Characteristics and clinical features of SARS-CoV-2 infections among ambulatory and hospitalized children and adolescents in an integrated health care system in Tennessee

BackgroundLittle is known regarding the full spectrum of illness among children with SARS-CoV-2 infection across ambulatory and inpatient settings. MethodsActive surveillance was performed for SARS-CoV-2 by polymerase chain reaction among asymptomatic and symptomatic individuals in a quaternary care academic hospital laboratory in Tennessee from March 12-July 17, 2020. For symptomatic patients [≤]18 years of age, we performed phone follow-up and medical record review to obtain sociodemographic and clinical data on days 2, 7, and 30 after diagnosis and on day 30 for asymptomatic patients [≤]18 years. Daily and 7-day average test positivity frequencies were calculated for children and adults beginning April 26, 2020. ResultsSARS-CoV-2 was detected in 531/10327 (5.1%) specimens from patients [≤]18 years, including 46/5752 (0.8%) asymptomatic and 485/4575 (10.6%) specimens from 459 unique symptomatic children. Cough (51%), fever (42%), and headache (41%) were the most common symptoms associated with SARS-CoV-2 infection. SARS-CoV-2-related hospitalization was uncommon (18/459 children; 4%); no children with SARS-CoV-2 infection during the study period required intensive care unit admission. Symptom resolution occurred by follow-up day 2 in 192/459 (42%), by day 7 in 332/459 (72%), and by day 30 in 373/396 (94%). The number of cases and percent positivity rose in late June and July in all ages. ConclusionsIn an integrated healthcare network, most pediatric SARS-CoV-2 infections were mild, brief, and rarely required hospital admission, despite increasing cases as community response measures were relaxed. Key pointsIn an integrated healthcare network in the Southeastern United States, symptomatic SARS-CoV-2 infection in children was generally mild, resolved rapidly, and rarely required hospitalization. Cases increased in children and adults as community mitigation measures became less restrictive.