COVID-19 in Children

Correlation Between Epidemiologic, Clinical

Characteristics, and RT-qPCR Cycle
Threshold Values

Nama
 BACKGROUND

01 The novel severe acute respiratory syndrome, COVID-19, caused by coronavirus-2 (SARS-
CoV-2) was first reported in December 2019 in a group of patients in Wuhan, China

Whole genome sequencing of SARS-CoV-2 enabled the development of a real-time reverse

02 transcription polymerase chain reaction (RT-qPCR) assay for the detection and quantification
of viral load.  

03 A systematic review of the clinical utility of cycle threshold values have suggested that Ct
values are useful to predict clinical outcome of COVID-19 patients

04 Another important factor is the time interval between the onset of symptoms and the date of
sample collection
 BACKGROUND

05
At the onset of the pandemic, adults were more severely affected than children and information
regarding the impact of disease in children was scarce.

06 The objective of this study was to assess the correlation between epidemiologic, clinical
features, and severity of COVID-19 in children and Ct values as estimates of viral load.
 MATERIALS AND METHODS

1 2 3

Study Design Sample A case report form was

This was a cross-sectional,
observational and
analytical study.
designed for
All children under 18 years of epidemiologic and clinical
age with a confirmed diagnosis data collection
of COVID-19, who assisted to
the Ricardo Gutiérrez Children
´s Hospital between March 1,
2020 and February 28, 2021,
and in whom a
semiquantitative estimate of
viral load
 MATERIALS AND METHODS
Disease Diagnosis Statistic
Severity
Disease severity was Cases were confirmed by a
established based on WHO • The variables was analyzed
real-time reverse transcription using t test or Wilcoxon’s test.
disease severity polymerase chain reaction (RT-
classification as critical • Categorical variables were
qPCR) test for SARS-CoV-2 in analyzed using a χ² test with
COVID or severe COVID- nasopharyngeal aspirate or
19 Yates’ correction or Fisher’s test.
swab specimens • To compare Ct values, we used
two-tailed Kruskal-Wallis test
and post hoc Bonferroni
correction.
• The statistical significance was
assumed for P < 0.05
RESULTS
A total of 419 COVID-19
cases were included.
Seasonal dis- tribution of
cases showed 2 peaks, the
first peak in epidemiologic
week (EW) 31/2020 and
the second in EW 2/2021
 RESULTS
Epidemiologic and clinical characteristics of COVID-19 cases
 RESULTS
Comparison of CT Values According To Age, Presence of Symptoms, Disease Severity and Time From
Symptom Onset to Sample Collection
 
 RESULTS
Comparison of Ct Values According to Symptoms Stratified
by Age

Comparison of Ct values according to symptoms in different age

groups. Median is represented as a solid line, interquartile ranges
are depicted by boxes, upper and lower adjacent values are
represented by whiskers and outliers are represented by isolated
points. yo, years old; AS, asymptomatic; S, symptomatic.
 RESULTS
Comparison of Ct values by age (under 2 years, 2–4 Comparison of Ct values according to severity of
years, 5–9 years and 10 years or older). symptoms. *P < 0.001
 RESULTS
Comparison of Ct values in symptomatic and
asymptomatic patients
 DISCUSSION AND
RELEVANCE
Preliminary evidence suggests that children have the same probability of
acquiring SARS-CoV-2 infection as adults, but have less chance of developing
symptoms or poor outcome, although some children are still at high risk of severe
1
disease.

2 Initial studies reported that a high proportion of infected children had been in
contact with a confirmed adult case, 90% of which were family members

Children with comorbidities have higher risk of severe COVID-19 and those
with more than one underlying condition experienced most severe disease 3
 DISCUSSION AND
RELEVANCE
In our study, 97.3% of cases were “non-severe.” Notably, Bunyavanich et al
found that angiotensin II enzyme (ACE2) receptor expression in the nasal
epithelium, which is the same receptor as the one for SARS-CoV-2, is age
4
dependent and children express less receptors than adults.

5 98% of our patients were tested within 10 days from the onset of symptoms and
we found lower Ct values during the first 4 days

The correlation between symptoms and Ct values as a proxy for viral load, was
suggested as a strategy to determine the risk of transmission and of severe illness
in children with COVID-19
6
 DISCUSSION AND
RELEVANCE

Although in our study, we found no Ct difference between severe and no severe

cases, we detected that Ct values were significantly lower in children under 2 7
years of age

In children over 2 years, we found significantly lower Ct values in

8 symptomatic cases. These results coincide with those reported by Pinninti et al
who showed that viral loads were significantly higher in symptomatic children
compared with asymptomatic cases.

Our study showed that children younger than 2 years with COVID-19 have
lower values of Ct than older children. in children over 2 years of age,
symptomatic patients with mild, moderate or severe disease had lower Ct values
9
compared with asymptomatic children.
THANK
YOU