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.