SARS-CoV-2 Infection in Pediatric Patients with Cancer

A report published in JAMA Oncology suggested that pediatric patients with cancer may not be more vulnerable than other children to infection or morbidity resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 

“Together, our results do not support the conjecture that children are a reservoir of unrecognized SARS-CoV-2 infection,” the authors wrote. 

Starting in mid-March 2020, researchers in the Memorial Sloan Kettering Cancer Center (MSK) Kids pediatric program instituted a screening and testing plan to mitigate risks associated with the coronavirus disease 2019 (COVID-19). 

On submission for outpatient or inpatient care, patients were screened for the presence of symptoms of COVID-19 or exposure to contacts with known SARS-CoV-2 infection. Additionally, testing for SARS-CoV-2 was instituted using a RT-PCR assay for 3 cohorts of individuals, including patients exposed to COVID-19 or with symptoms of infection, asymptomatic patients prior to deep sedation, myelosuppressive chemotherapy, or admission to the hospital, and caregivers accompanying patients for admission or multi-way outpatient chemotherapy. 

A total of 335 tests for SARS-CoV-2 were performed between March 10, 2020, and April 12, 2020, on pediatric patients and their caregivers. Of the 178 pediatric patients tested, 20 (11.2%) were found to have positive test results (mean [SD] age, 15.9 [6.6] years). 

Specifically, of the patients who tested for positive screening or symptoms, the rate of positivity for SARS-CoV-2 was 29.3% (95% CI, 18.1%-42.7%), compared with 2.5% (95% CI, 0.5%-7.1%) in 120 asymptomatic patients without known exposure (P < 0.001).

Of the 20 patients who tested positive for SARS-CoV-2, only 3 were female. Researchers indicated that this is a significant sex skewing when compared with pediatric patients who tested negative (15% [95% CI, 3%-38%] vs 43% [95% CI, 35%-51%]; P = 0.02). 

Notably, only 1 patient with COVID-19 required noncritical care hospitalization for COVID-19 symptoms. Further, 3 other patients without significant COVID-19 symptoms were admitted for concomitant fever and neutropenia, cancer morbidity, or planned chemotherapy. However, all other pediatric patients included in the study had mild symptoms and were cared for at home. 

Of the 74 adult caregivers of patients tested, 13 caregivers (17.6%) of 10 patients tested positive for SARS-CoV-2. In addition, of 68 asymptomatic and unexposed caregivers, 10 tested positive for SARS-CoV-2 (14.7%). Moreover, simultaneous detection of the virus in both patients and caregivers was detected in 5 patient/caregiver pairs, whereas 5 patients tested negative for the virus despite close exposure to caregivers with COVID-19. 

“Although this report is limited by small numbers, the data show that the overall morbidity of COVID-19 in pediatric patients with cancer is low with lonely 5% requiring hospitalization for symptoms of COVID-19; that the rate of SARS-CoV-2 infection among asymptomatic pediatric patients is very low; that unrecognized SARS-CoV-2 infection in asymptomatic caregivers is a major infection control consideration; and that consistent with the sex difference previously seen in adults with critical disease, there is a male bias in SARS-CoV-2 infections in children, suggesting a biological basis in skewed infectivity,” the authors wrote. 

Reference:

Boulad F, Kamboj M, Bouvier N, Maureen A, Kung AL. COVID-19 in Children With Cancer in New York City. JAMA Oncology. doi:10.1001/jamaoncol.2020.2028.