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Review
. 2022 Sep;18(9):582-588.
doi: 10.1007/s12519-022-00553-1. Epub 2022 Jun 4.

Gastrointestinal viral shedding in children with SARS-CoV-2: a systematic review and meta-analysis

Sepideh Benvari  1 , Shima Mahmoudi  2 , Mohsen Mohammadi  3
Affiliations
Review

Gastrointestinal viral shedding in children with SARS-CoV-2: a systematic review and meta-analysis

Sepideh Benvari et al. World J Pediatr. 2022 Sep.

Abstract

Background: Coronavirus disease 2019 (COVID-19) has different manifestations in pediatric cases. It is assumed that they might present more gastrointestinal symptoms with a different viral shedding pattern in gastrointestinal samples. In this systematic review and meta-analysis, we aimed to evaluate the viral shedding pattern in gastrointestinal specimens of children with COVID-19.

Methods: We searched all published studies in English language in PubMed, Web of Science, and Scopus, up to date as of October 2021. Our search included the term "severe acute respiratory syndrome coronavirus 2, COVID-19, SARS-CoV-2, novel coronavirus, or coronavirus; and shed, excrete, secret, or carriage; and stool or rectal; and children or pediatrics". We included studies evaluating SARS-CoV-2 shedding in gastrointestinal specimens, including rectal swabs and stool samples of children with COVID-19 infection. We excluded duplicated data, case reports, and studies without original data.

Results: Twelve studies met the eligibility criteria for the qualitative synthesis, 10 of which were included in the meta-analysis. The pooled prevalence of gastrointestinal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in children with COVID-19 was 86% (95% confidence interval 73%-96%, I2 = 62.28%). After respiratory specimen had become negative, 72% (43/60) had persistent shedding in gastrointestinal specimens. The gastrointestinal RNA had a positive test result for more than 70 days after symptoms onset.

Conclusions: Gastrointestinal shedding of SARS-CoV-2 might occur in a substantial portion of children and might persist long after negative respiratory testing. Further research is recommended to find the role of SARS-CoV-2 gastrointestinal shedding in transmission in children.

Keywords: Coronavirus disease 2019 (COVID-19); Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); Viral shedding.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Summary of the literature search and study selection
Fig. 2
Fig. 2
Forest plot diagram for the pooled prevalence of detectable SARS-CoV-2 RNA in gastrointestinal samples of children with confirmed COVID-19 infection. COVID-19 coronavirus disease 2019, SARS-CoV-2 severe acute respiratory syndrome coronavirus 2, ES effect size, CI confidence interval
Fig. 3
Fig. 3
a The funnel plot diagram for publication bias; b the Egger’s test for publication bias (P ≤ 0.001). SE standard error, SND standardized normal distribution, CI confidence interval
See this image and copyright information in PMC

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