Establishing A Pediatric COVID-19 Biorepository

Image courtesy: CDC

The global pandemic of COVID-19, caused by the highly infectious and transmissible coronavirus, SARS-CoV-2, has become a leading cause of death in older adults. The risk of severe disease and death has been highest in older patients and in persons with underlying co-morbidities such as cardiac disease, chronic lung disease and cancer1. Thus, while adults can develop life-threatening complications such as pneumonia, acute respiratory distress syndrome (ARDS), and sepsis from SARS-CoV-2 infection, its impact on children is less clinically apparent and needs to be studied. The limited data that is available demonstrates that the clinical manifestations of COVID-19 are generally milder in children compared with adults, with a small proportion of pediatric patients requiring hospitalization. In addition, the cases of infants confirmed to have COVID-19 are even fewer2,3.  Therefore, with the inherent differences in disease trajectory between adult and pediatric patients, there is a need to understand the biologic consequences of SARS-CoV-2 infection in children. To this end, collecting high-quality biospecimens from infants, children and in a standardized manner during the COVID-19 pandemic is essential.

In this paper, Lima et al. have described instituting a pediatric COVID-19 biorepository. The biorepository was created to address specific questions such as the role children play in viral transmission, differences in pediatric viral susceptibility and immune responses, and the impact of maternal SARS-CoV-2 infection on fetal development. The authors outlined a roadmap for establishing a biorepository of specimens obtained from infants, children and adolescents, with pediatric-specific considerations. The guidelines in this article aim to enable pediatric centers world-wide to collect samples in a standardized manner to move forward the understanding of pediatric COVID-194.

The biorepository included patients seen in urgent care clinics and hospital settings, neonates born to SARS-CoV-2-infected mothers, and asymptomatic children. Each study population required specific tailoring of study conduct to effectively and efficiently collect critical samples. Close communication and collaborations with the adult COVID-19 biorepository was maintained in order to enable paralleled processing procedures and to ensure consistency and harmonization across patient cohorts. There were 4 cohorts of patients from ages 0–25 years:  1) Pediatric patients with mild-moderate COVID-19, 2) Pediatric patients with severe COVID-19 requiring hospitalization, 3) Newborns born to mothers infected with SARS-CoV-2 at any point during their pregnancy and 4) asymptomatic children presenting to their well-visits during the pandemic. REDCap databases were used to record all study data, including enrollment, laboratory processing, demographic and clinical data, and answers to a survey about COVID-19 exposure.

According to the authors, the goal of the biorepository is to provide high quality biospecimens for studies understanding how infants and children are impacted by and contribute to COVID-19 pandemic. Key factors of interest that will be studied using this biorepository include: 1) pediatric contribution to viral transmission, 2) investigating the dichotomy between pediatric and adult immune responses to COVID-19, and 3) the impact of maternal SARS-CoV-2 infection on child fetal development4.

In the author’s own words – “Although children were initially felt to be spared from COVID-19, it has become clear that much needs to be learned as to how children and newborns are impacted by the pandemic. Research is needed to address viral transmission by children, differences in pediatric viral susceptibility and immune responses,  and the impact of maternal SARS-CoV-2 infection on fetal development. This Pediatric COVID-19 Biorepository will serve as an important resource providing critical insight into disease pathogenesis, COVID-19-susceptibility, and future treatment and vaccination strategies.”

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References:

  1. World Health Organization. https://www.who.int/emergencies/diseases/novel-coronavirus-2019. Accessed 10 November 2020.
  2. Cai J, Xu J, Lin D, Yang Z, Xu L, Qu Z, et al. A Case Series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clin Infect Dis. 2020.
  3. Shekerdemian LS, Mahmood NR, Wolfe KK, Riggs BJ, Ross CE, McKiernan CA, et al. Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units. JAMA Pediatr. 2020
  4. Lima R, Gootkind EF, De la Flor D, Yockey LJ, Bordt EA, D’Avino P, Ning S, Heath K, Harding K, Zois J, Park G, Hardcastle M, Grinke KA, Grimmel S, Davidson SP, Forde PJ, Hall KE, Neilan AM, Matute JD, Lerou PH, Fasano A, Shui JE, Edlow AG, Yonker LM. Establishment of a pediatric COVID-19 biorepository: unique considerations and opportunities for studying the impact of the COVID-19 pandemic on children. BMC Med Res Methodol. 2020 Sep 11;20(1):228.