Sjoerd Euser1, Sem Aronson1,2, Irene Manders1,3, Steven van Lelyveld2, Bjorn Herpers1, Jan Sinnige1, Jayant Kalpoe1, Claudia van Gemeren4, Dominic Snijders5, Ruud Jansen1, Sophie Schuurmans Stekhoven2, Marlies van Houten6, Ivar Lede7, James Cohen Stuart8, Fred Slijkerman Megelink9, Erik Kapteijns10, Jeroen den Boer1, Elisabeth Sanders11,12, Alex Wagemakers1, Dennis Souverein1. 1. Department of Epidemiology, Regional Public Health Laboratory Kennemerland, Haarlem, The Netherlands. 2. Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp/Haarlem, The Netherlands. 3. Department of Infectious Diseases, Public Health Service Kennemerland, Haarlem, The Netherlands. 4. Intensive Care Unit, Spaarne Gasthuis, Hoofddorp/Haarlem, the Netherlands. 5. Department of Pulmonary Disease, Spaarne Gasthuis, Hoofddorp/Haarlem, the Netherlands. 6. Department of Pediatrics, Spaarne Gasthuis, Hoofddorp/Haarlem, the Netherlands. 7. Department of Medical Microbiology, Comicro BV Medical Microbiology, Hoorn, The Netherlands. 8. Department of Medical Microbiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands. 9. Department of Infectious Diseases, Public Health Service Hollands Noorden, Alkmaar, The Netherlands. 10. Department of Pulmonary Disease, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands. 11. Department of Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. 12. Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Abstract
BACKGROUND: Describing the SARS-CoV-2 viral-load distribution in different patient groups and age categories. METHODS: All results from first nasopharyngeal (NP) and oropharyngeal (OP) swabs from unique patients tested via SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) collected between 1 January and 1 December 2020 predominantly in the Public Health Services regions Kennemerland and Hollands Noorden, province of North Holland, the Netherlands, were included in this study. SARS-CoV-2 PCR crossing-point (Cp)-values were used to estimate viral loads. RESULTS: In total, 278 455 unique patients were tested, of whom 9.1% (n = 25.374) were SARS-CoV-2-positive. PCRs performed by Public Health Services (n = 211 914), in which sampling and inclusion were uniform, revealed a clear relation between age and SARS-CoV-2 viral load, with especially children aged <12 years showing lower viral loads than adults (β: -0.03, 95% confidence interval: -0.03 to -0.02, p < 0.001), independently of sex and/or symptom duration. Interestingly, the median Cp-values between the >79- and <12-year-old populations differed by more than four PCR cycles, suggesting an ∼16-fold difference in viral load. In addition, the proportion of children aged <12 years with a low load (Cp-value >30) was higher compared with other patients (31.1% vs 17.2%, p-value < 0.001). CONCLUSIONS: In patients tested by Public Health Services, SARS-CoV-2 viral load increases with age. Further studies should elucidate whether the lower viral load in children is indeed related to their suggested limited role in SARS-CoV-2 transmission. Moreover, as rapid antigen tests are less sensitive than PCR, these results suggest that SARS-CoV-2 antigen tests have lower sensitivity in children than in adults.
BACKGROUND: Describing the SARS-CoV-2 viral-load distribution in different patient groups and age categories. METHODS: All results from first nasopharyngeal (NP) and oropharyngeal (OP) swabs from unique patients tested via SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) collected between 1 January and 1 December 2020 predominantly in the Public Health Services regions Kennemerland and Hollands Noorden, province of North Holland, the Netherlands, were included in this study. SARS-CoV-2 PCR crossing-point (Cp)-values were used to estimate viral loads. RESULTS: In total, 278 455 unique patients were tested, of whom 9.1% (n = 25.374) were SARS-CoV-2-positive. PCRs performed by Public Health Services (n = 211 914), in which sampling and inclusion were uniform, revealed a clear relation between age and SARS-CoV-2 viral load, with especially children aged <12 years showing lower viral loads than adults (β: -0.03, 95% confidence interval: -0.03 to -0.02, p < 0.001), independently of sex and/or symptom duration. Interestingly, the median Cp-values between the >79- and <12-year-old populations differed by more than four PCR cycles, suggesting an ∼16-fold difference in viral load. In addition, the proportion of children aged <12 years with a low load (Cp-value >30) was higher compared with other patients (31.1% vs 17.2%, p-value < 0.001). CONCLUSIONS: In patients tested by Public Health Services, SARS-CoV-2 viral load increases with age. Further studies should elucidate whether the lower viral load in children is indeed related to their suggested limited role in SARS-CoV-2 transmission. Moreover, as rapid antigen tests are less sensitive than PCR, these results suggest that SARS-CoV-2 antigen tests have lower sensitivity in children than in adults.
Authors: Yuan-Po Tu; Rachel Jennings; Brian Hart; Gerard A Cangelosi; Rachel C Wood; Kevin Wehber; Prateek Verma; Deneen Vojta; Ethan M Berke Journal: N Engl J Med Date: 2020-06-03 Impact factor: 91.245
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Authors: Daniel F Gudbjartsson; Agnar Helgason; Hakon Jonsson; Olafur T Magnusson; Pall Melsted; Gudmundur L Norddahl; Jona Saemundsdottir; Asgeir Sigurdsson; Patrick Sulem; Arna B Agustsdottir; Berglind Eiriksdottir; Run Fridriksdottir; Elisabet E Gardarsdottir; Gudmundur Georgsson; Olafia S Gretarsdottir; Kjartan R Gudmundsson; Thora R Gunnarsdottir; Arnaldur Gylfason; Hilma Holm; Brynjar O Jensson; Aslaug Jonasdottir; Frosti Jonsson; Kamilla S Josefsdottir; Thordur Kristjansson; Droplaug N Magnusdottir; Louise le Roux; Gudrun Sigmundsdottir; Gardar Sveinbjornsson; Kristin E Sveinsdottir; Maney Sveinsdottir; Emil A Thorarensen; Bjarni Thorbjornsson; Arthur Löve; Gisli Masson; Ingileif Jonsdottir; Alma D Möller; Thorolfur Gudnason; Karl G Kristinsson; Unnur Thorsteinsdottir; Kari Stefansson Journal: N Engl J Med Date: 2020-04-14 Impact factor: 91.245