Children hospitalized for coronavirus disease 2019 (COVID-19): A multicenter retrospective descriptive study
Authors: Bin Zhang, Shuyi Liu, Jue Zhang, Jijie Xiao, Shen Zhu, Yuhao Dong, Huanchu Yuan, Qingyang Zhong, Ke Yang, Yujian Zou, Shuixing Zhang
Journal: Journal of Infection (2020)

We read with interest the article by Dr. Song R and colleagues in the Journal of Infection titled "Clinical and epidemiological features of COVID-19 family clusters in Beijing, China."1Song R. Han B. Song M. et al.Clinical and epidemiological features of COVID-19 family clusters in Beijing, China.J Infect. 2020; https://doi.org/10.1016/j.jinf.2020.04.018Abstract Full Text Full Text PDF Scopus (56) Google Scholar, published online in April 2020. The authors presented the epidemiological and clinical features of the clusters of four families and found that SARS-CoV-2 is transmitted quickly in the form of family clusters. Children in the families generally showed milder symptoms. As of April 28, 2020, the coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been responsible for more than 3.05 million confirmed cases around the world. Early evidence showed that children seemed to be escaping the worst effects of the SARS-Cov-2.2Zunyou W. McGoogan J.M. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.JAMA. 2020; https://doi.org/10.1001/jama.2020.2648Crossref Scopus (12457) Google Scholar However, a recent study indicated children with SARS-CoV-2 infection could be detected in early January 2020 in Wuhan.3Liu W. Zhang Q. Chen J. et al.Detection of Covid-19 in Children in Early January 2020 in Wuhan, China.N Engl J Med. 2020; (published on March 12)https://doi.org/10.1056/NEJMc2003717Crossref Scopus (475) Google Scholar Another study reported that children are as susceptible to COVID-19 as adults.4Bi Q. Wu Y. Mei S. et al.Epidemiology and transmission of COVID-19 in Shenzhen China: analysis of 391 cases and 1,286 of their close contacts.medRxiv. 2020; (posted March 4. doi:)https://doi.org/10.1101/2020.03.03.20028423Crossref Scopus (0) Google Scholar As the number of children infected with COVID-19 gradually increases, the disease has been documented in infants, children and adolescents, however, limited reports analyzed pediatric patients with COVID-19. Although a recent review has summarized the clinical features and management of infected children,5Castagnoli R. Votto M. Licari A. et al.Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review.JAMA Pediatr. 2020; https://doi.org/10.1001/jamapediatrics.2020.1467Crossref PubMed Scopus (787) Google Scholar the spectrum of disease of children outside Wuhan are still limited. Therefore, we included 46 children (≤18 years of age) hospitalized with positive real-time fluorescence polymerase chain reaction (RT-PCR) results of throat swabs were included from four tertiary-care hospitals in Guangdong, Hunan, and Hubei Provinces, China between January 20, 2020 and March 9, 2020. Demographic data and clinical features are summarized in Table 1. Details of the laboratory, chest radiological findings and treatment are provided in Supplementary Tables 1–2 and Figure 1. All 46 children cases were non-severe by clinical examination. 29 children (63%) were male, with a median age of 8 years (interquartile range, 4–14 years; range, 7 months to 18 years). 32 children (70%) had at least one infected family member, indicating pediatric patients acquired infections mainly through close contact with their parents or other family members who lived in Wuhan, or had visited there. Unlike adults, no children in this study had comorbidities. 22 children (48%) were asymptomatic at the onset. The most common clinical symptoms were dry cough [12 children (26%)] and fever [eight children (17%)] accompanied by other upper respiratory symptoms, such as nasal congestion and runny nose. Our children cases had no gastrointestinal symptoms, such as nausea, vomiting, and diarrhea. No children had leukopenia and lymphopenia. 20 children (43%) had chest imaging abnormalities, such as unilateral nodular or patchy ground-glass opacities. Recent studies questioned the role of chest CT in the diagnosis of COVID-19 because of biologic effects of ionizing-radiations, therefore, doctors should choose the optimal radiological imaging tool (CT, X-ray, or US) based on clinical conditions and possible adverse events. According to the findings of previous literature and our study, chest CT may be not a preferred screening tool of COVID-19 in children. After confirmation of COVID-19, most of children were treated with one to three antiviral drugs. No children needed intensive care unit care or invasive mechanical ventilation. As of March 9, 2020, all children had been discharged and no children had died. No children had severe complications. The median length of hospital stay was 15 days. Four children had a positive rectal swabs but negative throat swabs after recovery; the time from hospital discharge to positive RT-PCR test after recovery was 2–12 days.Table 1Demographic and clinical characteristics of the study children.CharacteristicsValueMean (standard deviation) age, months105 (64)Median (interquartile) age, months96 (48–168)Age groups (years) 0–13 (7) 1–513 (28)) 6–1010 (22) 11–1820 (43)Sex Male29 (63) Female17 (37)Symptoms at onset Fever10 (22) Dry cough15 (33) Dry throat4 (9) Nasal congestion/runny nose6 (13) Weak3 (7)Epidemiologic historyNo. of infected family members 18 (17) 210 (22) ≥313 (28) Wuhan linkage22 (48)Body temperature on admission (°) ≤361 (2) 36–37.539 (85) >37.55 (11)Chest imaging abnormalities Ground-glass opacity13 (28) Consolidation1 (2) Mixed ground-glass opacity and Consolidation4 (9) Local patchy shadowing1 (2) Unilateral15 (33) Bilateral4 (9)Time from illness to first hospital admission, days2 (1–3)Note: Values are numbers (percentages) unless stated otherwise. Wuhan linkage was defined as residing in or visiting Wuhan or contact with visitors from Wuhan ≤2 weeks before the onset of infection. Open table in a new tab Note: Values are numbers (percentages) unless stated otherwise. Wuhan linkage was defined as residing in or visiting Wuhan or contact with visitors from Wuhan ≤2 weeks before the onset of infection. This report describes a spectrum of COVID-19 pneumonia in children outside Wuhan, China, which might provide an insight into the prevention and control of COVID-19 in children across other areas of China and other countries. In contrast with infected children from Wuhan, the SARS-CoV-2 infected children was more milder and insidious regarding the symptoms, laboratory, and radiological findings. The burden of COVID-19 in children may be low compared with adult patients, but the high proportion of asymptomatic or mildly symptomatic infections in children should be paid close attention. After discharge, a small proportion of the recovered children may still be virus carriers because persistent rectal swab positives occurred even after throat swab testing turned negative in children. The fecal viral shedding could be as long as 57 days.6Xu Y. Li X. Zhu B. et al.Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding.Nat Med. 2020; (Published online March 13)https://doi.org/10.1038/s41591020-0817-4Crossref Google Scholar Viral shedding through gastrointestinal tract suggested the possibility of fecal-oral viral transmission. However, this finding should be confirmed in larger studies. Available evidence showed recovered pediatric patients with positive RT-PCR might not be caused by virus recurrence or second virus infection. The authors declare no competing interests. Download .docx (.44 MB) Help with docx files