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SARS-CoV-2 Persistence in Immunocompromised Children
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  • Susan Dolan,
  • Jean Mulcahy Levy,
  • Angla Moss,
  • Kelly Pearce,
  • Samuel Dominguez,
  • Sarah Jung,
  • Molly Butler,
  • Eric Mwangi,
  • Kelly Maloney,
  • Suchitra Rao
Susan Dolan
Children\'s Hospital Colorado
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Jean Mulcahy Levy
University of Colorado Denver School of Medicine
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Angla Moss
University of Colorado Denver School of Medicine
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Kelly Pearce
Children\'s Hospital Colorado
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Samuel Dominguez
Children\'s Hospital Colorado
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Sarah Jung
Children\'s Hospital Colorado
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Molly Butler
Children\'s Hospital Colorado
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Eric Mwangi
Children\'s Hospital Colorado
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Kelly Maloney
Children's Hospital Colorado
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Suchitra Rao
University of Colorado Denver School of Medicine
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Abstract

Introduction/Objectives: We evaluated the length of time immunocompromised children (ICC) remain positive for SARS-CoV-2, identified factors associated with viral persistence and determined cycle threshold (CT) values of children with viral persistence as a surrogate of viral load. Methods: We conducted a retrospective cohort study of ICC at a pediatric hospital from March 2020-2021. Immunocompromised status was defined as primary, secondary or acquired due to medical comorbidities/immunosuppressive treatment. The primary outcome was time to first-of-two consecutive negative SARS-CoV-2 Polymerase chain reaction (PCR) tests at least 24 hours apart. Testing of sequential clinical specimens from the same subject was conducted using the Centers for Disease Control (CDC) 2019-nCoV Real-Time RT-PCR Diagnostic Panel assay. Descriptive statistics, Kaplan-Meier curve median event times and log-rank-sum tests were used to compare outcomes between groups. Results: Ninety-one children met inclusion criteria. Median age was 15.5 years (IQR 8-18 yrs), 64% were male, 58% were white, and 43% were Hispanic/Latinx. Most (67%) were tested in outpatient settings and 58% were asymptomatic. The median time to two negative tests was 42 days (IQR 25.0,55.0), with no differences in median time by illness presentation or level of immunosuppression. Seven children had >1 sample available for repeat testing, and 5/7 (71%) children had initial CT values of <30, (moderate to high viral load); 4 children had CT values of <30 3-4 weeks later, suggesting persistent moderate to high viral loads. Conclusions: Most ICC with SARS-CoV-2 infection had mild disease, with prolonged viral persistence >6 weeks and moderate to high viral load.

Peer review status:ACCEPTED

22 Jun 2021Submitted to Pediatric Blood & Cancer
22 Jun 2021Submission Checks Completed
22 Jun 2021Assigned to Editor
23 Jun 2021Reviewer(s) Assigned
15 Jul 2021Review(s) Completed, Editorial Evaluation Pending
15 Jul 2021Editorial Decision: Revise Minor
20 Jul 20211st Revision Received
20 Jul 2021Submission Checks Completed
20 Jul 2021Assigned to Editor
21 Jul 2021Review(s) Completed, Editorial Evaluation Pending
21 Jul 2021Editorial Decision: Accept