• Vol. 49 No. 8, 530–537
  • 01 August 2020

Comparative Analysis of Symptomatic and Asymptomatic SARS-CoV-2 Infection in Children



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Introduction: In this study, a comparison of clinical, epidemiological and laboratory parameters between symptomatic and asymptomatic children with SARS-CoV-2 infection was performed.

Methods: Data from all children with laboratory confirmed SARS-CoV-2 infection admitted to KK Women’s and Children’s Hospital (KKH), Singapore, from January to May 2020 were analysed.

Results: Of the 39 COVID-19 children included, 38.5% were asymptomatic. Household transmission accounted for 95% of cases. The presenting symptoms of symptomatic children were low-grade fever (54.2%), rhinorrhoea (45.8%), sore throat (25%), diarrhoea (12.5%) and acute olfactory dysfunction (5.4%). Children of Chinese ethnicity (37.5% vs 6.7%), complete blood count (45.8% vs 6.7%) and liver enzyme abnormalities (25% vs 7.7%) were more common in symptomatic versus asymptomatic children. All children had a mild disease course and none required oxygen supplementation or intensive care.

Conclusion: The high proportion of asymptomatic infected children coupled with household transmission as the main source of paediatric COVID-19 infection underscores the importance of early screening and isolation of children upon detection of an index case of COVID-19 in a household. Symptomatic children were more likely to have abnormal laboratory parameters but they did not have a poorer outcome compared to asymptomatic cases.

Singapore confirmed its first case of COVID-19 on 23 January 2020 in a Chinese national from Wuhan, and its first paediatric case on February 4, 2020. As of 24 July 2020, Singapore has reported 49,071 cases of COVID-19. Singapore initiated a comprehensive surveillance, testing and contact tracing strategy as part of its public health response to contain and mitigate the spread of COVID-19. Close contacts were placed under compulsory quarantine for 14 days, and were assessed by telephone for fever or respiratory symptoms by public health officials during the quarantine period. Contacts who became symptomatic were transferred to a hospital for further evaluation. From March 2020, as an additional measure for children, all asymptomatic paediatric close contacts of adults with COVID-19 were also screened for SARS-CoV-2 infection via nasopharyngeal (NP) sampling.

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