Children with asymptomatic coronavirus disease-19 (COVID-19): Insights from 2-to 15-year-old cases


 Summary of clinical characteristics of 25 confirmed cases of COVID-19 in children aged between 2 and 15 years, with at least one infected member in their family, are reported and discussed herein. Eighteen patients are asymptomatic, and seven have mild complications without requiring mechanical ventilation or intense unit care (ICU). Results suggested that children with infected family members are very likely to be asymptomatically infected.

Myocarditis in children might present with u-like symptoms, shortness of breath, tachycardia, dyspnea, nausea, decreased appetite, poor feeding, and tachypnea in infants [24][25][26]. Previous studies are performed within small groups of children, thus needs further investigation.

Patients And Methods
The total number of con rmed cases is 412 in Dijon until June 15, 2020, with a total number of 25 children aged between 2 and 15 years. In this study, demographics, epidemiological history, and symptoms of the 25 children are mentioned and discussed.

Results
Polymerase-chain-reaction (PCR) test and computed tomography (CT) were performed on the 25 children with at least one infected member in their family between March 20 and June 15, 2020, in Dijon. Table 1 shows the Summary of the clinical characteristics of the 25 patients. The median age of the patients was 8 (range 2 to 15). Although there were both male and female children in 23 of the 25 families, 17 of the patients were male. Both PCR and CT results were positive for all 25 patients. The CT test showed patchy ground-glass opacities (GGO) for all of them. Common clinical characteristics included fever (in two patients), cough (in ve) sore throat (in one), and the other 18 patients were asymptomatic. None of the patients had severe complications, and they did not receive mechanical ventilation or intense unit care (ICU). Finally, all patients were discharged home without requiring hospitalization.

Discussion
The children in families with at least one infected member with SARS-CoV-2 are very likely to be asymptomatically infected. In this study, a sample of 25 infected families were investigated; therefore, this can be generalized to other infected families who have children. Infected families are recommended to monitor their children to ensure a timely diagnosis.
Children who are infected by SARS-CoV-2 develop mild complications, while severe complications are observed in adults [27][28][29]. The reason may be different immune responses in children, including strong innate and weaker adaptive immune responses, compared to adults. This may help them with the clearance of the virus and reduced secondary lymphocyte-mediated in ammation [30][31][32][33].
Given the number of infections reported, the number of infected children aged less than 15 was small. This may be due to a lower risk of exposure rather than resistance to infection. Because children have fewer outdoor activities and travelings, making them less likely to get the virus [34].
Seventeen of the 25 children infected are male. Given that there have been both male and female children in the families reported in this study, therefore male children might be more susceptible to COVID-19 infection than female children.
The study was limited by a small sample size, inclusion only of children in Dijon with a population of 155,114; therefore, it still needs further investigation.

Declarations
This study was approved by the ethics committee of Hospital Center University DIjon Bourgogne.

Con ict of Interest
The authors declare that there is no con ict of interest.