To the editor.
Children are less frequently ill due to SARS-CoV-2 compared to adults [
[1]
]. However, the role of asymptomatic children and adolescent in disease transmission is still unknown and represents a major question in time of schools reopening.We report a pauci-symptomatic SARS-CoV-2 positive 14-years-old boy in a semi-closed child psychiatry inpatient facility. This unit welcomes 15 young people aged from 8 to 15 years old, in crisis for an average period of 6 weeks to 3 months. They are admitted for different purposes: suicidal attempt, depression, anorexia, behavior disorders, psychotic disorders.
On Day 0, the patient complained of a runny nose with no other symptoms. On day 1, SARS-CoV-2 antigenic test returned positive on a naso-pharyngeal swab a week after a contact with a SARS-CoV-2 positive and hospitalised parent. The patient could neither be sent home nor transferred to a paediatric ward for reason linked to his symptomatology. After team discussions, we decided to keep the patient in our facility and enforce strict infection prevention measures to protect both inpatients and health-care workers (Table 1). From day 8 to day 43, a total of 14 patients were tested per protocol twice a week for SARS-CoV-2 in their nasopharynx. All remained asymptomatic. The inpatient length of stay ranged from 1-5 weeks. All patients stayed in the facility all the time once admitted. The index case was tested twice a week. He tested positive from day 1 to his discharge on day 13 and an asymptomatic 14-years-old girl was also positive from day 8 to day 29. Given the 4-12 days incubation period, we do not know whether the transmission to the secondary case occurred before or after the implementation of infection control measures. None of the 12 other patients were ever positive during the 5 weeks follow-up and none of the health-care workers declared any symptom.
Table 1Enforced infection prevention measures implemented in the Child Psychiatry Unit. SARS-CoV-2 diagnostic tests realised in the hospitalised patients from first patient's positive test result to 10 days after last positive test
| Enforced infection prevention measures implemented in the Child Psychiatry Unit | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Unit description | Infection control measures in place since day 1 | Contacts still allowed after day 1 | |||||||||||
|
|
| |||||||||||
| SARS-CoV-2 diagnostic tests realised in the hospitalised patients from first patient's positive test result to 10 days after last positive test | |||||||||||||
| Age | Day 1 | Day 8 | Day 12 | Day 15 | Day 19 | Day 22 | Day 26 | Day 29 | Day 33 | Day 36 | Day 40 | Day 43 | |
| 1 | 13·8 | Ag | PCR | PCR | — | — | — | — | — | — | — | — | — |
| 2 | 13·8 | — | neg | neg | neg | — | — | — | — | — | — | — | — |
| 3 | 12·8 | — | neg | neg | neg | neg | neg | neg | neg | neg | neg | neg | neg |
| 4 | 14·5 | — | Ag | PCR | PCR | PCR | PCR | neg | PCR | neg | neg | neg | neg |
| 5 | 14·8 | — | neg | neg | neg | neg | neg | — | — | — | — | — | — |
| 6 | 11·3 | — | neg | neg | neg | neg | neg | neg | neg | neg | neg | neg | neg |
| 7 | 10·8 | — | — | neg | neg | neg | neg | neg | neg | neg | neg | neg | neg |
| 8 | 11·4 | — | — | — | — | — | neg | neg | neg | neg | neg | neg | neg |
| 9 | 13·8 | — | — | — | — | neg | neg | neg | neg | — | — | — | neg |
| 10 | 14·3 | — | — | — | — | neg | neg | neg | neg | neg | neg | neg | neg |
| 11 | 13·5 | — | — | — | — | — | — | — | — | neg | neg | neg | neg |
| 12 | 13·5 | — | — | — | — | — | — | — | — | neg | neg | neg | neg |
| 13 | 9·9 | — | — | — | — | — | — | — | — | neg | neg | neg | neg |
| 14 | 11·3 | — | — | — | — | — | — | — | — | — | — | neg | neg |
Ag = SARS-CoV-2 antigenic test positive; PCR = SARS-CoV-2 PCR test positive; neg = SARS-CoV-2 PCR test negative.
Some data suggest children are less susceptible to acquire, and eventually to transmit, the virus than adults. A study in China including 105 cases and 392 household contacts showed 20·5% secondary transmission in adults (60/292) compared to 4·0% in children (4/100) [
[2]
]. A symptomatic SARS-CoV-2 positive nine-years-old child did not infect any of his 112 school contacts in 3 schools and ski class despite transmission of other viruses [- Li W.
- Zhang B.
- Lu J.
- Liu S.
- Chang Z.
- Cao P.
- et al.
The characteristics of household transmission of COVID-19.
Clin Infect Dis. 2020; https://doi.org/10.1093/cid/ciaa450
[3]
] and children are the first to develop SARS-CoV-2 symptoms in only 8% (3/39) of family clusters [- Danis K.
- Epaulard O.
- Bénet T.
- Gaymard A.
- Campoy S.
- Bothelo-Nevers E.
- et al.
Cluster of coronavirus disease 2019 (Covid-19) in the French alps, 2020.
Clin Infect Dis. 2020; https://doi.org/10.1093/cid/ciaa424
[4]
]. Other studies reported non-differential attack rates in all age categories (around 6-7%) in the follow-up of 244 patients and 1286 close contacts [- Posfay-Barbe K.M.
- Wagner N.
- Gauthey M.
- Moussaoui D.
- Loevy N.
- Diana A.
- et al.
COVID-19 in children and the dynamics of infection in families.
Pediatrics. 2020; https://doi.org/10.1542/peds.2020-1576
[5]
].- Bi Q.
- Wu Y.
- Mei S.
- Ye C.
- Zou X.
- Zhang Z.
- et al.
Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study.
Lancet Infect Dis. 2020; https://doi.org/10.1016/S1473-3099(20)30287-5
Managing SARS-CoV-2 paediatric risk and health-care workers protection in an objective way is complicated. We described a successful multidisciplinary management of two positive cases in a semi-closed child psychiatry inpatient facility. No further contaminations occurred after implementation of appropriate infection control measures still allowing social life for children.
Conflict of interest
Authors have nothing to disclose.
Funding
No external funding was received for this study.
Authors' contributions
AT and PS were in charge of the infection prevention policies. MA, GL and VD were in charge of the child psychiatric unit. GD helped in the measure's implementation. AT and PR wrote the letter. All authors provided critical conceptual input and critically revised the letter.
References
- Coronavirus disease 2019 in children - United States, february 12-april 2, 2020.MMWR Morb Mortal Wkly Rep. 2020; 69: 422-426https://doi.org/10.15585/mmwr.mm6914e4
- The characteristics of household transmission of COVID-19.Clin Infect Dis. 2020; https://doi.org/10.1093/cid/ciaa450
- Cluster of coronavirus disease 2019 (Covid-19) in the French alps, 2020.Clin Infect Dis. 2020; https://doi.org/10.1093/cid/ciaa424
- COVID-19 in children and the dynamics of infection in families.Pediatrics. 2020; https://doi.org/10.1542/peds.2020-1576
- Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study.Lancet Infect Dis. 2020; https://doi.org/10.1016/S1473-3099(20)30287-5
Article Info
Publication History
Published online: August 13, 2020
Accepted:
August 5,
2020
Received in revised form:
August 4,
2020
Received:
June 23,
2020
Editor: S.J. CutlerIdentification
Copyright
© 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
