Recurrence of Positive SARS-CoV-2 RNA in 16 Discharged Children
- 1. National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, China
- 2. Department of Pediatrics, The Third People’s Hospital of Shenzhen, China
ABSTRACT
The epidemic of Corona virus disease-19 (COVID-19) attributed to SARS-CoV-2 (formerly 2019-nCoV) has brought a worldwide public health threat since December 2019 in Wuhan, Hubei Province, China
CITATION
Wang Y, Wang X, Li L, Pan D. Recurrence of Positive SARS-CoV-2 RNA in 16 Discharged Children. Ann Pediatr Child Health 8(6): 1192.
KEYWORDS
• COVID-19
• SARS-CoV-2
• Recurrence
• Children
INTRODUCTION
The epidemic of Corona virus disease-19 (COVID-19) attributed to SARS-CoV-2 (formerly 2019-nCoV) has brought a worldwide public health threat since December 2019 in Wuhan, Hubei Province, China [1]. It was reported that childhood cases were nonspecific and no children required respiratory support or intensive care [2]. Recently, recurrence of positive SARS-CoV-2 RNA test in some recovered adult patients has been reported [3- 5]. However, there is rare report about children and their clinical characteristics still remains unknown. Here we describe the clinical characteristics of discharged pediatric COVID-19 with recurrence of positive SARS-CoV-2 RNA.
A total of 40 confirmed COVID-19 children discharged from Shenzhen Third People’s Hospital from January 11, 2020 to May 11, 2020 were enrolled in this study. All discharged COVID-19 children were continued to be isolated and observed for at least 14 days, weekly followed-up and nucleic acid testing of pharyngeal and rectal swabs were performed timely. The children with recurrence were re-admitted to hospital for further medical observation and their close contacts were also followedup. Those children without recurrence were also followed-up outside the hospital.
By May 15, 2020, a total of 40 children were diagnosed as COVID-19 in Shenzhen, China. Overall, 16 children (40.0%, 16/40) showed recurrence of positive SARS-CoV-2 RNA in convalescence and were re-admitted to the only designated treatment center for SARS-CoV-2 in Shenzhen. During hospitalization of the first time, 8 were mild and 8 were ordinary COVID-19 (Table 1). Of the 16 cases, 5 were male and 11 female. The girls have relatively higher chance of recurrence than boys (P = 0.004) (Table 2).
The time from discharge to second admission ranged from 3 to 90 days (median time 14 days). Sustained remission of chest CT imaging was observed, symptoms were not seen among 15 cases (apart from case 10 had mild fever). 4 children tested positive over and over again and were admitted for four times. Up to May 11, 2020, all of 17 close contacts were tested negative for SARS-CoV-2 RNA, and no suspicious clinical symptoms were observed in those close contacts and positive SARS-CoV-2 IgM showed in all children.
According to our data, the recurrence of positive SARS-Cov-2 RNA occurred more often in girls than in boys. During the second admission, there was positive SARS-CoV-2 IgM in those children and the majority of them were asymptomatic. Their close contacts were not infected.
The time from illness onset to the last discharge ranged from 34 to 124 days. These children stayed at hospital or at designated hotel during the period. Long time isolation contributed to the children and their parents’ anxiety and it is necessary to strengthen psychotherapy and humanistic care to these people.
Table 1: Clinical characteristic of 16 children with Recurrence of Positive SARS-CoV-2 RNA.
| Patient (case number) | Age (y) | Gender | Time to diagnosis (d) | Symptoms and signs at first admission | Clinical classifications at first admission | Time from first discharge to re-admission (d) | Times admitted to hospital | Time from illness onset to the last discharge (d) |
| 1 | 6 | F | 5 | Fever and cough | Mild | 4 | 4 | 60 |
| 2 | 0.75 | F | 1 | NO | Ordinary | 8 | 2 | 75 |
| 3 | 8 | M | 1 | Nasal congestion | Ordinary | 19 | 4 | 74 |
| 4 | 6 | F | 1 | Fever | Ordinary | 7 | 2 | 53 |
| 5 | 2 | F | 1 | Fever | Ordinary | 14 | 2 | 75 |
| 6 | 6 | M | 2 | Cough | Ordinary | 4 | 2 | 34 |
| 7 | 13 | M | 0.5 | No | Mild | 7 | 4 | 92 |
| 8 | 12 | F | 1 | No | Mild | 3 | 3 | 58 |
| 9 | 10 | F | 1 | Running nose | Ordinary | 14 | 3 | 89 |
| 10 | 13 | M | 1 | Cough | Mild | 90 | 3 | 124 |
| 11 | 6 | F | 0.5 | No | Mild | 44 | 2 | 75 |
| 12 | 10 | F | 5 | Fever | Mild | 32 | 2 | 67 |
| 13 | 13 | F | 0.5 | No | Ordinary | 31 | 4 | 80 |
| 14 | 13 | M | 0.5 | No | Mild | 36 | 2 | 70 |
| 15 | 8 | F | 0.5 | No | Ordinary | 3 | 2 | 34 |
| 16 | 17 | F | 1 | wheeze | Mild | 30 | 3 | 89 |
Table 2: Gender-Specific proportion of recurrence COVID-19.
| Gender | Recurrence | No recurrence |
| male female total |
5(31.3) 11(68.7) 16(100.0) |
13(54.2) 11(45.8) 24(100.0) |
| Figures in brackets refer to percentage of total cases in the group | ||
FUNDING
This work is supported by grants from the Science and Technology Innovation Committee of Shenzhen Municipality (202002073000001).
This study was approved by the Ethics Committee of the Third People’s Hospital of Shenzhen, China, on March 12, 2020.
