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Objective <p>Limited research has examined the progression of disease symptoms and viral shedding dynamics using continuous daily cycle threshold (Ct) values in large pediatric populations infected with SARS-CoV-2.</p> Methods <p>This analysis included 7803 children and adolescents selected from a retrospective cohort of 174,371 individuals with COVID-19. Factors influencing symptom progression and viral shedding were evaluated across asymptomatic, asymptomatic-to-mild and mild symptom groups. Inverse Probability of Treatment Weighting (IPTW) was used to adjust for confounding and correct group imbalances.</p> Results <p>During follow-up, 86.2% of initially asymptomatic individuals progressed to mild disease. The median durations of hospital stay and viral shedding were both six days (interquartile range: 4–8 days). Older children (AOR: 1.13–1.53), females (AOR: 1.21), lower nadir N gene (AOR: 0.89) and vaccinated individuals (AOR by IPTW: 1.75–1.99) exhibited a higher likelihood of symptom progression. Older age (AHR: 1.13–1.44) and higher nadir N gene values (AHR: 1.15) were associated with an increased likelihood of viral shedding. Full vaccination demonstrated a modest association with viral shedding (AHR by IPTW: 1.08). Compared to the asymptomatic group, viral shedding was less likely in the asymptomatic-to-mild (AHR: 0.64) and mildly symptomatic (AHR: 0.60) groups.</p> Conclusion <p>In pediatric COVID-19 patients, older age, female sex, lower nadir N gene and vaccination are associated with an increased likelihood of progression from asymptomatic to mild symptoms. Older age and higher nadir N gene correlate with a greater probability of viral shedding. Vaccination status is associated with a higher probability of symptomatic presentation and a weakly accelerated viral clearance.</p>

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Symptom progression and viral shedding dynamics in children and adolescents with asymptomatic and mild COVID-19 infections

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月11日

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  • Peng Yang,
  • Xun Jiang,
  • Yuhai Zhang,
  • Wen Kang,
  • Yushen Liu,
  • Yi Gang,
  • Ruijuan Li,
  • Wei Wang,
  • Tianping Wang,
  • Wenjing Zhang,
  • Wenzhen Kang,
  • Lei Shang

摘要

Objective

Limited research has examined the progression of disease symptoms and viral shedding dynamics using continuous daily cycle threshold (Ct) values in large pediatric populations infected with SARS-CoV-2.

Methods

This analysis included 7803 children and adolescents selected from a retrospective cohort of 174,371 individuals with COVID-19. Factors influencing symptom progression and viral shedding were evaluated across asymptomatic, asymptomatic-to-mild and mild symptom groups. Inverse Probability of Treatment Weighting (IPTW) was used to adjust for confounding and correct group imbalances.

Results

During follow-up, 86.2% of initially asymptomatic individuals progressed to mild disease. The median durations of hospital stay and viral shedding were both six days (interquartile range: 4–8 days). Older children (AOR: 1.13–1.53), females (AOR: 1.21), lower nadir N gene (AOR: 0.89) and vaccinated individuals (AOR by IPTW: 1.75–1.99) exhibited a higher likelihood of symptom progression. Older age (AHR: 1.13–1.44) and higher nadir N gene values (AHR: 1.15) were associated with an increased likelihood of viral shedding. Full vaccination demonstrated a modest association with viral shedding (AHR by IPTW: 1.08). Compared to the asymptomatic group, viral shedding was less likely in the asymptomatic-to-mild (AHR: 0.64) and mildly symptomatic (AHR: 0.60) groups.

Conclusion

In pediatric COVID-19 patients, older age, female sex, lower nadir N gene and vaccination are associated with an increased likelihood of progression from asymptomatic to mild symptoms. Older age and higher nadir N gene correlate with a greater probability of viral shedding. Vaccination status is associated with a higher probability of symptomatic presentation and a weakly accelerated viral clearance.