Incidence of SARS-CoV-2 reinfection in a pediatric cohort in Kuwait

Objective: Subsequent protection from severe acute respiratory
syndrome-related coronavirus 2 (SARS-COV-2) infection in pediatrics is not
well reported in the literature. We aimed to describe the clinical
characteristics and dynamics of SARS-CoV-2 PCR repositivity in
children.  Design: This is a population-level retrospective
cohort study Setting: Patients were identified through multiple
national-level electronic coronavirus disease 2019 (COVID-19) databases
covering all Kuwait's primary, secondary and tertiary centers.
Participants: The study included children 12 years and younger over an
11-month period between 2020 and 2021. SARS-CoV-2 reinfection was defined
as having two or more positive SARS-CoV-2 PCR done on a respiratory
sample, at least 45 days apart. Clinical data were obtained from the
Pediatric COVID-19 Registry in Kuwait (PCR-Q8). Primary and secondary
outcome measures: The primary measure is to estimate the SARS-CoV-2 PCR
repositivity rate. The secondary objective was to establish average
duration between first and subsequent SARS-CoV-2 infection. Descriptive
statistics was used to present clinical data for each infection episode.
Also, incidence-sensitivity analysis was performed to evaluate 60- and
90-day PCR repositivity intervals. Results: Thirty pediatric COVID-19
patients had SARS-CoV-2 reinfection at an incidence of 1.02 (95% CI
0.71-1.45) infection per 100,000 person-days and a median time to
reinfection of 83 days (IQR 62-128.75). The incidence of reinfection
decreased to 0.78 (95% CI 0.52-1.17) and 0.47 (95% CI 0.28-0.79) per
person-days when the minimum interval between PCR repositivity was
increased to 60 and 90 days, respectively. The mean age of reinfected
subjects was 8.5 years (IQR 3.7-10.3) and the majority (70%) were females.
Most children (55.2%) had asymptomatic reinfection. Fever was the most
common presentation in symptomatic patients. One immunocompromised
experienced two reinfection episodes. Conclusion: SARS-CoV-2 reinfection
is uncommon in children. Previous confirmed COVID-19 in children seems to
result in milder reinfection.