Pediatric Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Clinical Presentation, Infectivity, and Immune Responses

• Published in: The Journal of pediatrics Vol. 227; pp. 45 - 52.e5
• Main Authors: Yonker, Lael M., Neilan, Anne M., Bartsch, Yannic, Patel, Ankit B., Regan, James, Arya, Puneeta, Gootkind, Elizabeth, Park, Grace, Hardcastle, Margot, St. John, Anita, Appleman, Lori, Chiu, Michelle L., Fialkowski, Allison, De la Flor, Denis, Lima, Rosiane, Bordt, Evan A., Yockey, Laura J., D'Avino, Paolo, Fischinger, Stephanie, Shui, Jessica E., Lerou, Paul H., Bonventre, Joseph V., Yu, Xu G., Ryan, Edward T., Bassett, Ingrid V., Irimia, Daniel, Edlow, Andrea G., Alter, Galit, Li, Jonathan Z., Fasano, Alessio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2020
• Subjects: Adolescent; Age Factors; Child; Child, Preschool; Comorbidity; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 - immunology; COVID-19 - transmission; COVID-19 Testing; Female; Humans; Infant; Infant, Newborn; Male; Massachusetts - epidemiology; Original; Pandemics; Severity of Illness Index; Viral Load; Young Adult; Massachusetts; COVID-19; ACE2; IPO8; MIS-C; SARS-CoV-2; RSV; RBD; IRB; NT-proBNB; MGH
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2020.08.037

As schools plan for re-opening, understanding the potential role children play in the coronavirus infectious disease 2019 (COVID-19) pandemic and the factors that drive severe illness in children is critical. Children ages 0-22 years with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presenting to urgent care clinics or being hospitalized for confirmed/suspected SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) at Massachusetts General Hospital were offered enrollment in the Massachusetts General Hospital Pediatric COVID-19 Biorepository. Enrolled children provided nasopharyngeal, oropharyngeal, and/or blood specimens. SARS-CoV-2 viral load, ACE2 RNA levels, and serology for SARS-CoV-2 were quantified. A total of 192 children (mean age, 10.2 ± 7.0 years) were enrolled. Forty-nine children (26%) were diagnosed with acute SARS-CoV-2 infection; an additional 18 children (9%) met the criteria for MIS-C. Only 25 children (51%) with acute SARS-CoV-2 infection presented with fever; symptoms of SARS-CoV-2 infection, if present, were nonspecific. Nasopharyngeal viral load was highest in children in the first 2 days of symptoms, significantly higher than hospitalized adults with severe disease (P = .002). Age did not impact viral load, but younger children had lower angiotensin-converting enzyme 2 expression (P = .004). Immunoglobulin M (IgM) and Immunoglobulin G (IgG) to the receptor binding domain of the SARS-CoV-2 spike protein were increased in severe MIS-C (P < .001), with dysregulated humoral responses observed. This study reveals that children may be a potential source of contagion in the SARS-CoV-2 pandemic despite having milder disease or a lack of symptoms; immune dysregulation is implicated in severe postinfectious MIS-C.