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Co-Infection and Other Clinical Characteristics of COVID-19 in Children

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Co-Infection and Other Clinical Characteristics of COVID-19 in Children Pre-publication Release Co-infection and Other Clinical Characteristics of COVID-19 in Children Qin Wu, MD, Yuhan Xing, MD, Lei Shi, MB, Wenjie Li, MS, Yang Gao, MS, Silin Pan, PhD, MD, Ying Wang, MS, Wendi Wang, MS, Quansheng Xing, PhD, MD DOI: 10.1542/peds.2020-0961 Journal: Pediatrics Article Type: Regular Article Citation: Wu Q, Xing Y, Shi L, et al. Co-infection and other clinical characteristics of COVID- 19 in children. Pediatrics. 2020; doi: 10.1542/peds.2020-0961 This is a pre-publication version of an article that has undergone peer review and been accepted for publication but is not the final version of record. This paper may be cited using the DOI and date of access. This paper may contain information that has errors in facts, figures, and statements, and will be corrected in the final published version. The journal is providing an early version of this article to expedite access to this information. The American Academy of Pediatrics, the editors, and authors are not responsible for inaccurate information and data described in this version. Downloaded from©2020 www.aappublications.org/news American Academy by of guest Pediatrics on September 28, 2021 Pre-publication Release Co-infection and Other Clinical Characteristics of COVID-19 in Children Qin Wu, MDa*, Yuhan Xing, MDb*, Lei Shi, MBa*, Wenjie Li, MSa, Yang Gao, MSa, Silin Pan, PhD, MDa, Ying Wang, MSc#, Wendi Wang, MSa#, Quansheng Xing, PhD, MDa# Affiliations: a Qingdao Women and Children’s Hospital, Qingdao University, Qingdao, China; bFaculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China, cWuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan , China. Address correspondence to Quansheng Xing, Department of Paediatrics, Qingdao Women and Children’s Hospital, Qingdao University,No.6 Tongfu Road, 266034, Qingdao, China. [[email protected]], 86 532 6866 1818 *Contributed equally as co-first authors #Corresponding author Funding Source: All phases of this study were supported by The National Natural Science Foundation of China (NSFC) , grant number 81770315] and Qingdao People's Livelihood Science and Technology Program, grant number 17-3-3-6-nsh. Dr. Quansheng Xing is also supported by Distinguished Taishan Scholars (2019) and Dr. Qin Wu is supported by Qingdao Outstanding Young Health Professional Development Fund (2020) . Financial Disclosure: The authors have no financial relationships relevant to this article to disclose. Conflict of Interest: All authors have indicated they have no potential conflicts of interest to disclose. Short Title: Co-infection and Other Characteristics of COVID-19 Downloaded from©2020 www.aappublications.org/news American Academy by of guest Pediatrics on September 28, 2021 Pre-publication Release Abbreviations: SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2; COVID-19, coronavirus disease 2019; WHO, World Health Organization, RT-PCR, real-time reverse transcription polymerase chain reaction; SARS, severe acute respiratory syndrome; CRP, C- reactive protein; PCT, procalcitonin; ESR, Erythrocyte sedimentation rate; MP, mycoplasma pneumoniae; RSV, respiratory syncytial virus ; EBV, Epstein-Barr virus; CMV, cytomegalovirus; CT, computed tomography; China CDC, China Centers for Disease Control and Prevention Table of Contents Summary：Pediatric COVID-19 patients presented with symptoms distinct from adults and were susceptible to co-infection. Persistent fecal shedding of viral RNA was found after respiratory specimens showing negative. What's Known on This Subject: Severe acute respiratory coronavirus 2 is a newly identified pathogen which mainly spreads by droplets. Most published studies focused on adult patients with coronavirus disease 2019, but data concerning pediatric patients are limited. What This Study Adds: Children with COVID-19 presented with distinct clinical characteristics from adult patients. Notably, co-infection with other respiratory pathogens were common in pediatric patients, highlighting the importance for screening of SARS-CoV-2. Contributors Drs Quansheng Xing, Wendi Wang and Ying Wang conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. Drs Qin Wu, Yuhan Xing and Ms Lei Shi conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. Drs Wenjie Li, Yang Gao and Silin Pan designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Downloaded from©2020 www.aappublications.org/news American Academy by of guest Pediatrics on September 28, 2021 Pre-publication Release Abstract BACKGROUND AND OBJECTIVE: 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 are 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. RESULTS: 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. Cough (32.43%) and fever (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 (51.35%) showed co-infection with other pathogens other than SARS-CoV-2. Ten (13.51%) children had RT-PCR analysis for fecal specimens and 8 of them showed prolonged existence of SARS-CoV-2 RNA. CONCLUSIONS: 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. Introduction During the last three months, we faced the fast-growing outbreak of coronavirus disease 2019 (COVID-19) that swept through China and rapidly spread to all over the world. The etiological agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified as a novel pathogen highly contagious to general population with relatively high mortality rate. By the end of April 2020, more than 3 million confirmed cases of COVID-19 were reported in over 200 countries and regions globally, causing more than 200,000 deaths.1 Currently, the epidemic Downloaded from©2020 www.aappublications.org/news American Academy by of guest Pediatrics on September 28, 2021 Pre-publication Release center has been shifted to the United States and Europe. Early studies on COVID-19 from the Chinese researchers 2-5 have provided first-hand knowledge and valuable treatment experiences for other countries to learn from, but most of the studies were targeted at adult patients. The majority of publication on pediatric cases of COVID-19 during the early stage of the disease were case reports or studies with relatively small sample size.6-11 To determine the spectrum of disease in children, we collected and analyzed epidemiological, clinical, laboratory, and radiologic data of 74 pediatric COVID-19 cases in two locations of northern and southern China. We hope our study would further the understanding of SARS-CoV-2 infection in children and provide an insight to treatment strategies and prophylactic control of the disease. Methods Data sources From January 20th to February 27th of 2020, we retrospectively reviewed electronic medical records of 74 pediatric COVID-19 cases admitted in Qingdao Women's and Children's Hospital and Wuhan Children's Hospital, including data recorded during hospitalization and follow-up period. Baseline information (gender, age, weight, time of onset, time of diagnosis by SARS- CoV-2 nucleic acid test, date of admission and discharge), epidemiological history, clinical manifestations, laboratory and radiologic findings, treatment, outcome and follow-up data were recorded with standardized data collection forms. This study was approved by the institutional review board of the ethics committee of Qingdao Women and Children’s Hospital (QFELL-KY-2020-11) and written informed consent was obtained from patients’ legal guardians prior to enrollment. Downloaded from©2020 www.aappublications.org/news American Academy by of guest Pediatrics on September 28, 2021 Pre-publication Release Determination of exposure history Detailed epidemiological data of all cases were collected and classified according to whether the case was household contacts of confirmed adult patients, the sequence of infection within the family, and whether the infected children transmitted the virus to others. Laboratory confirmation Confirmation of COVID-19 was based on
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