Symptoms associated with a positive result for a swab for SARS-CoV-2 infection among children in Alberta

Abstract

Background: Research involving children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has primarily focused on those presenting to emergency departments. We aimed to determine the symptoms most commonly associated with a positive result for a SARS-CoV-2 swab among community-based children.

Methods: We conducted an observational study among children tested and followed for SARS-CoV-2 infection using nasal, nasopharyngeal, throat or other (e.g., nasopharyngeal aspirate or tracheal secretions, or unknown) swabs between Apr. 13 and Sept. 30, 2020, in Alberta. We calculated positive likelihood ratios (LRs) for self-reported symptoms and a positive SARS-CoV-2 swab result in the entire cohort and in 3 sensitivity analyses: all children with at least 1 symptom, all children tested because of contact tracing whether they were symptomatic or not and all children 5 years of age or older.

Results: We analyzed results for 2463 children who underwent testing for SARS-CoV-2 infection; 1987 children had a positive result and 476 had a negative result. Of children with a positive test result for SARS-CoV-2, 714 (35.9%) reported being asymptomatic. Although cough (24.5%) and rhinorrhea (19.3%) were 2 of the most common symptoms among children with SARS-CoV-2 infection, they were also common among those with negative test results and were not predictive of a positive test (positive LR 0.96, 95% confidence interval [CI] 0.81-1.14, and 0.87, 95% CI 0.72-1.06, respectively). Anosmia/ageusia (positive LR 7.33, 95% CI 3.03-17.76), nausea/vomiting (positive LR 5.51, 95% CI 1.74-17.43), headache (positive LR 2.49, 95% CI 1.74- 3.57) and fever (positive LR 1.68, 95% CI 1.34-2.11) were the symptoms most predictive of a positive result for a SARS-CoV-2 swab. The positive LR for the combination of anosmia/ageusia, nausea/vomiting and headache was 65.92 (95% CI 49.48-91.92).

Interpretation: About two-thirds of the children who tested positive for SARS-CoV-2 infection reported symptoms. The symptoms most strongly associated with a positive SARS-CoV-2 swab result were anosmia/ageusia, nausea/vomiting, headache and fever.

Figure 1:

Flow chart for patient inclusion. We identified patients in this cohort through the Communicable Disease Outbreak Management (CDOM) database and linked them to the Alberta Provincial Laboratory database to determine when their first test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred. Note: ULI = Unique Lifetime Identifier.

Figure 2:

Positive likelihood ratios (LRs) for symptoms associated with positive results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swabs in children in Alberta. Estimates of positive LRs and associated 95% confidence intervals (CIs) are shown for the full cohort (black), those children identified as having a high risk of exposure through contact tracing (red), those with at least 1 symptom (green) and those aged 5 years or older (blue).