Viral Dynamics of the SARS-CoV-2 Omicron Variant in Pediatric Patients: A Prospective Cohort Study.

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    • Source:
      Publisher: Oxford University Press Country of Publication: United States NLM ID: 9203213 Publication Model: Print Cited Medium: Internet ISSN: 1537-6591 (Electronic) Linking ISSN: 10584838 NLM ISO Abbreviation: Clin Infect Dis Subsets: MEDLINE
    • Publication Information:
      Publication: Jan. 2011- : Oxford : Oxford University Press
      Original Publication: Chicago, IL : The University of Chicago Press, c1992-
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    • Abstract:
      Background: There are limited data on the viral dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children. Understanding viral load changes over the course of illness and duration of viral shedding may provide insight into transmission dynamics to inform public health and infection-control decisions.
      Methods: We conducted a prospective cohort study of children aged 18 years and younger with polymerase chain reaction-confirmed SARS-CoV-2 between 1 February 2022 and 14 March 2022. SARS-CoV-2 testing occurred on daily samples for 10 days; a subset of participants completed daily rapid antigen tests (RATs). Viral RNA trajectories were described in relation to symptom onset and resolution. The associations between both time since symptom onset/resolution and non-infectious viral load were evaluated using a Cox proportional hazards model.
      Results: Among 101 children aged 2 to 17 years, the median time to study-defined non-infectious viral load was 5 days post-symptom onset, with 75% meeting this threshold by 7 days and 90% by 10 days. On the day of and day after symptom resolution, 43 (49%) and 52 (60%) of 87 had met the non-infectious thresholds, respectively. Of the 50 participants completing a RAT, positivity at symptom onset and on the day after symptom onset was 67% (16/24) and 75% (14/20). On the first day where the non-infectious threshold was met, 61% (n = 27/44) of participant RAT results were positive.
      Conclusions: Children often met the study-defined non-infectiousness threshold on the day after symptom resolution. The RATs were often negative early in the course of illness and should not be relied on to exclude infection. Clinical Trials Registration.; NCT05240183.
      Competing Interests: Potential conflicts of interest. L. M. reports support for attending meetings and/or travel from Queen's University and Northern Ontario Medical School Public Health and Preventive Medicine residency programs to travel to and attend residency program events in 2022; other financial or nonfinancial interests: employment as a Public Health Physician at Public Health Ontario. C. B. B. reports voluntary unpaid leadership or a fiduciary role as the Board Chair of Kennedy House. P. J. reports payment as an expert witness on vaccine mandates for universities, hospitals, and municipalities from Hicks Morley Hamilton Stewart Storie LLP, City of Toronto, and Baker McKenzie LLP; other financial or nonfinancial interests: Abbott Vascular, Terumo, serves as an unpaid member of the steering group of trials funded by Abbott Vascular (EXCEL trial:; comparing XIENCE Stent in subjects with unprotected left main coronary artery disease with coronary artery bypass graft surgery; no active involvement for >3 years, no co-authored publication but still listed as an original member of the statistical executive committee) and Terumo (MASTER DAPT trial: 3020; comparing abbreviated DAPT (dual antiplatelet therapy) with prolonged DAPT in patients with a drug-eluting stent; ongoing active involvement as a member of the steering group). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
      (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: [email protected].)
    • Contributed Indexing:
      Keywords: SARS-CoV-2; children; viral dynamics; viral load
    • Molecular Sequence: NCT05240183
    • Accession Number:
      0 (RNA, Viral)
    • Subject Terms:
      SARS-CoV-2 variants
    • Publication Date:
      Date Created: 20231212 Date Completed: 20240613 Latest Revision: 20240620
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