-2 暴露和呼吸道症状与儿童，特别是婴儿的高病毒载量相关，而年龄、存在非呼吸道症状或无任何症状与低病毒载量相关。
关键信息：预测感染儿童病毒载量的最佳临床变量是既往 SARS-CoV-2 感染者接触史以及发热和呼吸道症状的存在（更高的病毒载量）。对当前文献的附加价值：这是第一篇证明这一点的文章。
SARS-CoV-2 病毒载量不应作为儿科人群 COVID-19 临床严重程度的衡量标准；然而，较低的病毒载量似乎与年长儿童无症状 COVID-19 相关。
