Journal
JOURNAL OF PEDIATRICS
Volume 227, Issue -, Pages 45-+Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jpeds.2020.08.037
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Funding
- National Heart, Lung, and Blood Institute [5K08HL143183]
- Cystic Fibrosis Foundation [YONKER18Q0]
- National Institute of Child Health and Human Development [K08 HD094638, R01HD100022]
- National Institute of Diabetes and Digestive and Kidney Diseases [DK039773, DK072381, DK104344]
- National Institute of Allergy and Infectious Disease [K24AI141036]
- Centers for Disease Control and Prevention [U01CK000490]
- Department of Pediatrics at Massachusetts General Hospital
- Department of Obstetrics/Gynecology at Massachusetts General Hospital
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Objectives 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. Study design 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. Results 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). ImmunoglobulinM(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. Conclusions 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.
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