Comparison of Symptoms and RNA Levels in Children and Adults With SARS-CoV-2 Infection in the Community Setting
Comparison of Symptoms and RNA Levels in Children and Adults With SARS-CoV-2 Infection in the Community Setting
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DOI：
10.1001/jamapediatrics.2021.2025
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发表时间：
2021-06-11
期刊：
影响因子：
26.1
通讯作者：
Chu, Helen Y.
中科院分区：
文献类型：
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作者：
Chung, Erin;Chow, Eric J.;Chu, Helen Y.
重要性COVID-19症状与社区儿童SARS-CoV-2病毒水平之间的关系尚未得到很好的理解。目的描述社区儿童COVID-19的症状，并分析儿童和成人症状与SARS-CoV-2 RNA水平之间的关系，近似为循环阈值（Ct）值。设计，设置，这项横断面研究使用呼吸道病毒监测平台，在2020年3月23日至11月9日期间对所有年龄段的人群进行社区COVID-19病例检测。研究对象为华盛顿金郡18岁以下儿童和成人，他们在网上登记，进行上呼吸道样本的家庭自我采集，用于SARS-CoV-2检测。方法通过逆转录-聚合酶链反应（RT-PCR）从参与者采集的样本中检测SARS-CoV-2 RNA。结果在555例SARS-CoV-2阳性受试者中（平均[SD]年龄33.7 [20.1]岁; 320例为女性[57.7%]），123例儿童中有47例（38.2%）无症状，432例成人中有31例（7.2%）无症状。当有症状时，儿童报告的症状少于成人（平均值[SD]，1.6 [2.0] vs 4.5 [3.1]）。有症状个体的Ct值（对应于较高的病毒RNA水平）低于无症状个体（儿童校正估计值，-3.0; 95% CI，-5.5至-0.6; P = 0.02;成人校正估计值，-2.9; 95% CI，-5.2至-0.6; P = 0.01）。有症状的儿童和有症状的成人之间的平均Ct值差异无统计学意义（校正估计值，-0.7; 95% CI，-2.2至0.9; P = 0.41）无症状儿童和无症状成人之间也无差异（调整后的估计值，-0.6; 95% CI，-4.0至2.8;结论和相关性在这项基于社区的横断面研究中，SARS-CoV-2 RNA水平，由Ct值确定，有症状个体的SARS-CoV-2 RNA水平显著高于无症状个体，且未发现显著的年龄相关差异。
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.