tetano
Editor, Senior Moderator
diatr Blood Cancer
. 2021 Aug 28;e29277.
doi: 10.1002/pbc.29277. Online ahead of print.
SARS-CoV-2 persistence in immunocompromised children
Susan A Dolan[SUP] 1 [/SUP], Jean Mulcahy Levy[SUP] 2 3 4 [/SUP], Angela Moss[SUP] 5 [/SUP], Kelly Pearce[SUP] 1 [/SUP], Molly Butler[SUP] 6 [/SUP], Sarah Jung[SUP] 6 [/SUP], Samuel R Dominguez[SUP] 7 [/SUP], Eric Mwangi[SUP] 6 [/SUP], Kelly Maloney[SUP] 2 [/SUP], Suchitra Rao[SUP] 8 [/SUP]
Affiliations
Abstract
Objectives: We evaluated the length of time immunocompromised children (ICC) remain positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), identified factors associated with viral persistence, and determined cycle threshold (C[SUB]T[/SUB] ) values of children with viral persistence as a surrogate of viral load.
Methods: We conducted a retrospective cohort study of ICC at a pediatric hospital from March 2020 to March 2021. Immunocompromised status was defined as primary, secondary, or acquired due to medical comorbidities/immunosuppressive treatment. The primary outcome was time to first of two consecutive negative SARS-CoV-2 polymerase chain reaction (PCR) tests at least 24 hours apart. Testing of sequential clinical specimens from the same subject was conducted using the Centers for Disease Control (CDC) 2019-nCoV real-time reverse transcriptase (RT)-PCR Diagnostic Panel assay. Descriptive statistics, Kaplan-Meier curve median event times and log-rank tests were used to compare outcomes between groups.
Results: Ninety-one children met inclusion criteria. Median age was 15.5 years (interquartile range [IQR] 8-18), 64% were male, 58% were White, and 43% were Hispanic/Latinx. Most (67%) were tested in outpatient settings and 58% were asymptomatic. The median time to two negative tests was 42 days (IQR 25.0-55.0), with no differences in median time by illness presentation or level of immunosuppression. Seven children had more than one sample available for repeat testing, and five of seven (71%) children had initial C[SUB]T[/SUB] values of <30 (moderate to high viral load); four children had C[SUB]T[/SUB] values of <30, 3-4 weeks later, suggesting persistent moderate to high viral loads.
Conclusions: Most ICC with SARS-CoV-2 infection had mild disease, with prolonged viral persistence >6 weeks and moderate to high viral load.
Keywords: COVID-19; SARS CoV-2; immunocompromised; pediatrics; shedding; viral persistence.
. 2021 Aug 28;e29277.
doi: 10.1002/pbc.29277. Online ahead of print.
SARS-CoV-2 persistence in immunocompromised children
Susan A Dolan[SUP] 1 [/SUP], Jean Mulcahy Levy[SUP] 2 3 4 [/SUP], Angela Moss[SUP] 5 [/SUP], Kelly Pearce[SUP] 1 [/SUP], Molly Butler[SUP] 6 [/SUP], Sarah Jung[SUP] 6 [/SUP], Samuel R Dominguez[SUP] 7 [/SUP], Eric Mwangi[SUP] 6 [/SUP], Kelly Maloney[SUP] 2 [/SUP], Suchitra Rao[SUP] 8 [/SUP]
Affiliations
- PMID: 34453477
- DOI: 10.1002/pbc.29277
Abstract
Objectives: We evaluated the length of time immunocompromised children (ICC) remain positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), identified factors associated with viral persistence, and determined cycle threshold (C[SUB]T[/SUB] ) values of children with viral persistence as a surrogate of viral load.
Methods: We conducted a retrospective cohort study of ICC at a pediatric hospital from March 2020 to March 2021. Immunocompromised status was defined as primary, secondary, or acquired due to medical comorbidities/immunosuppressive treatment. The primary outcome was time to first of two consecutive negative SARS-CoV-2 polymerase chain reaction (PCR) tests at least 24 hours apart. Testing of sequential clinical specimens from the same subject was conducted using the Centers for Disease Control (CDC) 2019-nCoV real-time reverse transcriptase (RT)-PCR Diagnostic Panel assay. Descriptive statistics, Kaplan-Meier curve median event times and log-rank tests were used to compare outcomes between groups.
Results: Ninety-one children met inclusion criteria. Median age was 15.5 years (interquartile range [IQR] 8-18), 64% were male, 58% were White, and 43% were Hispanic/Latinx. Most (67%) were tested in outpatient settings and 58% were asymptomatic. The median time to two negative tests was 42 days (IQR 25.0-55.0), with no differences in median time by illness presentation or level of immunosuppression. Seven children had more than one sample available for repeat testing, and five of seven (71%) children had initial C[SUB]T[/SUB] values of <30 (moderate to high viral load); four children had C[SUB]T[/SUB] values of <30, 3-4 weeks later, suggesting persistent moderate to high viral loads.
Conclusions: Most ICC with SARS-CoV-2 infection had mild disease, with prolonged viral persistence >6 weeks and moderate to high viral load.
Keywords: COVID-19; SARS CoV-2; immunocompromised; pediatrics; shedding; viral persistence.