AUTHOR=Khemiri Haifa , Gdoura Mariem , Ben Halima Samar , Krichen Henda , Cammà Cesare , Lorusso Alessio , Ancora Massimo , Di Pasquale Adriano , Cherni Asma , Touzi Henda , Sadraoui Amel , Meddeb Zina , Hogga Nahed , Ammi Radhia , Triki Henda , Haddad-Boubaker Sondes 

TITLE=SARS-CoV-2 excretion kinetics in nasopharyngeal and stool samples from the pediatric population

JOURNAL=Frontiers in Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1226207

DOI=10.3389/fmed.2023.1226207

ISSN=2296-858X

ABSTRACT=<sec id="sec1"><title>Background</title><p>The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for serious respiratory infections in humans. Even in the absence of respiratory symptoms, gastrointestinal (GI) signs were commonly reported in adults and children. Thus, oral–fecal transmission was suspected as a possible route of infection. The objective of this study was to describe RNA shedding in nasopharyngeal and stool samples obtained from asymptomatic and symptomatic children and to investigate virus viability.</p></sec><sec id="sec2"><title>Methods</title><p>This study included 179 stool and 191 nasopharyngeal samples obtained from 71 children, which included symptomatic (<italic>n</italic> = 64) and asymptomatic (<italic>n</italic> = 7) ones. They were collected every 7 days from the onset of the infection until negativation. Viral RNA was detected by real-time RT-PCR, targeting the N and ORF1 genes. Whole-genome sequencing was performed for positive cases. Viral isolation was assessed on Vero cells, followed by molecular detection confirmation.</p></sec><sec id="sec3"><title>Results</title><p>All cases included in this study (<italic>n</italic> = 71) were positive in their nasopharyngeal samples. SARS-CoV-2 RNA was detected in 36 stool samples obtained from 15 out of 71 (21.1%) children; 13 were symptomatic and two were asymptomatic. Excretion periods varied from 7 to 21 days and 7 to 14 days in nasopharyngeal and fecal samples, respectively. Four variants were detected: Alpha (<italic>n</italic> = 3), B.1.160 (<italic>n</italic> = 3), Delta (<italic>n</italic> = 7), and Omicron (<italic>n</italic> = 1). Inoculation of stool samples on cell culture showed no specific cytopathic effect. All cell culture supernatants were negative for RT-qPCR.</p></sec><sec id="sec4"><title>Conclusion</title><p>Our study demonstrated nasopharyngeal and fecal shedding of SARS-CoV-2 RNA by children up to 21 and 14 days, respectively. Fecal shedding was recorded in symptomatic and asymptomatic children. Nevertheless, SARS-CoV-2 was not isolated from positive stool samples.</p></sec>