Viral Load Dynamics After Symptomatic COVID-19 in Children With Underlying Malignancies During the Omicron Wave
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Purpose: This study aimed to investigate the viral load dynamics in children with underlying malignancies diagnosed with symptomatic coronavirus disease 2019 (COVID-19). Methods: This was a retrospective longitudinal cohort study of patients <19 years old with underlying hemato-oncologic malignancies that were diagnosed with their first symptomatic severe acute respiratory syndrome coronavirus 2 polymerase chain reaction (PCR)-confirmed COVID-19 infection during March 1 to August 30, 2022. Review of electronic medical records and telephone surveys were undertaken to assess the clinical presentations and transmission route of the patients. Thresholds of negligible likelihood of infectious virus was defined as E gene reverse transcription (RT)-PCR cycle threshold (Ct) value ≥25. Results: During the 6-month study period, a total of 43 children with 44 episodes of COVID-19 were included. Of the 44 episodes, the median age of the patients included was 8 years old (interquartile range [IQR], 4.9–10.5), and the most common underlying disease was acute lymphoid leukemia (n=30, 68.2%), followed by patients post-hematopoietic stem cell transplantation (n=8, 18.2%). Majority of the patients had mild COVID-19 (n=32, 72.7%), and three patients (7.0%) had severe/critical COVID-19. Furthermore, 2.3% (n=1) died of COVID-19 associated acute respiratory distress syndrome. The largest percentage of the patients showed E gene RT-PCR Ct value ≥25 between 15-21 days (n=13, 39.4%), followed by 22-28 days (n=10, 30.3%). In 15.2% (n=5), E gene RT-PCR Ct value remained <25 beyond 28 days after initial positive PCR. Refractory malignancy status (β, 67.0; 95% confidence interval, 7.0–17.0; P=0.030) was significantly associated with prolonged duration of E gene RT-PCR <25. A patient with prolonged duration of E gene RT-PCR Ct value <25 was suspected to have infectivity shown by the transmission of the virus to his mother at day 86 after his initial positive test. Children that acquire symptomatic COVID-19 during refractory malignancy state are at a high risk for prolonged shedding warranting PCR-based transmission precautions in this cohort of patients.
Abstract
Purpose: This study aimed to investigate the viral load dynamics in children with underlying malignancies diagnosed with symptomatic coronavirus disease 2019 (COVID-19). Methods: This was a retrospective longitudinal cohort study of patients <19 years old with underlying hemato-oncologic malignancies that were diagnosed with their first symptomatic severe acute respiratory syndrome coronavirus 2 polymerase chain reaction (PCR)-confirmed COVID-19 infection during March 1 to August 30, 2022. Review of electronic medical records and telephone surveys were undertaken to assess the clinical presentations and transmission route of the patients. Thresholds of negligible likelihood of infectious virus was defined as E gene reverse transcription (RT)-PCR cycle threshold (Ct) value ≥25. Results: During the 6-month study period, a total of 43 children with 44 episodes of COVID-19 were included. Of the 44 episodes, the median age of the patients included was 8 years old (interquartile range [IQR], 4.9–10.5), and the most common underlying disease was acute lymphoid leukemia (n=30, 68.2%), followed by patients post-hematopoietic stem cell transplantation (n=8, 18.2%). Majority of the patients had mild COVID-19 (n=32, 72.7%), and three patients (7.0%) had severe/critical COVID-19. Furthermore, 2.3% (n=1) died of COVID-19 associated acute respiratory distress syndrome. The largest percentage of the patients showed E gene RT-PCR Ct value ≥25 between 15-21 days (n=13, 39.4%), followed by 22-28 days (n=10, 30.3%). In 15.2% (n=5), E gene RT-PCR Ct value remained <25 beyond 28 days after initial positive PCR. Refractory malignancy status (β, 67.0; 95% confidence interval, 7.0–17.0; P=0.030) was significantly associated with prolonged duration of E gene RT-PCR <25. A patient with prolonged duration of E gene RT-PCR Ct value <25 was suspected to have infectivity shown by the transmission of the virus to his mother at day 86 after his initial positive test. Children that acquire symptomatic COVID-19 during refractory malignancy state are at a high risk for prolonged shedding warranting PCR-based transmission precautions in this cohort of patients.
참고문헌 (20)
- van der Vries E, "Prolonged influenza virus shedding and emergence of antiviral resistance in immunocompromised patients and ferrets", PLoS Pathog, 9, pp.e1003343~ (2013)
- Haessler S, "Norovirus gastroenteritis in immunocompromised patients", N Engl J Med, 368, pp.971~ (2013)
- Niyonkuru M, "Prolonged viral shedding of SARS-CoV-2 in two immunocompromised patients, a case report", BMC Infect Dis, 21, pp.743~ (2021)
- Altamirano-Molina M, "Prolonged viral shedding of SARS-CoV-2 in patients with acute leukemia", Hematol Transfus Cell Ther, 44, pp.299~300 (2022)
- Shoji K, "Prolonged shedding of infectious viruses with haplotype switches of SARS-CoV-2 in an immunocompromised patient", J Infect Chemother, 28, pp.1001~1004 (2022)
- Epstein RL, "Time to SARS-CoV-2 PCR clearance in immunocompromising conditions: is test-based removal from isolation necessary in severely immunocompromised individuals?", Open Forum Infect Dis, 8, pp.ofab164~ (2021)
- Puhach O, "SARS-CoV-2 viral load and shedding kinetics", Nat Rev Microbiol, 21, pp.147~161 (2023)
- Bullard J, "Predicting infectious severe acute respiratory syndrome coronavirus 2 from diagnostic samples", Clin Infect Dis, 71, pp.2663~2666 (2020)
- Jeong HW, "Viable SARS-CoV-2 in various specimens from COVID-19 patients", Clin Microbiol Infect, 26, pp.1520~1524 (2020)
- Singanayagam A, "Duration of infectiousness and correlation with RT-PCR cycle threshold values in cases of COVID-19, England, January to May 2020", Euro Surveill, 25, pp.2001483~ (2020)
- Zapor M, "Persistent detection and infectious potential of SARS-CoV-2 virus in clinical specimens from COVID-19 patients", Viruses, 12, pp.v12121384~ (2020)
- Reich P, "Infection prevention during the coronavirus disease 2019 pandemic", Infect Dis Clin North Am, 36, pp.15~37 (2022)
- Węcławek-Tompol J, "COVID-19 in pediatric cancer patients is associated with treatment interruptions but not with short-term mortality : a Polish national study", J Hematol Oncol, 14, pp.163~ (2021)
- "Coronavirus disease 2019 (COVID-19) treatment guidelines" (2023)[URL]
- Cevik M, "SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness : a systematic review and meta-analysis", Lancet Microbe, 2, pp.e13~e22 (2021)
- Meiring S, "Prolonged shedding of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)at high viral loads among hospitalized immunocompromised persons living with human immunodeficiency virus(HIV), South Africa", Clin Infect Dis, 75, pp.e144~e156 (2022)
- Tabatabai M, "An analysis of COVID-19 mortality during the dominancy of Alpha, Delta, and Omicron in the USA", J Prim Care Community Health, 14, pp.21501319231170164~ (2023)
- Jones TC, "Estimating infectiousness throughout SARS-CoV-2 infection course", Science, 373, pp.eabi5273~ (2021)
- Marks M, "Transmission of COVID-19 in 282 clusters in Catalonia, Spain : a cohort study", Lancet Infect Dis, 21, pp.629~636 (2021)
- Johnston C, "Immunity and infectivity in Covid-19", BMJ, 378, pp.e061402~ (2022)