Symptomatic Infection is Associated with Prolonged Duration of Viral Shedding in Mild Coronavirus Disease 2019: A Retrospective Study of 110 Children in Wuhan

Abstract

Background: Information regarding viral shedding in children with coronavirus disease 2019 (COVID-19) was limited. This study aims to investigate the clinical and laboratory characteristics associated with viral shedding in children with mild COVID-19. Methods: The clinical and laboratory information of 110 children with COVID-19 at Wuhan Children's Hospital, Wuhan, China, from January 30 to March 10, 2020, were analyzed retrospectively. Results: The median age was 6 years old. The median period of viral shedding of COVID-19 was 15 days (interquartile range [IQR], 11-20 days) as measured from illness onset to discharge. This period was shorter in asymptomatic patients (26.4%) compared with symptomatic patients (73.6%) (11 days vs. 17 days). Multivariable regression analysis showed increased odds of symptomatic infection was associated with age <6 years (odds ratio [OR] 8.94, 95% confidence interval [CI]: 2.55-31.35; P = 0.001), hypersensitive C-reactive protein >3.0 mg/L (OR 4.89; 95% CI: 1.10-21.75; P = 0.037) and presenting pneumonia in chest radiologic findings (OR 8.45; 95% CI: 2.69-26.61; P < 0.001). Kaplan-Meier analysis displayed symptomatic infection (P < 0.001), fever (P = 0.006), pneumonia (P = 0.003) and lymphocyte counts <2.0 × 109/L (P = 0.008) in children with COVID-19 were associated with prolonged duration of viral shedding in children with COVID-19. Conclusion: Prolonged duration of viral shedding in children with COVID-19 was associated with symptomatic infection, fever, pneumonia and lymphocyte count less than 2.0 × 109/L. Monitoring of symptoms could help to know the viral shedding in children with COVID-19.