Jurnal Internasional Aprika vol.12 issue 3 2022
African Journal of Emergency Medicine
SARS-CoV-2 in children and their accompanying caregivers: Implications for testing strategies in resource limited hospitals

Jurnal Internasional Aprika vol.12 issue 3 2022
African Journal of Emergency Medicine
SARS-CoV-2 in children and their accompanying caregivers: Implications for testing strategies in resource limited hospitals

SARS-CoV-2 Symptom screening Children and accompanying caregivers

Background: Identification of SARS-CoV-2 infected individuals is imperative to prevent hospital transmission, but symptom-based screening may fail to identify asymptomatic/mildly symptomatic infectious children and their caregivers. Methods: A COVID-19 period prevalence study was conducted between 13 and 26 August 2020 at Tygerberg Hos- pital, testing all children and their accompanying asymptomatic caregivers after initial symptom screening. One nasopharyngeal swab was submitted for SARS-CoV-2 using real-time reverse-transcription polymerase chain re- action (rRT-PCR). An additional Respiratory Viral 16-multiplex rRT-PCR test was simultaneously done in children presenting with symptoms compatible with possible SARS-CoV-2 infection. Results: SARS-Co-V 2 RT-PCR tests from 196 children and 116 caregivers were included in the analysis. The SARS-CoV-2 period prevalence in children was 5.6% (11/196) versus 15.5% (18/116) in asymptomatic care- givers ( p < 0.01). Presenting symptoms did not correlate with SARS-CoV-2 test positivity; children without typical symptoms of SARS-CoV-2 were more likely to be positive than those with typical symptoms (10.2% [10/99] vs 1% [1/97]; p < 0.01). Children with typical symptoms (97/196; 49.5%) mainly presented with acute respira- tory (68/97; 70.1%), fever (17/97; 17.5%), or gastro-intestinal complaints (12/97; 12.4%); Human Rhinovirus (23/81; 28.4%) and Respiratory Syncytial Virus (18/81; 22.2%) were frequently identified in this group. Children- caregiver pairs’ SARS-CoV-2 tests were discordant in 83.3%; 15/18 infected caregivers’ children tested negative. Symptom-based COVID-19 screening alone would have missed 90% of the positive children and 100% of asymp- tomatic but positive caregivers. Conclusion: Given the poor correlation between SARS-CoV-2 symptoms and RT-PCR test positivity, universal test- ing of children and their accompanying caregivers should be considered for emergency and inpatient paediatric admissions during high COVID-19 community transmission periods. Universal PPE and optimising ventilation is likely the most effective way to control transmission of respiratory viral infections, including SARS-CoV-2, where universal testing is not feasible. In these settings, repeated point prevalence studies may be useful to inform local testing and cohorting strategies.

Liezl Smit , Andrew Redfern , Sadia Murray , Juanita Lishman , Marieke M. van der Zalm , Gert van Zyl , Lilly M. Verhagen , Cornéde Vos , Helena Rabie , Annemarie Dyk , Mathilda Claassen , Jantjie Taljaar , Marina Aucamp , Angela Dramowski

www.elsevier.com/locate/afjem

18 April 2022

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