Exhaled Aerosols in SARS-CoV-2 Polymerase Chain Reaction-Positive Children and Age-Matched-Negative Controls

Desiree Gutmann, Helena Donath, Laura Herrlich, Timon Lehmkühler, Anton Landeis, Emily R Ume, Martin Hutter, Ann-Kathrin Goßmann, Frederik Weis, Maximilian Weiß, Holger F Rabenau, Stefan Zielen, Desiree Gutmann, Helena Donath, Laura Herrlich, Timon Lehmkühler, Anton Landeis, Emily R Ume, Martin Hutter, Ann-Kathrin Goßmann, Frederik Weis, Maximilian Weiß, Holger F Rabenau, Stefan Zielen

Abstract

Background: Children and adolescents seem to be less affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease in terms of severity, especially until the increasing spread of the omicron variant in December 2021. Anatomical structures and lower number of exhaled aerosols may in part explain this phenomenon. In a cohort of healthy and SARS-CoV-2 infected children, we compared exhaled particle counts to gain further insights about the spreading of SARS-CoV-2.

Materials and methods: In this single-center prospective observational trial, a total of 162 children and adolescents (age 6-17 years), of whom 39 were polymerase chain reaction (PCR)-positive for SARS-CoV-2 and 123 PCR-negative, were included. The 39 PCR-positive children were compared to 39 PCR-negative age-matched controls. The data of all PCR-negative children were analyzed to determine baseline exhaled particle counts in children. In addition, medical and clinical history was obtained and spirometry was measured.

Results: Baseline exhaled particle counts were low in healthy children. Exhaled particle counts were significantly increased in SARS-CoV-2 PCR-positive children (median 355.0/L; range 81-6955/L), compared to age-matched -negative children (median 157.0/L; range 1-533/L; p < 0.001).

Conclusion: SARS-CoV-2 PCR-positive children exhaled significantly higher levels of aerosols than healthy children. Overall children had low levels of exhaled particle counts, possibly indicating that children are not the major driver of the SARS-CoV-2 pandemic.

Trial registration: [ClinicalTrials.gov], Identifier [NCT04739020].

Keywords: COVID-19; COVID-19 in children; acute respiratory tract infection; aerosols; exhaled aerosol.

Conflict of interest statement

SZ declares receipt of grants or contracts from Böhringer Ingelheim (Germany). EU: Horizon 2020 Erydel in Ataxia, and DLR Projektträger 01KG2030 (Tipp Study). He has received honoraria for presentations from Novartis GmbH, GSK, Vifor Pharma, Böhringer Ingelheim, Lofarma GmbH, Allergopharma GmbH, Allergy Therapeutics, and Sanofi Genzyme. SZ reports personal fees from Aimmune, Novartis GmbH, Böhringer Ingelheim, and IMS HEALTH GmbH & Co. OHG. FW, A-KG, and MW were employed by Palas GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Gutmann, Donath, Herrlich, Lehmkühler, Landeis, Ume, Hutter, Goßmann, Weis, Weiß, Rabenau and Zielen.

Figures

FIGURE 1
FIGURE 1
Exhaled particle counts in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR)-positive and -negative children. Exhaled particle counts in particles/L Exhaled particle counts in particles/L, displayed on a logarithmic scale.
FIGURE 2
FIGURE 2
Spearman correlation of CT-value and exhaled particle count. Displaying the correlation between Ct-value (x-axis) and exhaled particles (y-axis).
FIGURE 3
FIGURE 3
Receiver Operating Characteristic (ROC) curve of the dataset. Displaying sensitivity (true positive fraction) in the y-axis and 1-specificity (false positive fraction) on the x-axis. Points on the curve show examples of cut-off values (aerosol particles per liter).

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