{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T16:32:42Z","timestamp":1770568362799,"version":"3.49.0"},"reference-count":47,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND AND OBJECTIVES:<\/jats:title>\n                  <jats:p>In children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, virological characteristics and correlation with disease severity have not been extensively studied. The primary objective in this study is to determine the correlation between SARS-CoV-2 viral load (VL) in infected children with age, disease severity, and underlying comorbidities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>Children &amp;lt;21 years, screened for SARS-CoV-2 at the time of hospitalization, who tested positive by polymerase chain reaction were included in this study. VL at different sites was determined and compared between groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>Of the 102 children included in this study, 44% of the cohort had asymptomatic infection, and children with &amp;gt;1 comorbidity were the most at risk for severe disease. VL in children with symptomatic infection was significantly higher than in children with asymptomatic infection (3.0 \u00d7 105 vs 7.2 \u00d7 103 copies per mL; P = .001). VL in the respiratory tract was significantly higher in children &amp;lt;1 year, compared with older children (3.3 \u00d7 107 vs 1.3 \u00d7 104 copies per mL respectively; P &amp;lt; .0001), despite most infants presenting with milder illness. Besides the respiratory tract, SARS-CoV-2 RNA was also detectable in samples from the gastrointestinal tract (saliva and rectum) and blood. In 13 children for whom data on duration of polymerase chain reaction positivity was available, 12 of 13 tested positive 2 weeks after initial diagnosis, and 6 of 13 continued to test positive 4 weeks after initial diagnosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>In hospitalized children with SARS-CoV-2, those with &amp;gt;1 comorbid condition experienced severe disease. SARS-CoV-2 VL in the respiratory tract is significantly higher in children with symptomatic disease and children &amp;lt;1 year of age.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2020-037812","type":"journal-article","created":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T09:30:19Z","timestamp":1614072619000},"source":"Crossref","is-referenced-by-count":19,"title":["Virological Characteristics of Hospitalized Children With SARS-CoV-2 Infection"],"prefix":"10.1542","volume":"147","author":[{"given":"Swetha G.","family":"Pinninti","sequence":"first","affiliation":[{"name":"Departments of Pediatrics and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil","family":"Pati","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudette","family":"Poole","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Misty","family":"Latting","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria C.","family":"Seleme","sequence":"additional","affiliation":[{"name":"Division of Hematology, Center for Cellular and Molecular Therapeutics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"April","family":"Yarbrough","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Children\u2019s of Alabama, Birmingham, Alabama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nitin","family":"Arora","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William J.","family":"Britt","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and"},{"name":"Microbiology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suresh","family":"Boppana","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and"},{"name":"Microbiology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2021,5,1]]},"reference":[{"issue":"5","key":"2021121008124553500_B1","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/S1473-3099(20)30120-1","article-title":"An interactive web-based dashboard to track COVID-19 in real time. [published correction appears in Lancet Infect Dis. 2020;20(9):e215]","volume":"20","author":"Dong","year":"2020","journal-title":"Lancet Infect Dis"},{"issue":"13","key":"2021121008124553500_B2","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) outbreak in China: summary of a report of 72\u202f314 cases from the Chinese Center for Disease Control and Prevention","volume":"323","author":"Wu","year":"2020","journal-title":"JAMA"},{"issue":"1","key":"2021121008124553500_B3","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1161\/CIRCULATIONAHA.120.047549","article-title":"The science underlying COVID-19: implications for the cardiovascular system","volume":"142","author":"Liu","year":"2020","journal-title":"Circulation"},{"issue":"7","key":"2021121008124553500_B4","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1001\/jamacardio.2020.1286","article-title":"Potential effects of coronaviruses on the cardiovascular system: a Review","volume":"5","author":"Madjid","year":"2020","journal-title":"JAMA Cardiol"},{"issue":"6","key":"2021121008124553500_B5","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1681\/ASN.2020030276","article-title":"Renal involvement and early prognosis in patients with COVID-19 pneumonia","volume":"31","author":"Pei","year":"2020","journal-title":"J Am Soc Nephrol"},{"issue":"23","key":"2021121008124553500_B6","doi-asserted-by":"crossref","first-page":"2950","DOI":"10.1016\/j.jacc.2020.04.031","article-title":"COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review","volume":"75","author":"Bikdeli","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"7","key":"2021121008124553500_B7","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1002\/jmv.25915","article-title":"Central nervous system involvement by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)","volume":"92","author":"Paniz-Mondolfi","year":"2020","journal-title":"J Med Virol"},{"issue":"18","key":"2021121008124553500_B8","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical characteristics of coronavirus disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N Engl J Med"},{"issue":"10229","key":"2021121008124553500_B9","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. [Lancet. 2020;395(10229):1038]","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet"},{"issue":"7","key":"2021121008124553500_B10","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1001\/jamainternmed.2020.0994","article-title":"Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. [published correction appears in JAMA Intern Med. 2020;180(7):1031]","volume":"180","author":"Wu","year":"2020","journal-title":"JAMA Intern Med"},{"issue":"26","key":"2021121008124553500_B11","doi-asserted-by":"crossref","first-page":"2534","DOI":"10.1056\/NEJMsa2011686","article-title":"Hospitalization and mortality among black patients and white patients with covid-19","volume":"382","author":"Price-Haywood","year":"2020","journal-title":"N Engl J Med"},{"issue":"9","key":"2021121008124553500_B12","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1001\/jamapediatrics.2020.1948","article-title":"Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian Pediatric Intensive Care Units","volume":"174","author":"Shekerdemian","year":"2020","journal-title":"JAMA Pediatr"},{"key":"2021121008124553500_B13","article-title":"Screening and severity of coronavirus disease 2019 (COVID-19) in children in Madrid, Spain [published online ahead of print April 8, 2020]","author":"Tagarro","journal-title":"JAMA Pediatr"},{"issue":"9","key":"2021121008124553500_B14","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/S2352-4642(20)30177-2","article-title":"COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study","volume":"4","author":"G\u00f6tzinger","year":"2020","journal-title":"Lancet Child Adolesc Health"},{"issue":"8","key":"2021121008124553500_B15","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1007\/s00431-020-03683-8","article-title":"Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks","volume":"179","author":"Parri","year":"2020","journal-title":"Eur J Pediatr"},{"issue":"5","key":"2021121008124553500_B16","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1161\/CIRCULATIONAHA.120.048360","article-title":"Acute heart failure in multisystem inflammatory syndrome in children in the context of global SARS-CoV-2 pandemic","volume":"142","author":"Belhadjer","year":"2020","journal-title":"Circulation"},{"issue":"4","key":"2021121008124553500_B17","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1056\/NEJMoa2021756","article-title":"Multisystem inflammatory syndrome in children in New York state","volume":"383","author":"Dufort","year":"2020","journal-title":"N Engl J Med"},{"issue":"4","key":"2021121008124553500_B18","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1056\/NEJMoa2021680","article-title":"Multisystem inflammatory syndrome in U.S. children and adolescents","volume":"383","author":"Feldstein","year":"2020","journal-title":"N Engl J Med"},{"key":"2021121008124553500_B19","article-title":"Multi-inflammatory syndrome in children related to SARS-CoV-2 in Spain [published online ahead of print July 25, 2020]","author":"Moraleda","journal-title":"Clin Infect Dis"},{"issue":"6522","key":"2021121008124553500_B20","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1126\/science.abe1107","article-title":"Preexisting and de novo humoral immunity to SARS-CoV-2 in humans","volume":"370","author":"Ng","year":"2020","journal-title":"Science"},{"issue":"7","key":"2021121008124553500_B21","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.pathol.2020.08.001","article-title":"SARS-CoV-2 in children: spectrum of disease, transmission and immunopathological underpinnings","volume":"52","author":"Williams","year":"2020","journal-title":"Pathology"},{"issue":"9","key":"2021121008124553500_B22","doi-asserted-by":"crossref","first-page":"2469","DOI":"10.1093\/cid\/ciaa556","article-title":"SARS-CoV-2 (COVID-19): what do we know about children? A systematic review","volume":"71","author":"Mehta","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"4","key":"2021121008124553500_B23","doi-asserted-by":"crossref","first-page":"e2020003186","DOI":"10.1542\/peds.2020-003186","article-title":"Early experience of COVID-19 in a US children\u2019s hospital","volume":"146","author":"Kainth","year":"2020","journal-title":"Pediatrics"},{"issue":"4","key":"2021121008124553500_B24","doi-asserted-by":"crossref","first-page":"e2020009951","DOI":"10.1542\/peds.2020-009951","article-title":"Racial and\/or ethnic and socioeconomic disparities of SARS-CoV-2 infection among children","volume":"146","author":"Goyal","year":"2020","journal-title":"Pediatrics"},{"issue":"9","key":"2021121008124553500_B25","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1001\/jamapediatrics.2020.3651","article-title":"Age-related differences in nasopharyngeal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) levels in patients with mild to moderate coronavirus disease 2019 (COVID-19)","volume":"174","author":"Heald-Sargent","year":"2020","journal-title":"JAMA Pediatr"},{"key":"2021121008124553500_B26","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.jpeds.2020.08.078","article-title":"Kinetics of viral clearance and antibody production across age groups in children with severe acute respiratory syndrome coronavirus 2 infection","volume":"227","author":"Bahar","year":"2020","journal-title":"J Pediatr"},{"key":"2021121008124553500_B27","article-title":"Comparing nasopharyngeal and midturbinate nasal swab testing for the identification of severe acute respiratory syndrome coronavirus 2 [published online ahead of print June 29, 2020]","author":"Pinninti","journal-title":"Clin Infect Dis"},{"issue":"6","key":"2021121008124553500_B28","doi-asserted-by":"crossref","first-page":"e20200702","DOI":"10.1542\/peds.2020-0702","article-title":"Epidemiology of COVID-19 among children in China","volume":"145","author":"Dong","year":"2020","journal-title":"Pediatrics"},{"key":"2021121008124553500_B29","article-title":"Coronavirus disease 2019 (COVID-19) treatment guidelines","author":"COVID-19 Treatment Guidelines Panel; National Institutes of Health"},{"key":"2021121008124553500_B30","author":"World Health Organization"},{"issue":"2","key":"2021121008124553500_B31","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1056\/NEJMc2007617","article-title":"Children with Covid-19 in pediatric emergency departments in Italy","volume":"383","author":"Parri","year":"2020","journal-title":"N Engl J Med"},{"key":"2021121008124553500_B32","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.jpeds.2020.05.007","article-title":"Severe coronavirus disease-2019 in children and young adults in the Washington, DC, metropolitan region","volume":"223","author":"DeBiasi","year":"2020","journal-title":"J Pediatr"},{"issue":"1","key":"2021121008124553500_B33","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1001\/jamapediatrics.2020.3988","article-title":"Clinical characteristics and viral RNA detection in children with coronavirus disease 2019 in the Republic of Korea","volume":"175","author":"Han","year":"2021","journal-title":"JAMA Pediatr"},{"issue":"5","key":"2021121008124553500_B34","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1002\/ppul.24748","article-title":"Lessons unfolding from pediatric cases of COVID-19 disease caused by SARS-CoV-2 infection","volume":"55","author":"Yonker","year":"2020","journal-title":"Pediatr Pulmonol"},{"issue":"7809","key":"2021121008124553500_B35","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1038\/s41586-020-2196-x","article-title":"Virological assessment of hospitalized patients with COVID-2019. [published correction appears in Nature. 2020;588(7839):E35]","volume":"581","author":"W\u00f6lfel","year":"2020","journal-title":"Nature"},{"issue":"11","key":"2021121008124553500_B36","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1164\/rccm.202003-0572LE","article-title":"SARS-CoV-2 viral load in clinical samples from critically ill patients","volume":"201","author":"Huang","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"issue":"6","key":"2021121008124553500_B37","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/S1473-3099(20)30232-2","article-title":"Viral dynamics in mild and severe cases of COVID-19","volume":"20","author":"Liu","year":"2020","journal-title":"Lancet Infect Dis"},{"issue":"8","key":"2021121008124553500_B38","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.3201\/eid2608.201016","article-title":"Asymptomatic SARS-CoV-2 infection in household contacts of a healthcare provider, Wuhan, China","volume":"26","author":"Luo","year":"2020","journal-title":"Emerg Infect Dis"},{"issue":"8","key":"2021121008124553500_B39","doi-asserted-by":"crossref","first-page":"1924","DOI":"10.3201\/eid2608.201142","article-title":"Secondary transmission of coronavirus disease from presymptomatic persons, China","volume":"26","author":"Zhang","year":"2020","journal-title":"Emerg Infect Dis"},{"issue":"5","key":"2021121008124553500_B40","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1093\/jpids\/piaa097","article-title":"Burden of illness in households with severe acute respiratory syndrome coronavirus 2-infected children","volume":"9","author":"Teherani","year":"2020","journal-title":"J Pediatric Infect Dis Soc"},{"issue":"10","key":"2021121008124553500_B41","doi-asserted-by":"crossref","first-page":"2494","DOI":"10.3201\/eid2610.202403","article-title":"Culture-competent SARS-CoV-2 in nasopharynx of symptomatic neonates, children, and adolescents","volume":"26","author":"L\u2019Huillier","year":"2020","journal-title":"Emerg Infect Dis"},{"issue":"12","key":"2021121008124553500_B42","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1056\/NEJMc2001737","article-title":"SARS-CoV-2 viral load in upper respiratory specimens of infected patients","volume":"382","author":"Zou","year":"2020","journal-title":"N Engl J Med"},{"issue":"7","key":"2021121008124553500_B43","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1001\/jamacardio.2020.1096","article-title":"Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19)","volume":"5","author":"Inciardi","year":"2020","journal-title":"JAMA Cardiol"},{"issue":"11","key":"2021121008124553500_B44","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1001\/jamacardio.2020.3557","article-title":"Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). [published correction appears in JAMA Cardiol. 2020;5(11):1308]","volume":"5","author":"Puntmann","year":"2020","journal-title":"JAMA Cardiol"},{"issue":"7","key":"2021121008124553500_B45","doi-asserted-by":"crossref","first-page":"e95","DOI":"10.1097\/INF.0000000000002729","article-title":"Symptomatic infection is associated with prolonged duration of viral shedding in mild coronavirus disease 2019: a retrospective study of 110 children in Wuhan","volume":"39","author":"Lu","year":"2020","journal-title":"Pediatr Infect Dis J"},{"issue":"9","key":"2021121008124553500_B46","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1001\/jamaoncol.2020.2028","article-title":"COVID-19 in children with cancer in New York City","volume":"6","author":"Boulad","year":"2020","journal-title":"JAMA Oncol"},{"key":"2021121008124553500_B47","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.ejca.2020.05.028","article-title":"High mortality rate in cancer patients with symptoms of COVID-19 with or without detectable SARS-COV-2 on RT-PCR","volume":"135","author":"Assaad","year":"2020","journal-title":"Eur J Cancer"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2020-037812\/1181979\/peds_2020037812.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2020-037812\/1181979\/peds_2020037812.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T20:06:27Z","timestamp":1639166787000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/147\/5\/e2020037812\/180854\/Virological-Characteristics-of-Hospitalized"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,1]]},"references-count":47,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,1]]},"published-print":{"date-parts":[[2021,5,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2020-037812","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,1]]},"article-number":"e2020037812"}}