SARS-COV-2 INFECTION DYNAMICS IN CHILDREN AND HOUSEHOLD CONTACTS IN A SLUM IN RIO DE JANEIRO
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SARS-CoV-2 Infection Dynamics in
Children and Household Contacts in a
Slum in Rio de Janeiro
P^amella Lugon, MD,a Trevon Fuller, PhD,a,b Luana Damasceno, MS,a Guilherme Calvet, MD, PhD,a
Paola Cristina Resende, PhD,a Aline Rocha Matos, PhD,a Tulio Machado Fumian, PhD,a Fabio Correia Malta, MS,a
Aline Dessimoni Salgado, MD,a Fernanda Christina Morone Fernandes, BS,a Liege Maria Abreu de Carvalho, MD,a
Lusiele Guaraldo, PharmD, DSc,a Leonardo Bastos, PhD,a Oswaldo Gonçalves Cruz, PhD,a James Whitworth, MD,c
Chris Smith, MD, PhD,c Karin Nielsen-Saines, MD, MPH,b Marilda Siqueira, PhD,a Marilia Sa Carvalho, MD, PhD,a
Patricia Brasil, MD, PhDa
To investigate the dynamics of severe acute respiratory syndrome coronavirus 2
OBJECTIVES: abstract
(SARS-CoV-2) infection in a vulnerable population of children and their household contacts.
METHODS:SARS-CoV-2 reverse transcription polymerase chain reaction assays and coronavirus
disease 2019 (COVID-19) immunoglobulin G serology tests were performed in children and
their household contacts after enrollment during primary health care clinic visits. Participants
were followed prospectively with subsequent specimens collected through household visits in
Manguinhos, an impoverished urban slum (a favela) in Rio de Janeiro at 1, 2, and 4 weeks and
quarterly post study enrollment.
RESULTS:Six hundred sixty-seven participants from 259 households were enrolled from May to
September 2020. This included 323 children (0–13 years), 54 adolescents (14–19 years), and
290 adults. Forty-five (13.9%) children had positive test results for SARS-CoV-2 polymerase
chain reaction. SARS-CoV-2 infection was most frequent in children agedAs of May 2021, >168 million such as slums, where household after enrollment, then quarterly.
confirmed cases of severe acute density is high. As is the case in SARS-CoV-2 polymerase chain
respiratory syndrome coronavirus 2 other low middle income countries, reaction (PCR) assays and
(SARS-CoV-2) have been reported multigenerational dwellings are immunoglobulin G (IgG) serology
worldwide, 10% of which occurred in common in Brazil,9 potentially tests were performed on all children
Brazil. Since the first report of providing opportunities for and their household contacts after
coronavirus disease 2019 (COVID-19) transmission between the pediatric written informed consent by the
in Brazil on February 26, 2020, >16 population and older age groups. parent or legal guardian or the
million confirmed cases and 454 000 Our main objective in this study was patient’s own informed consent if
deaths have been reported in the to investigate the dynamics of SARS- they were aged $18 years. Children
country, making Brazil second only to CoV-2 infection in children and their aged $6 years also provided written
the United States in the absolute household contacts living in a assent to study participation.
number of deaths due to COVID-19.1 vulnerable urban slum in Rio de Seroprevalence was defined as a
Rio de Janeiro has the highest Janeiro. positive serological result, which
number of COVID-19 deaths of any was counted once for each
city in Brazil.2 Because children are METHODS individual who tested positive, on
generally paucisymptomatic and tend the date of their first positive result.
We recruited and followed children
to adhere less to hygiene and social Nasopharyngeal swabs were tested
agedsociodemographic variables, prevalence of SARS-CoV-2 in We calculated Spearman’s
including number of residents and children as the following: correlation between these variables
number of rooms and the and the percentage of children from
NZ2 pð1 pÞ
proportion of children living with n¼ the neighborhood who tested
d2 ðN 1Þ þ Z2 pð1 pÞ
siblings, grandparents, and other positive for SARS-CoV-2 by RT-PCR.
family members. Targeted physical where n is the number of children
examinations of all children and that must be sampled to estimate The study was approved by the
symptomatic adults were the prevalence of SARS-CoV-2 with Brazilian National Ethics Committee
performed concurrently. All data 95% confidence. Z is the critical under register number
and laboratory results were value of the standard normal 30639420.0.0000.5262.
recorded through a Research distribution corresponding to this
Electronic Data Capture tool confidence level. We defined d, the RESULTS
(REDCap; Vanderbilt University, allowable margin of error, as 5%. N
Recruitment and follow-up took
Nashville, TN).12 Household size is defined as the number of children
place between May 18 and
was defined as the number of treated at GSFHC. We obtained the
September 24, 2020. In total, 78.6%
residents per room. number of children agedhad IgG-positive test results,
indicating that they had already
been exposed to SARS-CoV-2 by
September 2020 (Fig 4). Of the 45
children who had PCR-positive test
results, 26 had an adult contact who
provided specimens for SARS-CoV-2
testing at the time of pediatric study
enrollment. All 26 samples from
concurrent adult household contacts
tested positive either by PCR or
chemiluminescence immunoassay .
The 19 remaining adult contacts did
not consent to provide a sample of
their own. However, all 19 adults
reported with symptoms of
suspected COVID-19.
The number of persons per room
FIGURE 1
Flowchart of children enrolled in the study.
was not significantly correlated with
the percentage of household
members with positive test results
children aged .05) (Fig 1).
(21%) (Fig 4A). The frequency of positive results had positive The proportion of children who
SARS-CoV-2 infection was also higher gastrointestinal and respiratory tract lived with grandparent(s) (ie,
in the same age group when IgG specimens. One additional individual multigenerational family
results were considered (Fig 4B). with persistently positive results had households) was not significantly
positive gastrointestinal specimens. different among those who had
Eight participants in our study had positive test results for SARS-CoV-2
persistently positive results for A total of 32.5% (79 of 243) of by PCR versus those who had
SARS-CoV-2 RNA for >14 days: 4 children agedFIGURE 3 A, Incidence of SARS-CoV-2 based on RT-PCR per 100 person-years (PY). *P < .05. B, Prevalence of SARS-CoV-2 IgG antibodies. “Tested” denotes the number of children aged
However, comparisons of SARS-CoV-
2 VL in younger and older children
have yielded conflicting results, with
one study reporting higher VL in the
former,19 whereas others have
found no effect of age.20,21 In our
population, we observed that
children agedsame community, was investigated. strategies based on individual children acquire infection from Because of factors such as the risk protection and vaccination strategies adults rather than transmitting it to of urban violence in Manguinhos, aimed at achieving herd immunity. If them. Our results support the children do not usually play outside minimally 85% of susceptible strategy of safely reopening schools alone until they are over 5 years of individuals need to be immunized to and day care centers in our setting, age. On the other hand, there is curb the COVID-19 pandemic in particularly with strict COVID-19 considerable variation among 5-to- high-incidence countries, this level mitigation measures and staff 12-year-old children regarding the of protection can only be achieved immunization. In low-resource time spent outside of the home. with the inclusion of children in settings such as ours, this is critical Children aged $13 years typically immunization programs, especially because access to online classes spend a substantial proportion of in Brazil, where 25% of the remains limited. time outside their home. population is aged
Copyright © 2021 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: Funded by the Oswaldo Cruz Foundation; Programa Inova: Geraç~ao de Conhecimento: Enfrentamento da Pandemia e Pos-Pandemia Covid-19
(VPPCB-005-FIO-20-2-93); the Carlos Chagas Foundation for the Advancement of Science of the State of Rio de Janeiro (E-26/202.862/2018, E-26/210.149/2020,
and E-26/211.565/2019); the Brazilian National Science Foundation (307282/2017-1); the National Institutes of Health and National Institutes of Allergy and
Infectious Diseases (AI129534 and AI140718); and the UK Medical Research Council (MR/V033530/1). Funded by the National Institutes of Health (NIH).
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
REFERENCES 10. Souza Pereira FC. Analysis of the Depo- 18. Szablewski CM, Chang KT, Brown MM,
1. World Health Organization. WHO corona- sition of Dredged Material in the et al. SARS-CoV-2 transmission and
virus (COVID-19) dashboard. 2020. Avail- Funda~o and Cunha Canals in Rio de infection among attendees of an over-
able at: https://covid19.who.int/. Janeiro. Rio de Janeiro, Brazil: Rio de night camp - Georgia, June 2020.
Accessed May 26, 2021 Janeiro State University; 2012 MMWR Morb Mortal Wkly Rep.
2020;69(31):1023–1025
2. Grinberg F. The city of Rio Becomes the 11. Silveira Tovar C. Attitudes about Air and
Municipality With the Highest Number Water Quality and Their Health Impacts 19. Heald-Sargent T, Muller WJ, Zheng X,
of Deaths From COVID-19 in Brazil [in Among Residents of the Community of Rippe J, Patel AB, Kociolek LK. Age-
Portuguese]. Rio de Janeiro, Brazil: O Carlos Chagas in the Neighborhood of related differences in nasopharyn-
Globo; 2021 Manguinhos. Rio de Janeiro, Rio de geal severe acute respiratory syn-
Janeiro: Oswaldo Cruz Foundation; 2016 drome coronavirus 2 (SARS-CoV-2)
3. Viner RM, Russell SJ, Croker H, et al. levels in patients with mild to mod-
School closure and management practi- 12. Harris PA, Taylor R, Minor BL, et al; RED- erate coronavirus disease 2019
ces during coronavirus outbreaks Cap Consortium. The REDCap consor- (COVID-19). JAMA Pediatrics.
including COVID-19: a rapid systematic tium: building an international 2020;174(9):902–903
review. Lancet Child Adolesc Health. community of software platform part-
2020;4(5):397–404 ners. J Biomed Inform. 2019;95:103208 20. Maltezou HC, Magaziotou I, Dedoukou
X, et al. Children and adolescents
4. Monto AS. Studies of the community 13. Arya R, Antonisamy B, Kumar S. Sample with SARS-CoV-2 infection: epidemiol-
and family: acute respiratory illness size estimation in prevalence studies. ogy, clinical course and viral loads.
and infection. Epidemiol Rev. Indian J Pediatr. 2012;79(11):1482–1488 Pediatr Infect Dis J.
1994;16(2):351–373 14. Anand S, Montez-Rath M, Han J, et al. 2020;39(12):e388–e392
5. Lau LLH, Nishiura H, Kelly H, Ip DKM, Prevalence of SARS-CoV-2 antibodies in 21. Yonker LM, Neilan AM, Bartsch Y, et al.
Leung GM, Cowling BJ. Household trans- a large nationwide sample of patients Pediatric severe acute respiratory syn-
mission of 2009 pandemic influenza A on dialysis in the USA: a cross-sectional drome coronavirus 2 (SARS-CoV-2): clin-
(H1N1): a systematic review and meta- study. Lancet. 2020;396(10259): ical presentation, infectivity, and
analysis. Epidemiology. 1335–1344 immune responses. J Pediatr.
2012;23(4):531–542 2020;227:45–52.e5
15. Miranda P, Koeller P, Zucoloto G,
6. Petrie JG, Ohmit SE, Cowling BJ, et Machado W, De Negri F. Socioeconomic 22. Dong Y, Mo X, Hu Y, et al. Epidemiology
al. Influenza transmission in a Aspects of COVID-19: What Do Data of COVID-19 among children in China.
cohort of households with children: From the City of Rio de Janeiro Tell Us? Pediatrics. 2020;145(6):e20200702
2010-2011. PLoS One. 2013;8(9): Brasılia, Brazil: Institute of Applied Eco- 23. Hallal PC, Hartwig FP, Horta BL, et al.
e75339 nomics Research, Ministry of the Econ- SARS-CoV-2 antibody prevalence in Bra-
7. Somekh E, Gleyzer A, Heller E, et al. The omy of Brazil; 2020 zil: results from two successive nation-
role of children in the dynamics of intra 16. Rio de Janeiro Municipal Health Depart- wide serological household surveys.
family coronavirus 2019 spread in ment. Rio COVID-19 platform. 2021. Lancet Global Health. 2020;8(11):
densely populated area. Pediatr Infect Available at: https://experience.arcgis. e1390–e1398
Dis J. 2020;39(8):e202–e204 com/experience/38efc69787 24. Brazilian Institute of Geography and Sta-
8. Lewis SJ, Munro APS, Smith GD, Pollock a346959c931568bd9e2cc4. Accessed tistics. Pesquisa Nacional por Amostra
AM. Closing schools is not evidence March 2, 2021 de Domicılios [National Household Sam-
based and harms children. BMJ. 17. Lopez AS, Hill M, Antezano J, et al. pling Study]. Brasılia, Brazil: IBGE; 2019
2021;372:n521 Transmission dynamics of COVID-19 out- 25. Le Bert N, Tan AT, Kunasegaran K, et al.
9. Population Division. Database on House- breaks associated with child care facili- SARS-CoV-2-specific T cell immunity in
hold Size and Composition. New York, ties - Salt Lake City, Utah, April-July cases of COVID-19 and SARS, and unin-
NY: United Nations Department of Eco- 2020. MMWR Morb Mortal Wkly Rep. fected controls. Nature.
nomic and Social Affairs; 2019 2020;69(37):1319–1323 2020;584(7821):457–462
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8 LUGON et alSARS-CoV-2 Infection Dynamics in Children and Household Contacts in a Slum
in Rio de Janeiro
Pâmella Lugon, Trevon Fuller, Luana Damasceno, Guilherme Calvet, Paola Cristina
Resende, Aline Rocha Matos, Tulio Machado Fumian, Fábio Correia Malta, Aline
Dessimoni Salgado, Fernanda Christina Morone Fernandes, Liege Maria Abreu de
Carvalho, Lusiele Guaraldo, Leonardo Bastos, Oswaldo Gonçalves Cruz, James
Whitworth, Chris Smith, Karin Nielsen-Saines, Marilda Siqueira, Marilia Sa Carvalho
and Patricia Brasil
Pediatrics 2021;148;
DOI: 10.1542/peds.2021-050182 originally published online April 16, 2021;
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/148/1/e2021050182
References This article cites 17 articles, 2 of which you can access for free at:
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Downloaded from www.aappublications.org/news by guest on September 29, 2021SARS-CoV-2 Infection Dynamics in Children and Household Contacts in a Slum
in Rio de Janeiro
Pâmella Lugon, Trevon Fuller, Luana Damasceno, Guilherme Calvet, Paola Cristina
Resende, Aline Rocha Matos, Tulio Machado Fumian, Fábio Correia Malta, Aline
Dessimoni Salgado, Fernanda Christina Morone Fernandes, Liege Maria Abreu de
Carvalho, Lusiele Guaraldo, Leonardo Bastos, Oswaldo Gonçalves Cruz, James
Whitworth, Chris Smith, Karin Nielsen-Saines, Marilda Siqueira, Marilia Sa Carvalho
and Patricia Brasil
Pediatrics 2021;148;
DOI: 10.1542/peds.2021-050182 originally published online April 16, 2021;
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/148/1/e2021050182
Data Supplement at:
http://pediatrics.aappublications.org/content/suppl/2021/06/17/peds.2021-050182.DCSupplemental
Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
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the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2021
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