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Comparative Study
. 2021 Oct 1;175(10):e212025.
doi: 10.1001/jamapediatrics.2021.2025. Epub 2021 Oct 4.

Comparison of Symptoms and RNA Levels in Children and Adults With SARS-CoV-2 Infection in the Community Setting

Erin Chung  1 , Eric J Chow  2 , Naomi C Wilcox  2 , Roy Burstein  3 , Elisabeth Brandstetter  2   4 , Peter D Han  4   5 , Kairsten Fay  6 , Brian Pfau  4   5 , Amanda Adler  7 , Kirsten Lacombe  7 , Christina M Lockwood  4   8 , Timothy M Uyeki  9 , Jay Shendure  4   5   10 , Jeffrey S Duchin  2   11 , Mark J Rieder  4   5 , Deborah A Nickerson  4   5 , Michael Boeckh  2   6 , Michael Famulare  3 , James P Hughes  12 , Lea M Starita  4   5 , Trevor Bedford  4   5   6 , Janet A Englund  7 , Helen Y Chu  2
Affiliations
Comparative Study

Comparison of Symptoms and RNA Levels in Children and Adults With SARS-CoV-2 Infection in the Community Setting

Erin Chung et al. JAMA Pediatr. .

Abstract

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Drs Adler and Lockwood and Ms Lacombe report grants from the Bill and Melinda Gates Foundation during the conduct of the study. Dr Shendure is a consultant with Guardant Health, Maze Therapeutics, Camp4 Therapeutics, Nanostring, Phase Genomics, Adaptive Biotechnologies, and Stratos Genomics; and has a research collaboration with Illumina. Dr Boeckh is a consultant for Moderna, VirBio, and Merck; has received research support from Regeneron, Ridgeback, Merck, and VirBio outside the submitted work; and has received research support from the Bill and Melinda Gates Foundation during the conduct of the study. Dr Hughes reports grants from the Bill and Melinda Gates Foundation during the conduct of the study and National Institutes of Health outside the submitted work. Dr Bedford reports grants from the Bill and Melinda Gates Foundation, The Pew Charitable Trusts, and the National Institute of General Medical Sciences during the conduct of the study. Dr Englund receives research support paid to her institution from AstraZeneca, the Bill and Melinda Gates Foundation, Chimerix, GlaxoSmithKline, Novavax, Merck, and Pfizer; and is a consultant for Sanofi Pasteur and Meissa Vaccines. Dr Chu has served as a consultant with Ellume, Pfizer, the Bill and Melinda Gates Foundation, GlaxoSmithKline, and Merck; and has received research funding from Sanofi Pasteur and support and reagents from Ellume and Cepheid outside of the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Number of COVID-19 Signs and Symptoms Reported by Participants at Enrollment by Age
The total number of signs and symptoms at enrollment are shown by age group with individual locally estimated scatterplot smoothing regression lines plotted for each age group. Data points represent SARS-CoV-2–positive individuals. Shaded areas represent 95% CIs.
Figure 2.
Figure 2.. Adjusted Mean SARS-CoV-2 Orf1b Cycle Threshold (Ct) Values by Age Group, Grouped by Symptom Status
Boxes range from the first to third quartiles. Midlines represent median values. Error bars represent the minimum and maximum values. Individual points represent SARS-CoV-2–positive individuals. There were 47 asymptomatic children, 31 asymptomatic adults, 76 symptomatic children, and 401 symptomatic adults. Ct values are adjusted for swab type.
Figure 3.
Figure 3.. Mean SARS-CoV-2 Orf1b Cycle Threshold (Ct) Values by Age
The scatterplot depicts Ct values adjusted by swab type. The gray line represents the locally estimated scatterplot smoothing curve using unadjusted Ct values. Linear regression lines per age group (orange indicates adults; blue indicates children) are adjusted by swab type. Data points represent SARS-CoV-2–positive individuals. Shaded areas represent 95% CIs.
See this image and copyright information in PMC

Comment in

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