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JAMA Pediatr., Published Online: August 28, 2020. | 10.1001/jamapediatrics.2020.3988 Clinical Characteristics and Viral RNA Detection in Children With Coronavirus Disease 2019 in the Republic of Korea

Mi Seon Han, MD, PhD¹; Eun Hwa Choi, MD, PhD^2,*; Sung Hee Chang, MD³; Byoung-Lo Jin, MD⁴; Eun Joo Lee, MD⁵; Baek Nam Kim, MD⁶; Min Kyoung Kim, MD⁷; Kihyun Doo, MD⁸; Ju-Hee Seo, MD, PhD⁹; Yae-Jean Kim, MD, PhD¹⁰; Yeo Jin Kim, MD¹¹; Ji Young Park, MD, PhD¹²; Sun Bok Suh, MD, PhD¹³; Hyunju Lee, MD, PhD¹⁴; Eun Young Cho, MD¹⁵; Dong Hyun Kim, MD¹⁶; Jong Min Kim, MD¹⁷; Hye Young Kim, MD, PhD¹⁸; Su Eun Park, MD, PhD¹⁹; Joon Kee Lee, MD, PhD²⁰; Dae Sun Jo, MD, PhD²¹; Seung-Man Cho, MD²²; Jae Hong Choi, MD²³; Kyo Jin Jo, MD¹⁹; Young June Choe, MD, PhD²⁴; Ki Hwan Kim, MD²⁵; Jong-Hyun Kim, MD, PhD^26,*

¹Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
²Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
³Department of Pediatrics, Seoul Medical Center, Seoul, Korea
⁴Department of Pediatrics, Hongseong Medical Center, Hongseong, Korea
⁵Department of Pediatrics, Seongnam Citizens Medical Center, Seongnam, Korea
⁶Department of Pediatrics, Gyeonggi Provincial Medical Center Ansung Hospital, Ansung, Korea
⁷Department of Pediatrics, Seonam Hospital, Seoul, Korea
⁸Department of Pediatrics, Gyeonggi Provincial Medical Center Icheon Hospital, Icheon, Korea
⁹Department of Pediatrics, Dankook University Hospital, Cheonan, Korea
¹⁰Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
¹¹Department of Pediatrics, Masan Medical Center, Changwon, Korea
¹²Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
¹³Department of Pediatrics, Busan Medical Center, Busan, Korea
¹⁴Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
¹⁵Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
¹⁶Department of Pediatrics, Inha University Hospital, Incheon, Korea
¹⁷Department of Pediatrics, Myongji Hospital, Goyang, Korea
¹⁸Department of Pediatrics, Pusan National University Hospital, Busan, Korea
¹⁹Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan, Korea
²⁰Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Korea
²¹Department of Pediatrics, Jeonbuk National University Medical School, Jeonju, Korea
²²Department of Pediatrics, Dongguk University College of Medicine, Gyeongju, Korea
²³Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
²⁴Department of Social and Preventive Medicine, Hallym University College of Medicine, Chuncheon, Korea
²⁵Department of Pediatrics, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, Korea
²⁶Department of Pediatrics, St Vincent's Hospital, The Catholic University of Korea, Suwon, Korea

^*Corresponding author

Abstract

Importance There is limited information describing the full spectrum of coronavirus disease 2019 (COVID-19) and the duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection in children.

Objective To analyze the full clinical course and the duration of SARS-CoV-2 RNA detectability in children confirmed with COVID-19 in the Republic of Korea, where rigorous public health interventions have been implemented.

Design, Setting, and Participants This case series of children with COVID-19 was conducted in 20 hospitals and 2 nonhospital isolation facilities across the country from February 18, 2020, to March 31, 2020. Children younger than 19 years who had COVID-19 were included.

Exposures Confirmed COVID-19, detected via SARS-CoV-2 RNA in a combined nasopharyngeal and oropharyngeal swab or sputum by real-time reverse transcription–polymerase chain reaction.

Main Outcomes and Measures Clinical manifestations during the observation period, including the time and duration of symptom occurrence. The duration of SARS-CoV-2 RNA detection was also analyzed.

Results A total of 91 children with COVID-19 were included (median [range] age, 11 [0-18] years; 53 boys [58%]). Twenty children (22%) were asymptomatic during the entire observation period. Among 71 symptomatic cases, 47 children (66%) had unrecognized symptoms before diagnosis, 18 (25%) developed symptoms after diagnosis, and only 6 (9%) were diagnosed at the time of symptom onset. Twenty-two children (24%) had lower respiratory tract infections. The mean (SD) duration of the presence of SARS-CoV-2 RNA in upper respiratory samples was 17.6 (6.7) days. Virus RNA was detected for a mean (SD) of 14.1 (7.7) days in asymptomatic individuals. There was no difference in the duration of virus RNA detection between children with upper respiratory tract infections and lower respiratory tract infections (mean [SD], 18.7 [5.8] days vs 19.9 [5.6] days; P = .54). Fourteen children (15%) were treated with lopinavir-ritonavir and/or hydroxychloroquine. All recovered, without any fatal cases.

Conclusions and Relevance In this case series study, inapparent infections in children may have been associated with silent COVID-19 transmission in the community. Heightened surveillance using laboratory screening will allow detection in children with unrecognized SARS-CoV-2 infection.

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