Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding

Yi Xu; Xufang Li; Bing Zhu; Huiying Liang; Chunxiao Fang; Yu Gong; Qiaozhi Guo; Xin Sun; Danyang Zhao; Jun Shen; Huayan Zhang; Hongsheng Liu; Huimin Xia; Jinling Tang; Kang Zhang; Sitang Gong

doi:10.1038/s41591-020-0817-4

Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding

Nat Med. 2020 Apr;26(4):502-505. doi: 10.1038/s41591-020-0817-4. Epub 2020 Mar 13.

Authors

Yi Xu^#¹, Xufang Li^#¹, Bing Zhu^#², Huiying Liang^#^{3

4}, Chunxiao Fang¹, Yu Gong¹, Qiaozhi Guo⁵, Xin Sun⁵, Danyang Zhao⁵, Jun Shen¹, Huayan Zhang^{1

4

6}, Hongsheng Liu⁷, Huimin Xia^{8

9

10}, Jinling Tang^{11

12}, Kang Zhang^{13

14

15}, Sitang Gong^{16

17}

Affiliations

¹ Department of Pediatric, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
² Department of Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
³ Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
⁴ Guangdong Provincial Children's Medical Research Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
⁵ Department of Medical Administration, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
⁶ Division of Neonatology and Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA.
⁷ Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
⁸ Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. huiminxia@hotmail.com.
⁹ Guangdong Provincial Children's Medical Research Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. huiminxia@hotmail.com.
¹⁰ Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. huiminxia@hotmail.com.
¹¹ Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. jltang@cuhk.edu.hk.
¹² Guangdong Provincial Children's Medical Research Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. jltang@cuhk.edu.hk.
¹³ Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. kang.zhang@gmail.com.
¹⁴ Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China. kang.zhang@gmail.com.
¹⁵ Center for Biomedicine and Innovations, Faculty of Medicine, Macau University of Science and Technology, Macau, China. kang.zhang@gmail.com.
¹⁶ Department of Pediatric, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. sitangg@126.com.
¹⁷ Guangdong Provincial Children's Medical Research Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. sitangg@126.com.

^# Contributed equally.

Abstract

We report epidemiological and clinical investigations on ten pediatric SARS-CoV-2 infection cases confirmed by real-time reverse transcription PCR assay of SARS-CoV-2 RNA. Symptoms in these cases were nonspecific and no children required respiratory support or intensive care. Chest X-rays lacked definite signs of pneumonia, a defining feature of the infection in adult cases. Notably, eight children persistently tested positive on rectal swabs even after nasopharyngeal testing was negative, raising the possibility of fecal-oral transmission.

Publication types

Case Reports
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Betacoronavirus / genetics
Betacoronavirus / isolation & purification*
COVID-19
COVID-19 Testing
Child
Child, Preschool
Clinical Laboratory Techniques
Coronavirus Infections / complications
Coronavirus Infections / diagnosis
Coronavirus Infections / virology*
Feces / virology*
Female
Humans
Infant
Male
Nasopharynx / virology
Pandemics
Pneumonia, Viral / complications
Pneumonia, Viral / diagnosis
Pneumonia, Viral / virology*
Radiography, Thoracic
Real-Time Polymerase Chain Reaction
Rectum / virology
SARS-CoV-2
Virus Shedding*