• Jillian H Hurst, Sarah M Heston, Hailey N Chambers, Hannah M Cunningham, Meghan J Price, Lilianna Suarez, Carter G Crew, Shree Bose, Jhoanna N Aquino, Stuart T Carr, S Michelle Griffin, Stephanie H Smith, Kirsten Jenkins, Trevor S Pfeiffer, Javier Rodriguez, C Todd DeMarco, Nicole A De Naeyer, Thaddeus C Gurley, Raul Louzao, Congwen Zhao, Coleen K Cunningham, William J Steinbach, Thomas N Denny, Debra J Lugo, M Anthony Moody, Sallie R Permar, Alexandre T Rotta, Nicholas A Turner, Emmanuel B Walter, Christopher W Woods, and Matthew S Kelly.
• Department of Pediatrics, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.
• Clin. Infect. Dis. 2021 Nov 2; 73 (9): e2875-e2882.

BackgroundChild with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection typically have mild symptoms that do not require medical attention, leaving a gap in our understanding of the spectrum of SARS-CoV-2-related illnesses that the viruses causes in children.MethodsWe conducted a prospective cohort study of children and adolescents (aged <21 years) with a SARS-CoV-2-infected close contact. We collected nasopharyngeal or nasal swabs at enrollment and tested for SARS-CoV-2 using a real-time polymerase chain reaction assay.ResultsOf 382 children, 293 (77%) were SARS-CoV-2-infected. SARS-CoV-2-infected children were more likely to be Hispanic (P < .0001), less likely to have asthma (P = .005), and more likely to have an infected sibling contact (P = .001) than uninfected children. Children aged 6-13 years were frequently asymptomatic (39%) and had respiratory symptoms less often than younger children (29% vs 48%; P = .01) or adolescents (29% vs 60%; P < .001). Compared with children aged 6-13 years, adolescents more frequently reported influenza-like (61% vs 39%; P < .001) , and gastrointestinal (27% vs 9%; P = .002), and sensory symptoms (42% vs 9%; P < .0001) and had more prolonged illnesses (median [interquartile range] duration: 7 [4-12] vs 4 [3-8] days; P = 0.01). Despite the age-related variability in symptoms, wWe found no difference in nasopharyngeal viral load by age or between symptomatic and asymptomatic children.ConclusionsHispanic ethnicity and an infected sibling close contact are associated with increased SARS-CoV-2 infection risk among children, while asthma is associated with decreased risk. Age-related differences in clinical manifestations of SARS-CoV-2 infection must be considered when evaluating children for coronavirus disease 2019 and in developing screening strategies for schools and childcare settings.© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

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