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Epidemiological and Clinical Characteristics of Children with Coronavirus Disease 2019

27 Pages Posted: 1 Apr 2020

See all articles by Qin Wu

Qin Wu

Qingdao University - Qingdao Women and Children’s Hospital

Yuhan Xing

The Chinese University of Hong Kong (CUHK) - Department of Paediatrics

Lei Shi

Qingdao University - Qingdao Women and Children’s Hospital

Wenjie Li

Qingdao University - Qingdao Women and Children’s Hospital

Yang Gao

Qingdao University - Qingdao Women and Children’s Hospital

Silin Pan

Qingdao University - Qingdao Women and Children’s Hospital

Ying Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Paediatrics

Wendi Wang

Qingdao University - Qingdao Women and Children’s Hospital

Quansheng Xing

Qingdao University - Qingdao Women and Children’s Hospital

More...

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly identified pathogen which mainly spreads by droplets. Most published studies focused on adult patients with coronavirus disease 2019 (COVID-19), but data concerning pediatric patients is limited. This study aimed to determine epidemiological characteristics and clinical features of pediatric patients with COVID-19.

Methods: We reviewed and analyzed data on pediatric patients with laboratory-confirmed COVID-19, including basic information, epidemiological history, clinical manifestations, laboratory and radiologic findings, treatment, outcome and follow-up results.

Findings: From January 20 th to February 27 th of 2020, a total of 74 pediatric patients with COVID-19 were included in this study. Of the 68 cases whose epidemiological data were complete, 65 (65/68, 95.59%) cases were household contacts of adults whose symptoms developed earlier. Forty (59.46%) of the infected children were male, and the median age and body weight are 6 (0.10-15.08) years and 24 (4.20-87.00) kg, respectively. Except for one critically ill case, 20 (27.03%) patients did not show any symptoms of infection, 24 (32.43%) patients had acute upper respiratory tract infection and 29 (39.19%) patients were diagnosed with mild pneumonia. Cough (24/74, 32.43%) and fever (20, 27.03%) were the predominant symptoms of 44 (59.46%) symptomatic patients at onset of the illness. Abnormalities in leukocyte count were found in 23 (31.08%) children and 10 (13.51%) children presented with abnormal lymphocyte count. Of the 34 (45.95%) patients who had nucleic acid testing results for common respiratory pathogens, 19 (19 / 34, 51.35%) showed co-infection with other pathogens other than SARS-CoV-2. Ten (13.51%) children had RT-PCR analysis of SARS-CoV-2 for fecal specimens and 8 of them showed prolonged existence of SARS-CoV-2 RNA 11 (5-23) days after nasopharynx swabs turning negative. Abnormalities in chest imaging were observed in 37 (50.00%) patients and 28 (37.84%) of them only presented with nontypical changes. All children had good prognosis with a median hospitalization duration of 11 days and follow-up period of 16.5 days. During the follow-up period, all the patients remained in quarantine at designated site and home for two 14-day observation periods and showed no clinical manifestation, but 3 of the 8 cases with prolonged fecal shedding of SARS-CoV-2 still showed positive result of feces test.

Interpretation: Pediatric patients with COVID-19 presented with distinct epidemiological, clinical, and radiological characteristics from adult patients. Nearly half of the infected children had co-infection with other common respiratory pathogens. It is not uncommon for pediatric patients to have prolonged fecal shedding of SARS-CoV-2 RNA during the convalescent phase. More investigations would be warranted to facilitate the diagnosis, prevention and control of COVID-19 in children.

Funding Statement: This work is supported by The National Natural Science Foundation of China (NSFC) [Grant number 81770315]; Distinguished Taishan Scholars (2019); Qingdao Outstanding Young Health Professional Development Fund (2020) and Qingdao People's Livelihood Science and Technology Program(17-3-3-6-nsh).

Declaration of Interests: All authors declare no competing interests.

Ethics Approval Statement: This study was approved by the institutional review board of the ethics committee in our hospital (QFELL-KY-2020-11) and written informed consent was obtained from patients’ legal guardians prior to enrollment.

Keywords: Coronavirus disease 2019, SARS-CoV-2, pediatric patient

Suggested Citation

Wu, Qin and Xing, Yuhan and Shi, Lei and Li, Wenjie and Gao, Yang and Pan, Silin and Wang, Ying and Wang, Wendi and Xing, Quansheng, Epidemiological and Clinical Characteristics of Children with Coronavirus Disease 2019 (3/20/2020). Available at SSRN: https://ssrn.com/abstract=3559563 or http://dx.doi.org/10.2139/ssrn.3559563

Qin Wu

Qingdao University - Qingdao Women and Children’s Hospital

Shandong
China

Yuhan Xing

The Chinese University of Hong Kong (CUHK) - Department of Paediatrics ( email )

China

Lei Shi

Qingdao University - Qingdao Women and Children’s Hospital ( email )

Shandong
China

Wenjie Li

Qingdao University - Qingdao Women and Children’s Hospital

Shandong
China

Yang Gao

Qingdao University - Qingdao Women and Children’s Hospital

Shandong
China

Silin Pan

Qingdao University - Qingdao Women and Children’s Hospital ( email )

Shandong
China

Ying Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Paediatrics ( email )

China

Wendi Wang

Qingdao University - Qingdao Women and Children’s Hospital ( email )

Shandong
China

Quansheng Xing (Contact Author)

Qingdao University - Qingdao Women and Children’s Hospital ( email )

Shandong
China

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