Characteristics of pediatric SARS-CoV-2 infection and persistent fecal viral shedding.

Characteristics of pediatric SARS-CoV-2 infection and persistent fecal viral shedding. Spencer EA, Heneghan C.

https://www.cebm.net/study/characteristics-of-pediatric-sars-cov-2-infection-and-persistent-fecal-viral-shedding/

Published on July 16, 2020

Reference Xu Y, Li X, Zhu B et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med 26, 502–505 (2020). https://doi.org/10.1038/s41591-020-0817-4
Study type
Country China
Setting Hospital
Funding Details National Key Research and Development Program of China and Guangzhou Regenerative Medicine Guangdong Laboratory.
Transmission mode Orofecal
Exposures

Bottom Line

This study of ten children with COVID-19 found that symptoms among children were nonspecific and relatively mild; rectal swabs tested positive among 8/10 cases even once nasopharyngeal tests became negative.

Evidence Summary

In a close-contacts screening program, 745 children (and 3,174 adults) were screened by nasopharyngeal swab real-time PCR with reverse transcription (RT–PCR) for SARS-CoV-2 infection; ten children tested positive.

Symptoms in the ten paediatric cases were nonspecific. None sought medical care and were investigated only due to their exposure history and testing positive.  None of these ten children required respiratory support or intensive care. 

Chest X-rays lacked definite signs of pneumonia, a defining feature of the infection in adult cases.  Eight  children persistently tested positive on rectal swabs even after nasopharyngeal testing was negative, raising the possibility of fecal-oral transmission.

What did they do?

Within a close-contacts screening program, 745 children (and 3,174 adults) were screened by nasopharyngeal swab real-time PCR with reverse transcription (RT–PCR) for SARS-CoV-2 infection. 10/745 children tested positive and this study reports the results of epidemiological and clinical investigations for these. The researchers also looked for evidence of viral excretion through the gastrointestinal and respiratory tracts.

Study reliability

Within this observational study, ten paediatric cases only were found; the findings need replicating before firm conclusions can be drawn.

Clearly defined setting Demographic characteristics described Follow-up length was sufficient Transmission outcomes assessed Main biases are taken into consideration
Yes Yes N/A N/A Unclear

What else should I consider?

“However, we do not have evidence of replication-competent virus in fecal swabs, which is required to confirm the potential for fecal–oral transmission.”

About the authors

Carl Heneghan

Carl Heneghan

Carl is Professor of EBM & Director of CEBM at the University of Oxford. He is also a GP and tweets @carlheneghan. He has an active interest in discovering the truth behind health research findings

Elizabeth Spencer

Elizabeth Spencer

Dr Elizabeth Spencer; MMedSci, PhD. Epidemiologist, Nuffield Department for Primary Care Health Sciences, University of Oxford.