Infectivity of severe acute respiratory syndrome coronavirus 2 in children compared with adults
Jared Bullard, Duane J. Funk, Kerry Dust, Lauren Garnett, Kaylie N. Tran, Alex Bello, James E. Strong, Santina J. Lee, Jillian L.M. Waruk, Adam Hedley, David C. Alexander, Paul Van Caeseele, Carla Loeppky, Guillaume Poliquin
Abstract
<h3>BACKGROUND:</h3> The role of children in the transmission and community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear. We aimed to quantify the infectivity of SARS-CoV-2 in nasopharyngeal samples from children compared with adults. <h3>METHODS:</h3> We obtained nasopharyngeal swabs from adult and pediatric cases of coronavirus disease 2019 (COVID-19) and from their contacts who tested positive for SARS-CoV-2 in Manitoba between March and December 2020. We compared viral growth in cell culture, cycle threshold values from the reverse transcription polymerase chain reaction (RT-PCR) of the SARS-CoV-2 envelope (E) gene and the 50% tissue culture infective dose (TCID<sub>50</sub>/mL) between adults and children. <h3>RESULTS:</h3> Among 305 samples positive for SARS-CoV-2 by RT-PCR, 97 samples were from children aged 10 years or younger, 78 were from children aged 11–17 years and 130 were from adults (≥ 18 yr). Viral growth in culture was present in 31% of samples, including 18 (19%) samples from children 10 years or younger, 18 (23%) from children aged 11–17 years and 57 (44%) from adults (children v. adults, odds ratio 0.45, 95% confidence interval [CI] 0.28–0.72). The cycle threshold was 25.1 (95% CI 17.7–31.3) in children 10 years or younger, 22.2 (95% CI 18.3–29.0) in children aged 11–17 years and 18.7 (95% CI 17.9–30.4) in adults (<i>p</i> < 0.001). The median TCID<sub>50</sub>/mL was significantly lower in children aged 11–17 years (316, interquartile range [IQR] 178–2125) than adults (5620, IQR 1171 to 17 800, <i>p</i> < 0.001). Cycle threshold was an accurate predictor of positive culture in both children and adults (area under the receiver-operator curve, 0.87, 95% CI 0.81–0.93 v. 0.89, 95% CI 0.83–0.96, <i>p</i> = 0.6). <h3>INTERPRETATION:</h3> Compared with adults, children with nasopharyngeal swabs that tested positive for SARS-CoV-2 were less likely to grow virus in culture, and had higher cycle thresholds and lower viral concentrations, suggesting that children are not the main drivers of SARS-CoV-2 transmission.