Introduction
The Coronavirus Disease 2019 (COVID-19) pandemic caused by the Severe
Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus continues to
be an ongoing global health crisis. SARS-CoV-2 causes mild to moderate
upper respiratory tract infection in most children, but the true burden
of disease is unknown due to asymptomatic infection. Viral load
typically peaks with symptom onset and falls to undetectable levels by
the third week, when patients generally begin to develop
antibodies.1
Patients with a suppressed immune system, such as those being treated
for cancer, are susceptible to more severe viral
infections.2 While these infections, including
SARS-CoV-2, have potential to be more severe in immunocompromised
adults3,4, emerging data suggests that SARS-CoV-2 does
not necessarily present with an increased risk of severe disease in
immunocompromised children (ICC).5-8 However, the
persistence of SARS-CoV-2 infection in pediatric immunosuppressed
patients is still unknown, with case series suggesting that infection
can be more prolonged in this population.9
An understanding of viral persistence in immunocompromised hosts has
important public health implications. Specific impacts include the
effective prevention of disease transmission through infection control
practices, as well as decreasing the risk of emerging variants given the
concern that SARS-CoV-2 variants may have emerged from prolonged
replication within immunocompromised hosts.10,11 The
objectives of our study were to determine the length of time that ICC
are positive for SARS-CoV-2; identify the sociodemographic and clinical
factors associated with prolonged viral shedding; and determine the
CT values of a subset of patients with viral persistence
as a surrogate of viral load and potential transmissibility.