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Comparison of Symptoms and RNA Levels in Children and Adults With SARS-CoV-2 Infection in the Community Setting.
JAMA Pediatr. 2021 10 01; 175(10):e212025.JP

Abstract

Importance

The association between COVID-19 symptoms and SARS-CoV-2 viral levels in children living in the community is not well understood.

Objective

To characterize symptoms of pediatric COVID-19 in the community and analyze the association between symptoms and SARS-CoV-2 RNA levels, as approximated by cycle threshold (Ct) values, in children and adults.

Design, Setting, and Participants

This cross-sectional study used a respiratory virus surveillance platform in persons of all ages to detect community COVID-19 cases from March 23 to November 9, 2020. A population-based convenience sample of children younger than 18 years and adults in King County, Washington, who enrolled online for home self-collection of upper respiratory samples for SARS-CoV-2 testing were included.

Exposures

Detection of SARS-CoV-2 RNA by reverse transcription-polymerase chain reaction (RT-PCR) from participant-collected samples.

Main Outcomes and Measures

RT-PCR-confirmed SARS-CoV-2 infection, with Ct values stratified by age and symptoms.

Results

Among 555 SARS-CoV-2-positive participants (mean [SD] age, 33.7 [20.1] years; 320 were female [57.7%]), 47 of 123 children (38.2%) were asymptomatic compared with 31 of 432 adults (7.2%). When symptomatic, fewer symptoms were reported in children compared with adults (mean [SD], 1.6 [2.0] vs 4.5 [3.1]). Symptomatic individuals had lower Ct values (which corresponded to higher viral RNA levels) than asymptomatic individuals (adjusted estimate for children, -3.0; 95% CI, -5.5 to -0.6; P = .02; adjusted estimate for adults, -2.9; 95% CI, -5.2 to -0.6; P = .01). The difference in mean Ct values was neither statistically significant between symptomatic children and symptomatic adults (adjusted estimate, -0.7; 95% CI, -2.2 to 0.9; P = .41) nor between asymptomatic children and asymptomatic adults (adjusted estimate, -0.6; 95% CI, -4.0 to 2.8; P = .74).

Conclusions and Relevance

In this community-based cross-sectional study, SARS-CoV-2 RNA levels, as determined by Ct values, were significantly higher in symptomatic individuals than in asymptomatic individuals and no significant age-related differences were found. Further research is needed to understand the role of SARS-CoV-2 RNA levels and viral transmission.

Authors+Show Affiliations

Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle.Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle.Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle.Institute for Disease Modeling, Seattle, Washington.Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle. Brotman Baty Institute for Precision Medicine, Seattle, Washington.Brotman Baty Institute for Precision Medicine, Seattle, Washington. Department of Genome Sciences, University of Washington, Seattle.Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.Brotman Baty Institute for Precision Medicine, Seattle, Washington. Department of Genome Sciences, University of Washington, Seattle.Seattle Children's Research Institute, Seattle, Washington.Seattle Children's Research Institute, Seattle, Washington.Brotman Baty Institute for Precision Medicine, Seattle, Washington. Department of Laboratory Medicine and Pathology, University of Washington, Seattle.Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.Brotman Baty Institute for Precision Medicine, Seattle, Washington. Department of Genome Sciences, University of Washington, Seattle. Howard Hughes Medical Institute, Seattle, Washington.Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle. Public Health-Seattle & King County, Seattle, Washington.Brotman Baty Institute for Precision Medicine, Seattle, Washington. Department of Genome Sciences, University of Washington, Seattle.Brotman Baty Institute for Precision Medicine, Seattle, Washington. Department of Genome Sciences, University of Washington, Seattle.Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.Institute for Disease Modeling, Seattle, Washington.Department of Biostatistics, University of Washington, Seattle.Brotman Baty Institute for Precision Medicine, Seattle, Washington. Department of Genome Sciences, University of Washington, Seattle.Brotman Baty Institute for Precision Medicine, Seattle, Washington. Department of Genome Sciences, University of Washington, Seattle. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.Seattle Children's Research Institute, Seattle, Washington.Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle.

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

34115094

Citation

Chung, Erin, et al. "Comparison of Symptoms and RNA Levels in Children and Adults With SARS-CoV-2 Infection in the Community Setting." JAMA Pediatrics, vol. 175, no. 10, 2021, pp. e212025.
Chung E, Chow EJ, Wilcox NC, et al. Comparison of Symptoms and RNA Levels in Children and Adults With SARS-CoV-2 Infection in the Community Setting. JAMA Pediatr. 2021;175(10):e212025.
Chung, E., Chow, E. J., Wilcox, N. C., Burstein, R., Brandstetter, E., Han, P. D., Fay, K., Pfau, B., Adler, A., Lacombe, K., Lockwood, C. M., Uyeki, T. M., Shendure, J., Duchin, J. S., Rieder, M. J., Nickerson, D. A., Boeckh, M., Famulare, M., Hughes, J. P., ... Chu, H. Y. (2021). Comparison of Symptoms and RNA Levels in Children and Adults With SARS-CoV-2 Infection in the Community Setting. JAMA Pediatrics, 175(10), e212025. https://doi.org/10.1001/jamapediatrics.2021.2025
Chung E, et al. Comparison of Symptoms and RNA Levels in Children and Adults With SARS-CoV-2 Infection in the Community Setting. JAMA Pediatr. 2021 10 1;175(10):e212025. PubMed PMID: 34115094.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Symptoms and RNA Levels in Children and Adults With SARS-CoV-2 Infection in the Community Setting. AU - Chung,Erin, AU - Chow,Eric J, AU - Wilcox,Naomi C, AU - Burstein,Roy, AU - Brandstetter,Elisabeth, AU - Han,Peter D, AU - Fay,Kairsten, AU - Pfau,Brian, AU - Adler,Amanda, AU - Lacombe,Kirsten, AU - Lockwood,Christina M, AU - Uyeki,Timothy M, AU - Shendure,Jay, AU - Duchin,Jeffrey S, AU - Rieder,Mark J, AU - Nickerson,Deborah A, AU - Boeckh,Michael, AU - Famulare,Michael, AU - Hughes,James P, AU - Starita,Lea M, AU - Bedford,Trevor, AU - Englund,Janet A, AU - Chu,Helen Y, Y1 - 2021/10/04/ PY - 2022/06/11/pmc-release PY - 2021/6/12/pubmed PY - 2021/10/16/medline PY - 2021/6/11/entrez SP - e212025 EP - e212025 JF - JAMA pediatrics JO - JAMA Pediatr VL - 175 IS - 10 N2 - Importance: The association between COVID-19 symptoms and SARS-CoV-2 viral levels in children living in the community is not well understood. Objective: To characterize symptoms of pediatric COVID-19 in the community and analyze the association between symptoms and SARS-CoV-2 RNA levels, as approximated by cycle threshold (Ct) values, in children and adults. Design, Setting, and Participants: This cross-sectional study used a respiratory virus surveillance platform in persons of all ages to detect community COVID-19 cases from March 23 to November 9, 2020. A population-based convenience sample of children younger than 18 years and adults in King County, Washington, who enrolled online for home self-collection of upper respiratory samples for SARS-CoV-2 testing were included. Exposures: Detection of SARS-CoV-2 RNA by reverse transcription-polymerase chain reaction (RT-PCR) from participant-collected samples. Main Outcomes and Measures: RT-PCR-confirmed SARS-CoV-2 infection, with Ct values stratified by age and symptoms. Results: Among 555 SARS-CoV-2-positive participants (mean [SD] age, 33.7 [20.1] years; 320 were female [57.7%]), 47 of 123 children (38.2%) were asymptomatic compared with 31 of 432 adults (7.2%). When symptomatic, fewer symptoms were reported in children compared with adults (mean [SD], 1.6 [2.0] vs 4.5 [3.1]). Symptomatic individuals had lower Ct values (which corresponded to higher viral RNA levels) than asymptomatic individuals (adjusted estimate for children, -3.0; 95% CI, -5.5 to -0.6; P = .02; adjusted estimate for adults, -2.9; 95% CI, -5.2 to -0.6; P = .01). The difference in mean Ct values was neither statistically significant between symptomatic children and symptomatic adults (adjusted estimate, -0.7; 95% CI, -2.2 to 0.9; P = .41) nor between asymptomatic children and asymptomatic adults (adjusted estimate, -0.6; 95% CI, -4.0 to 2.8; P = .74). Conclusions and Relevance: In this community-based cross-sectional study, SARS-CoV-2 RNA levels, as determined by Ct values, were significantly higher in symptomatic individuals than in asymptomatic individuals and no significant age-related differences were found. Further research is needed to understand the role of SARS-CoV-2 RNA levels and viral transmission. SN - 2168-6211 UR - https://www.unboundmedicine.com/medline/citation/34115094/Comparison_of_Symptoms_and_RNA_Levels_in_Children_and_Adults_With_SARS_CoV_2_Infection_in_the_Community_Setting_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2021.2025 DB - PRIME DP - Unbound Medicine ER -