The Epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 in a Pediatric Healthcare Network in the United States

• Published in: Journal of the Pediatric Infectious Diseases Society 2020-11, Vol.9 (5), p.523-529
• Main Authors: Otto, William R, Geoghegan, Sarah, Posch, Leila C, Bell, Louis M, Coffin, Susan E, Sammons, Julia S, Harris, Rebecca M, Odom John, Audrey R, Luan, Xianqun, Gerber, Jeffrey S
• Format: Article
• Language: English
• Subjects: Adolescent; Asymptomatic Diseases; Betacoronavirus; Child; Child, Preschool; Clinical Laboratory Techniques; Coronavirus Infections - complications; Coronavirus Infections - diagnosis; Coronavirus Infections - epidemiology; Coronavirus Infections - mortality; COVID-19; COVID-19 Testing; Female; Hospitalization; Humans; Infant; Male; New Jersey - epidemiology; Original; Pandemics; Pennsylvania - epidemiology; Pneumonia, Viral - complications; Pneumonia, Viral - diagnosis; Pneumonia, Viral - epidemiology; Pneumonia, Viral - mortality; Polymerase Chain Reaction; Retrospective Studies; SARS-CoV-2
• ISSN: 2048-7207; 2048-7193; 2048-7207
• DOI: 10.1093/jpids/piaa074

Understanding the prevalence and clinical presentation of coronavirus disease 2019 in pediatric patients can help healthcare providers and systems prepare and respond to this emerging pandemic. This was a retrospective case series of patients tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) across a pediatric healthcare network, including clinical features and outcomes of those with positive test results. Of 7256 unique children tested for SARS-CoV-2, 424 (5.8%) tested positive. Patients aged 18-21 years had the highest test positive rate (11.2%), while those aged 1-5 years had the lowest (3.9%). By race, 10.6% (226/2132) of black children tested positive vs 3.3% (117/3592) of white children. By indication for testing, 21.1% (371/1756) of patients with reported exposures or clinical symptoms tested positive vs 3.8% (53/1410) of those undergoing preprocedural or preadmission testing. Of 424 patients who tested positive for SARS-CoV-2, 182 (42.9%) had no comorbidities, 87 (20.5%) had asthma, and 55 (13.0%) were obese. Overall, 52.1% had cough, 51.2% fever, and 14.6% shortness of breath. Seventy-seven (18.2%) SARS-CoV-2-positive patients were hospitalized, of whom 24 (31.2%) required respiratory support. SARS-CoV-2-targeted antiviral therapy was given to 9 patients, and immunomodulatory therapy to 18 patients. Twelve (2.8%) SARS-CoV-2-positive patients required mechanical ventilation, and 2 patients required extracorporeal membrane oxygenation. Two patients died. In this large cohort of pediatric patients tested for SARS-CoV-2, the rate of infection was low but varied by testing indication. The majority of cases were mild and few children had critical illness.