Comparison of upper respiratory viral load distributions in asymptomatic and symptomatic children diagnosed with SARS-CoV-2 infection in pediatric hospital testing programs

Larry K. Kociolek, William J. Muller, Rebecca Yee, Jennifer Dien Bard, Cameron A. Brown, Paula A. Revell, Hanna Wardell, Timothy J. Savage, Sarah Jung, Samuel Dominguez, Bijal A. Parikh, Robert C. Jerris, Sue C. Kehl, Aaron Campigotto, Jeffrey M. Bender, Xiaotian Zheng, Emily Muscat, Matthew Linam, Lisa Abuogi, Christiana SmithKelly Graff, Ariel Hernandez-Leyva, David Williams, Nira R. Pollock*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

64 Scopus citations


The distribution of upper respiratory viral loads (VL) in asymptomatic children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. We assessed PCR cycle threshold (Ct) values and estimated VL in infected asymptomatic children diagnosed in nine pediatric hospital testing programs. Records for asymptomatic and symptomatic patients with positive clinical SARSCoV-2 tests were reviewed. Ct values were (i) adjusted by centering each value around the institutional median Ct value from symptomatic children tested with that assay and (ii) converted to estimated VL (numbers of copies per milliliter) using internal or manufacturer data. Adjusted Ct values and estimated VL for asymptomatic versus symptomatic children (118 asymptomatic versus 197 symptomatic children aged 0 to 4 years, 79 asymptomatic versus 97 symptomatic children aged 5 to 9 years, 69 asymptomatic versus 75 symptomatic children aged 10 to 13 years, 73 asymptomatic versus 109 symptomatic children aged 14 to 17 years) were compared. The median adjusted Ct value for asymptomatic children was 10.3 cycles higher than for symptomatic children (P < 0.0001), and VL were 3 to 4 logs lower than for symptomatic children (P < 0.0001); differences were consistent (P < 0.0001) across all four age brackets. These differences were consistent across all institutions and by sex, ethnicity, and race. Asymptomatic children with diabetes (odds ratio [OR], 6.5; P = 0.01), a recent contact (OR, 2.3; P = 0.02), and testing for surveillance (OR, 2.7; P = 0.005) had higher estimated risks of having a Ct value in the lowest quartile than children without, while an immunocompromised status had no effect. Children with asymptomatic SARS-CoV-2 infection had lower levels of virus in their nasopharynx/oropharynx than symptomatic children, but the timing of infection relative to diagnosis likely impacted levels in asymptomatic children. Caution is recommended when choosing diagnostic tests for screening of asymptomatic children.

Original languageEnglish (US)
Article numbere02593-20
JournalJournal of clinical microbiology
Issue number1
StatePublished - Jan 2021


  • COVID-19
  • Diagnostics
  • Pediatric infectious disease
  • SARS-CoV-2

ASJC Scopus subject areas

  • Microbiology (medical)


Dive into the research topics of 'Comparison of upper respiratory viral load distributions in asymptomatic and symptomatic children diagnosed with SARS-CoV-2 infection in pediatric hospital testing programs'. Together they form a unique fingerprint.

Cite this