[Skip to Content]

Quiz

Coronavirus (COVID-19)

Clinical Characteristics and Viral RNA Detection in Children With Coronavirus Disease 2019 in the Republic of Korea

Educational Objective To analyze the full clinical course and the duration of severe acute respiratory syndrome coronavirus 2 RNA detectability in children confirmed with coronavirus disease 2019 (COVID-19) in the Republic of Korea, where rigorous public health interventions have been implemented.

1 Credit CME

JAMA Pediatrics

Published Online: August 28, 2020

Original Investigation

Article Information and Disclosures

Author Affiliations

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

Read article on JAMA Network

Read Article Take Quiz

Key Points

Question How long is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detected in children, and are children with coronavirus disease 2019 (COVID-19) identifiable by symptoms?

Findings In this case series of 91 children with COVID-19 in Korea, 22.0% were asymptomatic. Only 8.5% of symptomatic cases were diagnosed at the time of symptom onset, while 66.2% had unrecognized symptoms before diagnosis and 25.4% developed symptoms after diagnosis; SARS-CoV-2 RNA was detected for a mean of 17.6 days overall and 14.1 days in asymptomatic cases.

Meaning Symptom screening fails to identify most COVID-19 cases in children, and SARS-CoV-2 RNA in children is detected for an unexpectedly long time.

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.

Take Quiz

Sign in to take quiz and track your certificates

Buy This Activity

Article Information

Accepted for Publication: June 17, 2020.

Corresponding Authors: Jong-Hyun Kim, MD, PhD, Department of Pediatrics, St Vincent's Hospital, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, Korea, 16247 (jh00mn@catholic.ac.kr); Eun Hwa Choi, MD, PhD, Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea, 03080 (eunchoi@snu.ac.kr).

Published Online: August 28, 2020. doi:10.1001/jamapediatrics.2020.3988

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Han MS et al. JAMA Pediatrics.

Author Contributions: Drs Han and Choi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Han, E. Choi, Jong-Hyun Kim.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Han, E. Choi, S. Park, Choe.

Critical revision of the manuscript for important intellectual content: Han, E. Choi, Chang, Jin, E. Lee, B. Kim, M. Kim, Doo, Seo, Yae-Jean Kim, Yeo Jin Kim, J. Park, Suh, H. Lee, E. Cho, D. Kim, Jong Min Kim, H. Kim, J. Lee, D. Jo, S. Cho, J. Choi, K. Jo, Choe, K. Kim, Jong-Hyun Kim.

Statistical analysis: Han, Choe.

Administrative, technical, or material support: Han, E. Choi, Chang, Jin, E. Lee, B. Kim, M. Kim, Doo, Seo, Yae-Jean Kim, Yeo Jin Kim, J. Park, Suh, H. Lee, E. Cho, D. Kim, Jong Min Kim, H. Kim, S. Park, J. Lee, D. Jo, S. Cho, J. Choi, K. Jo, K. Kim, Jong-Hyun Kim.

Supervision: E. Choi, Jong-Hyun Kim.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank all the medical staff at hospitals, city and provincial medical centers, and community facilities for their dedication to provide care for COVID-19; staff at the local health departments for their dedication; members of the Korean Society of Pediatric Infectious Diseases for their valuable advice on the management of COVID-19 cases; and staff at the Korea Centers for Disease Control and Prevention for their tireless efforts to combat this public health emergency.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.