Wang-Erickson Anna F, Zhang Xueyan, Dauer Klancie, Zerr Danielle M, Adler Amanda, Englund Janet A, Lee Brian, Schuster Jennifer E, Selvarangan Rangaraj, Rohlfs Chelsea, Staat Mary A, Sahni Leila C, Boom Julie A, Balasubramani G K, Williams John V, Michaels Marian G
From the Department of Pediatrics, Division of Infectious Diseases, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
Institute for Infection, Inflammation, and Immunity in Children (i4Kids), Pittsburgh, PA.
Pediatr Infect Dis J. 2025 Jan 1;44(1):47-53. doi: 10.1097/INF.0000000000004547. Epub 2024 Sep 18.
The burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in asymptomatic children was initially presumed to be high, which influenced hospital, school and childcare policies. Before vaccines were widely available, some hospitals implemented universal preprocedural SARS-CoV-2 polymerase chain reaction testing on asymptomatic patients. Understanding SARS-CoV-2 prevalence in asymptomatic children is needed to illuminate the diversity of viral characteristics and inform policies implemented during future pandemics.
Data were extracted from patient records of outpatient children who were preprocedurally tested for SARS-CoV-2 from 5 US hospital systems between March 1, 2020, and February 28, 2021. Prevalence was determined from positive test results. Adjusted odds ratios (AORs) were calculated using mixed logistic regression with the site as a random effect.
This study analyzed 93,760 preprocedural SARS-CoV-2 test results from 74,382 patients and found 2693 infections (3.6%) from 2889 positive tests (3.1%). Site-specific prevalence varied across sites. Factors modestly associated with infection included being uninsured [AOR, 1.76 (95% confidence interval [CI], 1.45-2.13)], publicly insured [AOR, 1.17 (95% CI, 1.05-1.30)], Hispanic [AOR, 1.78 (95% CI, 1.59-1.99)], Black [AOR, 1.22 (95% CI, 1.06-1.39)], elementary school age [5-11 years; AOR, 1.15 (95% CI, 1.03-1.28)], or adolescent [12-17 years; AOR, 1.26 (95% CI, 1.13-1.41)].
SARS-CoV-2 prevalence was low in outpatient children undergoing preprocedural testing, a population that was predominantly asymptomatic at the time of testing. This study contributes evidence that suggests that undetected infection in children likely did not play a predominant role in SARS-CoV-2 transmission during the early prevaccine pandemic period when the general population was naive to the virus.
最初认为严重急性呼吸综合征冠状病毒2（SARS-CoV-2）在无症状儿童中的负担很高，这影响了医院、学校和儿童保育政策。在疫苗广泛可用之前，一些医院对无症状患者实施了普遍的术前SARS-CoV-2聚合酶链反应检测。了解无症状儿童中SARS-CoV-2的流行情况，有助于阐明病毒特征的多样性，并为未来大流行期间实施的政策提供依据。
数据取自2020年3月1日至2021年2月28日期间美国5个医院系统对门诊儿童进行术前SARS-CoV-2检测的患者记录。根据阳性检测结果确定患病率。使用以机构为随机效应的混合逻辑回归计算调整后的优势比（AOR）。
本研究分析了74382名患者的93760份术前SARS-CoV-2检测结果，在2889份阳性检测结果（3.1%）中发现2693例感染（3.6%）。各机构的特定患病率各不相同。与感染有适度关联的因素包括未参保[AOR，1.76（95%置信区间[CI]，1.45-2.13）]、公共保险参保者[AOR，1.17（95%CI，1.05-1.30）]、西班牙裔[AOR，1.78（95%CI，1.59-1.99）]、黑人[AOR，1.22（95%CI，1.06-1.39）]、小学年龄[5-11岁；AOR，1.15（95%CI，1.03-1.28）]或青少年[12-17岁；AOR，1.26（95%CI，1.13-1.41）]。
在接受术前检测的门诊儿童中，SARS-CoV-2患病率较低，这一人群在检测时主要为无症状感染者。本研究提供的证据表明，在疫苗接种前的大流行早期，当普通人群对该病毒缺乏免疫力时，儿童中未被检测到的感染可能在SARS-CoV-2传播中未起主要作用。
