
































J Nepal Paediatr Soc | VOL 42 | ISSUE 02 |MAY-AUG,  202266

Original Article Platelet Volume as a marker of sePsisOriginal Article

DOI: 103126/JNPS.V4113

Arvind Kumar1, Harmeet Singh Arora2, Vikas Marwah1, Satish Chandra Mishra3, Akhil K R1, Dinesh 
Kumar Kalra4, Subhash Chandra Shaw2

1Department of Respiratory and Sleep Medicine, Army Institute of Cardio-Thoracic Science, Pune-411040, Maharashtra, India 
2Department of Paediatrics, Army Hospital (Research and Referral), New Delhi-110010, India 
3Department of Cardiology, Army Institute of Cardio-Thoracic Science, Pune-411040, Maharashtra, India
4Department of Pathology, Command Hospital, Pune-411040, Maharashtra, India

Pediatric Severe Acute Respiratory Syndrome Coronavirus 2 
(SARS-CoV-2): Clinical Characteristics and Cycle Threshold 
Value (CT value) of Reverse Transcriptase Polymerase Chain 
Reaction (RT-PCR) of Nasopharyngeal Samples

Introduction: We aimed to characterize epidemiological and clinical 
characteristics of children and adolescents with Severe Acute Respiratory 
Syndrome Coronavirus 2 (SARS-CoV-2) infection, and to evaluate relationship 
of cycle threshold value (CT value) of Reverse Transcriptase Polymerase Chain 
Reaction (RT-PCR) test (As surrogate marker of viral load) with patient age and 
severity of infection.
 
Methods: We retrospectively collected data of children and adolescents 
admitted in our center from April 2020 to July 2020 with positive RT-PCR test 
for SARS-CoV-2.

Results: Total 62 children, with median (IQR) of age 96 (54 - 122) months 
and 39 adolescents with median (IQR) of age 19.5 (18.2 - 20) years were 
included. 56 (90%) children and 34 (87%) adolescents had history of SARS-
CoV-2 positive cases in their family. Only nine (14%) children had associated 
risk factor for severe SARS-CoV-2 infection. Fever was the commonest symptom 
which was present in 24 (39%) children and 16 (41%) adolescents. Cough 
was present in 17 (27%) children and 10 (26%) adolescents. Diarrhea was 
found in 14 (23%) children and three (8%) adolescents. CT values of RT-PCR test 
were similar in children and adolescence (p = 0.48). However, asymptomatic 
children had higher CT values than symptomatic children (p = 0.01). 
 
Conclusions: Majority of children have asymptomatic or mild SARS-CoV-2 
infection with similar CT values in children and adolescents.

Abstract

*Corresponding Author
Subhash Chandra Shaw 
Professor (Paediatrics) and Neonatologist,
Department of Paediatrics, 
Army Hospital (Research and Referral), 
New Delhi-110010, India.
Email: drscshaw77@gmail.com 

Article History 
Received On : 20 Dec, 2021
Accepted On : 09 Dec, 2022

Funding sources: None

Conflict of Interest: None

Keywords: COVID-19; Children; Cycle 
Threshold Value; RT-PCR test; Vaccination

Online Access

DOI:
https://doi.org/10.3126/jnps.v42i2.41521

Introduction
It has been more than two years since outbreak of Corona virus disease 2019 
(COVID-19) caused by severe acute respiratory syndrome corona virus 2 (SARS-
CoV-2).1 Globally studies have shown that primary and secondary attacks rate of 
SARS-CoV-2 in children are same as in adults population but children were rarely 
index cases in household, and adult age group patients are often the index cases in 
household who had travelled or moved out in public places.2 

Copyrights & Licensing © 2022 by author(s). This is an Open Access article distribut-
ed under Creative Commons Attribution License (CC BY NC )



J Nepal Paediatr Soc | VOL 42 | ISSUE 02 |MAY-AUG,  2022 67

Original ArticleCliniCal CharaCteristiCs and Ct value of rt-PCr in PaediatriC sars-Cov-2

There are limited studies, as such from India, about epidemiology, 
clinical manifestations and risk of infectivity of SARS-CoV-2 in 
different age groups of children. Moreover, there has also been 
association between viral load and risk of transmission, as seen 
in other similar respiratory diseases.3-5 There is uncertainty about 
the extent to which children can be source of infection as Indian 
adult citizens are being immunized, with the largest vaccination 
program of the world.6

Hence, we aimed to study the epidemiology, clinical characteristics 
and viral loads in nasopharyngeal swabs as a surrogate marker 
of infectivity in different age groups of children. We assessed viral 
loads by measuring cycle threshold value (CT value) of Reverse 
Transcriptase Polymerase Chain Reaction (RT-PCR) test for SARS-
CoV-2 in nasopharyngeal sample of COVID-19 patients. The CT 
value is the number of replications cycle required for RT-PCT test 
to become positive.

Methods
We did retrospective review of 101 patients’ (Children between 
one month to 15 years and adolescents between 15 years to 
20 years) admitted from 01 April 2020 to 31 July 2020 in a 
dedicated tertiary care COVID-19 center in Maharashtra, India. 
The study was approved by the Institute Ethics Committee. 
COVID-19 case was identified by detection of nucleic acid of 
SARS-COV-2 in nasopharyngeal swab using RT-PCR test. Details 
of each admitted cases including demographic data, contact 
and travel history, vaccination history, living condition, clinical 
manifestation, co-morbid condition, treatment received and 
outcome were entered in pre-designed proforma. Children were 

classified as asymptomatic infection who had positive RT-PCR 
test without any clinical features, upper respiratory tract infection 
when there was fever, cough, nasal congestion, etc without signs 
of pneumonia in chest radiology, mild COVID-19 pneumonia with 
respiratory symptoms and radiological evidence whereas severe 
COVID-19 pneumonia was defined in presence of fast breathing, 
hypoxemia (SpO2 < 90%), altered sensorium, feeding difficulty.

7 
Critical infection had any one of following: respiratory failure, 
shock or multiple organ failure.8 Sample for RT-PCR were taken 
from nasopharyngeal swab with AllplexTM 2019-nCoV Assay 
by Seegene Inc. CT value represents the number of replication 
cycles required for detection of virus. It is inversely correlated to 
amount of viral nucleic acid in sample. Sample was considered 
positive when CT value of all genes were less than 40 cycles. In 
case of repeat RT-PCR testing, we included only initial RT-PCR test 
CT value for this study. All data were analyzed by using STATA / 
IC statistical software version 16.0 (StataCorp). The quantitative 
variables of different groups were measured in median with 
interquartile ranges and compared using Krushal-wallis test, 
whereas all categorical data were analyzed by chi 2 test. We 
used spearman correlation test to evaluate relationship between 
two variables. A P value of < 0.05 was considered statistically 
significant. 

Results
A total of 101 patients were enrolled in this study. The 
demographic, clinical characteristics and CT value and clinical 
severity have been depicted respectively in Tables 1, 2 and 3 
and Figure 1. 

Table 1. Clinical characteristics of the study population

Variable
Children less than 15 years 
of age (n = 62 )

Adolescents
age (< 15 years to 20 years ), n = 39

 P value

Presence of risk factor, n (%) 9 (7+2) (14%) 4 (10%) P = 0.54

Fever, n (%) 24 (39%) 16 (41%) P = 0.81

Cough, n (%) 17 (27%) 10 (26%) P = 0.84

Running nose, n (%) 10 (16%) 6 (15%) P = 0.92

Sore throat, n (%) 11 (18%) 9 (23%) P = 0.51

Body ache, n (%) 4 (6%) 6 (15%) P = 0.15

Loss of appetite,  n (%) 3 (5%) 5 (13%) P = 0.25

Diarrhea, n (%) 14 (23 %) 3 (8%) P = 0.04

Loss of smell, n (%) 8 (13%) 6 (15%) P = 0.62

Loss of taste, n (%) 4 (6%) 5 (13%) P = 0.26

 Symptoms category

Asymptomatic, n (%) 34 (55%)
28 (45%)
0

22 (57%)
15 (38%)
2 (5%)

P = 0.17Mild, n (%)

Moderate, n (%)



J Nepal Paediatr Soc | VOL 42 | ISSUE 02 |MAY-AUG,  202268

Original Article CliniCal CharaCteristiCs and Ct value of rt-PCr in PaediatriC sars-Cov-2

Table 2. Demographic characteristics of the study population

Children less than 15 
years of age (n = 62 )

Adolescents  age (< 15 years 
to 20 years ), (n = 39)

P value

BMI (Kg / m2), median (IQR) 15.6 (14.0, 17.7) 20.2 (19.1, 21.2) P = 0.001

CT value, median (IQR) 25.5 (22, 30) 24 (22, 28) P = 0.59

Male, n (% ) 34 (55%) 20 (51%) P = 0.75

 Residence Rural, n (%) 18 (29%) 3 (8%) P = 0.01

Urban, n (%) 44 (71%) 36 (92%)

 Father occupation Govt. sec., n (%)   47 (76%) 22 (56%) P = 0.002

Agriculture, n (%) 10 (16%) 3 (8%)

Private sec., n (%) 5 (8%) 14 (36%)

(Size of  family (numbers Three , n (%) 12 (19%)

36 (58%)

8 (13%)

2 (3%) 

12 (31%)

16 (41%)

9 (23%)

2 (5%)

P = 0.21

four, n (%)

five, n (%)

six, n (%)

  Vaccination received BCG + MMR, n (%) 40 (65%)

11 (18%)

4 (6%)

7 (11%)

34 (88%)

1 (2%)

1 (2%)

3 (8%)

P = 0.06

BCG+MMR+ Pneumococcal, n (%)

BCG+MMR+ Pneumococcal+ Influenza, n (%)

Only BCG , n (% )

Travel history present, n (%) 4 (6%) 4 (10%) P = 0.40

Family member infected,  n (%) 56 (90%) 34 (87%) P = 0.30

 Infected member in family Father alone, n (%) 22 (35%)

4 (6%)

12(19%)

16 (26%)

7 (11%)

21 (54%)

4 (10%)

7 (18%)

7 (18%)

0

P = 0.15

Mother alone, n (%)

Sibling alone, n (%)

Both parent, n (%)

All family members, n (%)

BMI-body mass index, CT value – cycle threshold value, BCG- Bacille Calmette-Guérin, MMR-measles, mumps, rubella.

Table 3. Severity of symptoms and cycle threshold (CT) values 

Severity of symptoms CT values ( median , IQR) P Value 

Asymptomatic (n = 56) 26 (24, 28) 0.01 

Mild (n = 43) 22 (22, 30)

Moderate (n = 2) 17.5 (14, 21) 

Severe (n = 0)

Figure 1. Severity of symptoms and cycle threshold (CT) values

We did not notice any statistically significant correlation between 
severity of infection and vaccination received or presence of risk 
factors of COVID-19 infection either. We noted that CT value had 
weak negative but statistically significant correlation with severity 
of COVID infection (Table 3, Fig 1). 

Discussion 
Since COVID-19 is a novel infection, there is limited knowledge 
about it, especially from paediatric age group. To date, majority of 
COVID-19 related paediatric studies have originated from either 
China or western countries, data from Indian subcontinent are 
scarce.9,10 As many country specific factors (climate, food habit, 
socio-economic status and health care facilities etc) may affect 
natural course of any pandemic, we reported an observation 
study of epidemiology, clinical characteristics and CT value of RT-
PCR (as surrogate marker of viral load) in nasopharyngeal swab 
of SARS-CoV-2 infected children from a large city in southern part 
of India. It was one of the epicenters of COVID-19 cases in India.11

There was male predominance (55%) in admitted children in our 
study which is almost similar to another large study from China.8 
As seen in previous studies, main source of infection in majority 
of children was house hold contact.12,13 This was prominently seen 
in our study too. Clinically, almost all children in this study had 



J Nepal Paediatr Soc | VOL 42 | ISSUE 02 |MAY-AUG,  2022 69

Original ArticleCliniCal CharaCteristiCs and Ct value of rt-PCr in PaediatriC sars-Cov-2

asymptomatic or mild SARS-CoV-2 infection. Previous multicenter 
studies and recent meta-analysis too, revealed that majority of 
SARS-CoV-2 infected children had mild or no symptoms of infection 
worldwide.12,14 Fever (39%), cough (27%) and diarrhea (23%) 
were common symptoms in children in our study. Similar clinical 
characteristics were reported in cohorts of previous large studies 
from China too.8,9 We noticed that higher proportion of children 
had symptomatic infection with increasing age. Complaints of 
loss of taste, loss of appetite and body ache were more prevalent 
in < 15 years of adolescence than children, whereas diarrhea 
was more common in children (23% vs 8%) in our study. Similar 
results were reported in another multicenter study including 
tertiary centers of China, France and Germany.15 However, we 
found that higher proportion of children in our study had diarrheal 
episodes compared to previous studies from US and China.16,17 
The reason for this differences may be due to sanitation, food 
habits, vaccination coverage, and poor nutritional status.  We did 
not have any child with severe or critical infection, which is also 
supported by finding of the COVID-19 data summary-NYC Heath, 
in which less than 1% children had critical infection. 18

Besides diagnosing, it is also important to know whether infected 
person is infectious or not, for containing pandemic. Though, 
viral cell culture is gold standard to determine infectivity but in 
the absence of it, one may use viral load / CT value of RT- PCR 
as a surrogate marker of likelihood of infectivity. The correlation 
between CT values of RT-PCR test and viral cell culture was found 
significant in a study in France.19 Similarly, another study from 
Canada showed there was significant correlation between CT 
values and infectivity in cell culture; and concluded that infectivity 
of patients may be low who has CT value <24.20 However, a study 
from US showed positive culture growth from samples with CT 
values of 34.21 Later, systematic review from Stanford University 
analyzed this study and revealed that study population (elderly 
patients in elder care facility) of this study might not represent 
the general population.22 Recently, authors of another systematic 
review including 17 studies on viral load (CT values) and symptom 
severity, concluded that infectivity decreases after a week of viral 
shedding and cycle threshold value of 24.23 In our study, we did 
not find any significant difference in CT values of paediatric and 
adolescence age groups. 

Since the early phase of this pandemic, many studies worldwide 
assessed relationship between severity of infection, age and 
infectivity. Earlier this year, a study from Chicago, U.S. including 
97 children and 48 adults revealed similar CT values in older 
children (< 5 years to 17 years of age) and adults. However, 
younger children (< 5 years of age ) had significant lower CT 
values than adults.24 In another study from Switzerland, authors 
compared viral load values of 53 children with values of 352 
adults and found no significant difference.25 Similarly, a study of 
201 children from Greece reported no difference in viral load of 
paediatric and adolescence age groups, neither any difference 
of viral loads between symptomatic and asymptomatic children.26 
However, another study from US comprising of  339 asymptomatic 
and 478 symptomatic children found significantly higher CT values 
of asymptomatic children than symptomatic children of all age 
groups.27 We too found significant higher median (IQR) CT values 
of asymptomatic children than mild symptomatic children, 26 (24, 
28) vs 22 (22, 30), p = 0.01. 

Our study has some limitations. Asymptomatic children in our 
study may not be representing recent infection due to possibility 

of picking up remote infection in the screening tests. However, the 
strength of our study is that the nasopharyngeal swabs were taken 
by single team of trained health care staff and analyzed by same 
commercial kit in microbiological laboratory of our center. 

Conclusions
To conclude, majority of children have asymptomatic or mild SARS-
CoV-2 infection with similar CT values in children and adolescents. 
Further studies are needed to evaluate the role of children in the 
ongoing pandemic with upcoming new mutations. 

References 
1.  Wang C, Horby PW, Hayden FG, Gao GF. A novel 

coronavirus outbreak of global health concern. Lancet. 2020 
Feb 15;395(10223):470-473.     
DOI: 10.1016/S0140-6736(20)30185-9. Erratum in: Lancet. 
2020 Jan 29; PMID: 31986257; PMCID: PMC7135038. 

2. Bi Q, Wu Y, Mei S, Ye C, Zou X, Zhang Z, et al. Epidemiology 
and transmission of COVID-19 in 391 cases and 1286 of 
their close contacts in Shenzhen, China: a retrospective 
cohort study. Lancet Infect Dis. 2020 Aug;20(8):911-919. 
DOI: 10.1016/S1473-3099(20)30287-5. Erratum in: Lancet 
Infect Dis. 2020 Jul;20(7): e148.    
PMID: 32353347; PMCID: PMC7185944.

3. Vos LM, Bruyndonckx R, Zuithoff NP, Little P, Oosterheert JJ, 
Broekhuizen BD, et al. Lower respiratory tract infection in the 
community: associations between viral aetiology and illness 
course. Clin Microbiol Infect. 2021 Jan; 27(1): 96–104.  
DOI: 10.1016/j.cmi.2020.03.023. PMID: 32244051; 
PMCID: PMC7118666.

4. Li CC, Wang L, Eng HL, You HL, Chang LS, Tang KS, et 
al. Correlation of pandemic (H1N1) 2009 viral load with 
disease severity and prolonged viral shedding in children. 
Emerg Infect Dis. 2010 Aug;16(8):1265.   
DOI: 10.3201/eid1608.091918

5. Lee N, Chan PK, Hui DS, Rainer TH, Wong E, Choi KW, 
et al. Viral loads and duration of viral shedding in adult 
patients hospitalized with influenza. J Infect Dis. 2009 
Aug 15;200(4):492-500.    
DOI: 10.1086/600383. PMID: 19591575; PMCID: 
PMC7110250.

6. Kumar VM, Pandi-Perumal SR, Trakht I, Thyagarajan 
SP. Strategy for COVID-19 vaccination in India: the country 
with the second highest population and number of cases. npj 
Vaccines 6, 60 (2021).     
DOI: https://doi.org/10.1038/s41541-021-00327-2

7. Sahi PK, Jhamb U, Dabas A. Pediatric Coronavirus Disease 
2019: Clinical Features and Management. Indian Pediatr. 
2021 May 15;58(5):453-460.     
DOI: 10.1007/s13312-021-2216-4. PMID: 33612488; 
PMCID: PMC8139223.

8. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology 
of COVID-19 Among Children in China. Pediatrics. 2020 
Jun;145(6): e20200702.     
DOI: 10.1542/peds.2020-0702. PMID: 32179660.

9. Bai K, Liu W, Liu C, Fu Y, Hu J, Qin Y, et al. Clinical Analysis 

https://doi.org/10.3201%2Feid1608.091918
https://doi.org/10.1038/s41541-021-00327-2


J Nepal Paediatr Soc | VOL 42 | ISSUE 02 |MAY-AUG,  202270

Original Article CliniCal CharaCteristiCs and Ct value of rt-PCr in PaediatriC sars-Cov-2

of 25 COVID-19 Infections in Children. Pediatr Infect Dis. 
2020 Jul 1;39(7): e100-3.     
DOI: 10.1097/INF.0000000000002740. PMID: 
32520888.

10. Shekerdemian LS, Mahmood NR, Wolfe KK, Riggs BJ, Ross 
CE, McKiernan CA, et al. Characteristics and outcomes 
of children with coronavirus disease 2019 (COVID-19) 
infection admitted to US and Canadian pediatric intensive 
care units. JAMA Pediatr. 2020 Sep 1;174(9):868-873.                                                                    
DOI: 10.1001/jamapediatrics.2020.1948. PMID: 
32392288;PMCID: PMC7489842.

11. Bogam P, Joshi A, Nagarkar S, Jain D, Gupte N, Shashidhara 
LS, et al. Burden of COVID-19 and case fatality rate in 
Pune, India: an analysis of the first and second wave of the 
pandemic. IJID Regions. 2022 Mar 1; 2: 74-81.   
DOI: http//doi.org/10.1016/j.ijregi.2021.12.006.

12. Zimmermann P, Curtis N. Coronavirus infections in children 
including COVID-19: an overview of the epidemiology, 
clinical features, diagnosis, treatment and prevention options 
in children. Pediatr Infect Dis J. 2020; 39(5): 355- 368.                            
DOI: 10.1097/INF.0000000000002660. PMID: 
32310621; PMCID: PMC7158880. 

13. Choi SH, Kim HW, Kang JM, Kim DH, Cho EY. Epidemiology 
and clinical features of coronavirus disease 2019 in children. 
Clin Exp Pediatr. 2020 Apr; 63 (4): 125-32.   
DOI: 10.3345/cep.2020.00535. PMID: 32252139; 
PMCID: PMC7170785.

14. Meena J, Yadav J, Saini L, Yadav A, Kumar J. Clinical 
features and outcome of SARS-CoV-2 infection in children: A 
systematic review and meta-analysis. Indian Pediatr. 2020 
Sep;57(9):820-826.      
DOI: 10.1007/s13312-020-1961-0. PMID: 32583808; 
PMCID: PMC7498550.

15. Qiu C, Cui C, Hautefort C, Haehner A, Zhao J, Yao Q, et al. 
Olfactory and gustatory dysfunction as an early identifier of 
COVID-19 in adults and children: An International Multicenter 
Study. Otolaryngol Head Neck Surg. 2020; 163: 714–21. 
DOI: 10.1177/0194599820934376. Epub 2020 Jun 16. 
PMID: 32539586; PMCID: PMC7298561.

16. CDC COVID-19 Response Team. Coronavirus Disease 2019 in 
Children - United States, February 12-April 2, 2020. MMWR 
Morb Mortal Wkly Rep. 2020 Apr 10;69(14):422-426.      
DOI: 10.15585/mmwr.mm6914e4. PMID: 32271728; 
PMCID: PMC7147903. 

17. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. 
Early Transmission Dynamics in Wuhan, China, of Novel 
Coronavirus-Infected Pneumonia. N Engl J Med. 2020 Mar 
26;382(13):1199-1207.     
DOI: 10.1056/NEJMoa2001316. PMID: 31995857; 
PMCID: PMC7121484.

18. COVID-19: Data Summary—NYC Health. https:// www1.
nyc.gov/site/doh/covid/covid-19-data.page (17 August 
2020, date last accessed). 

19. La Scola B, Le Bideau M, Andreani J, Hoang VT, Grimaldier 
C, Colson P, et al. Viral RNA load as determined by cell 
culture as a management tool for discharge of SARS-CoV-2 
patients from infectious disease wards. Eur J of Clin Microbiol 
& Infect Dis. 2020;39(6):1059-1061.    

DOI: 10.1007/s10096-020-03913-9. PMID: 32342252; 
PMCID: PMC7185831.

20. Bullard J, Dust K, Funk D, Strong JE, Alexander D, Garnett 
L, et al. Predicting Infectious Severe Acute Respiratory 
Syndrome Coronavirus 2 From Diagnostic Samples. Clin 
Infect Dis. 2020 Dec 17;71(10):2663-2666.    
DOI: 10.1093/cid/ciaa638. PMID: 32442256; PMCID: 
PMC7314198.

21. Arons MM, Hatfield KM, Reddy SC, Kimball A, James A, 
Jacobs JR, et al. Presymptomatic SARS-CoV-2 infections and 
transmission in a skilled nursing facility. N Engl J Med. 2020 
Apr 24; 382:2081-2090.     
DOI: 10.1056/NEJMoa2008457. PMID: 32329971; 
PMCID: PMC7200056.

22. Savvides C, Siegel R. Asymptomatic and presymptomatic 
transmission of SARS-CoV-2: A systematic review. medRxiv 
[Preprint]. 2020 Jun 17:2020.06.11.20129072.   
DOI: 10.1101/2020.06.11.20129072. PMID: 32587980; 
PMCID: PMC7310638.

23. Jefferson T, Spencer EA, Brassey J, Heneghan C. Viral 
Cultures for Coronavirus Disease 2019 Infectivity Assessment: 
A Systematic Review. Clin Infect Dis. 2021 Dec 6;73(11): 
e3884-e3899.      
DOI: 10.1093/cid/ciaa1764. PMID: 33270107; PMCID: 
PMC7799320.

24. Heald-Sargent T, Muller WJ, Zheng X, Rippe J, Patel AB, 
Kociolek LK. Age-Related Differences in Nasopharyngeal 
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-
CoV-2) Levels in Patients with Mild to Moderate Coronavirus 
Disease 2019 (COVID-19). JAMA Pediatr. 2020 Sep 
1;174(9):902-903.      
DOI: 10.1001/jamapediatrics.2020.3651. PMID: 
32745201; PMCID: PMC7393583.

25. Baggio S, L’Huillier AG, Yerly S, Bellon M, Wagner N, Rohr 
M, et al. Severe Acute Respiratory Syndrome Coronavirus 
2 (SARS-CoV-2) Viral Load in the Upper Respiratory Tract of 
Children and Adults with Early Acute Coronavirus Disease 
2019 (COVID-19). Clin Infect Dis. 2021 Jul 1;73(1):148-
150.       
DOI: 10.1093/cid/ciaa1157. PMID: 32761228; PMCID: 
PMC7454380.

26. Maltezou HC, Magaziotou I, Dedoukou X, Eleftheriou 
E, Raftopoulos V, Michos A, et al. for Greek Study Group 
on SARS-CoV-2 Infections in Children. Children and 
Adolescents with SARS-CoV-2 Infection: Epidemiology, 
Clinical Course and Viral Loads. Pediatr Infect Dis J. 2020 
Dec;39(12): e388-e392.                                                                                                   
DOI: 10.1097/INF.0000000000002899.     
PMID:33031141.

27. Kociolek LK, Muller WJ, Yee R, Dien Bard J, Brown CA, 
Revell PA, et al. Comparison of Upper Respiratory Viral Load 
Distributions in Asymptomatic and Symptomatic Children 
Diagnosed with SARS-CoV-2 Infection in Pediatric Hospital 
Testing Programs. J Clin Microbiol. 2020 Dec 17;59(1): 
e02593-20.       
DOI: 10.1128/JCM.02593-20. PMID: 33093026; PMCID: 
PMC7771452.


