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NIH study seeks to answer questions about COVID-19 and kids

An NIH-funded study will seek answers to questions about COVID-19 in children. The Human Epidemiology and Response to SARS-CoV-2, or HEROS, study will attempt to determine the rate of SARS-CoV-2 infection in children and the percentage of infected children who develop symptoms of COVID-19, the NIH announced.

The study also will assess the rates of SARS-CoV-2 infection among children with asthma or other allergic conditions and determine if they differ from the rates among children without these comorbidities.

“One interesting feature of this novel coronavirus pandemic is that very few children have become sick with COVID-19 compared to adults,” National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci, MD, said in a statement. “Is this because children are resistant to infection with SARS-CoV-2, or because they are infected but do not develop symptoms? The HEROS study will help us begin to answer these and other key questions.”

Researchers will enroll 6,000 people from 2,000 participating families in 11 U.S. cities — Baltimore; Boston; Cincinnati; Dallas; Denver; Detroit; Madison, Wisconsin; Marshfield, Wisconsin; Nashville; New York; and St. Louis.

The study team plans to follow participating children and their families for 6 months to observe who becomes infected, whether the virus is transmitted to family members and which family members develop COVID-19.

The study will be led by Tina V. Hartert, MD, MPH, who heads the Center for Asthma & Environmental Sciences Research at Vanderbilt University.

“So far, data on the extent of SARS-CoV-2 infection in the U.S. population have been limited to people who physically interact with the health care system: those who are tested especially those who test positive and those with severe disease,” Hartert said in a prepared statement. “These data provide real-time guidance in a setting of limited test availability, but they don’t enable us to understand the full extent of SARS-CoV-2 infection in the entire population. The HEROS study will help fill this knowledge gap and inform public health interventions.”

The study, which will be completed remotely, requires a caregiver in the home to collect nasal swabs from the primary pediatric study participant and all other family members, every 2 weeks. The samples will then be mailed to a laboratory for analysis.

On the same day the nasal swab samples are taken, the caregiver will complete an online questionnaire about the participant’s symptoms, social distancing practices, activities outside the home and exposure to those who are not sick.

If any member of the participating family begins to develop symptoms of a viral illness, the caregiver will be required to fill out an additional questionnaire, which will determine the likelihood of a SARS-CoV-2 infection. If a case of COVID-19 is likely, the caregiver will need to collect nasal swab samples from all participants, as well as a stool sample from the symptomatic member.

Preliminary evidence has suggested that having an allergic condition paradoxically may reduce an individual’s susceptibility to the SARS-CoV-2 infection, the NIH explained. A recent study, funded by the NIAID, examined the expression of angiotensin-converting enzyme 2 (ACE2) — the gene that codes the receptor for the coronavirus — in upper and lower airway cells. ACE2 is needed for a cell to make the receptor. Individuals with high levels of asthma and sensitivity to allergens had the lowest levels of expression of ACE2. The HEROS study will further observe whether reduced ACE2 gene expression in airway cells of children relates to lower SARS-CoV-2 rates.

“There may be children with other conditions in the cohorts, but the study is not specifically aiming to selectively study the incidence of SARS-CoV-2 in children with other conditions,” Alkis Togias, MD, chief of the Allergy, Asthma, and Airway Biology Branch at NIAID, told Healio. – by Ken Downey Jr.

Disclosures: The authors report no relevant financial disclosures.

An NIH-funded study will seek answers to questions about COVID-19 in children. The Human Epidemiology and Response to SARS-CoV-2, or HEROS, study will attempt to determine the rate of SARS-CoV-2 infection in children and the percentage of infected children who develop symptoms of COVID-19, the NIH announced.

The study also will assess the rates of SARS-CoV-2 infection among children with asthma or other allergic conditions and determine if they differ from the rates among children without these comorbidities.

“One interesting feature of this novel coronavirus pandemic is that very few children have become sick with COVID-19 compared to adults,” National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci, MD, said in a statement. “Is this because children are resistant to infection with SARS-CoV-2, or because they are infected but do not develop symptoms? The HEROS study will help us begin to answer these and other key questions.”

Researchers will enroll 6,000 people from 2,000 participating families in 11 U.S. cities — Baltimore; Boston; Cincinnati; Dallas; Denver; Detroit; Madison, Wisconsin; Marshfield, Wisconsin; Nashville; New York; and St. Louis.

The study team plans to follow participating children and their families for 6 months to observe who becomes infected, whether the virus is transmitted to family members and which family members develop COVID-19.

The study will be led by Tina V. Hartert, MD, MPH, who heads the Center for Asthma & Environmental Sciences Research at Vanderbilt University.

“So far, data on the extent of SARS-CoV-2 infection in the U.S. population have been limited to people who physically interact with the health care system: those who are tested especially those who test positive and those with severe disease,” Hartert said in a prepared statement. “These data provide real-time guidance in a setting of limited test availability, but they don’t enable us to understand the full extent of SARS-CoV-2 infection in the entire population. The HEROS study will help fill this knowledge gap and inform public health interventions.”

The study, which will be completed remotely, requires a caregiver in the home to collect nasal swabs from the primary pediatric study participant and all other family members, every 2 weeks. The samples will then be mailed to a laboratory for analysis.

On the same day the nasal swab samples are taken, the caregiver will complete an online questionnaire about the participant’s symptoms, social distancing practices, activities outside the home and exposure to those who are not sick.

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If any member of the participating family begins to develop symptoms of a viral illness, the caregiver will be required to fill out an additional questionnaire, which will determine the likelihood of a SARS-CoV-2 infection. If a case of COVID-19 is likely, the caregiver will need to collect nasal swab samples from all participants, as well as a stool sample from the symptomatic member.

Preliminary evidence has suggested that having an allergic condition paradoxically may reduce an individual’s susceptibility to the SARS-CoV-2 infection, the NIH explained. A recent study, funded by the NIAID, examined the expression of angiotensin-converting enzyme 2 (ACE2) — the gene that codes the receptor for the coronavirus — in upper and lower airway cells. ACE2 is needed for a cell to make the receptor. Individuals with high levels of asthma and sensitivity to allergens had the lowest levels of expression of ACE2. The HEROS study will further observe whether reduced ACE2 gene expression in airway cells of children relates to lower SARS-CoV-2 rates.

“There may be children with other conditions in the cohorts, but the study is not specifically aiming to selectively study the incidence of SARS-CoV-2 in children with other conditions,” Alkis Togias, MD, chief of the Allergy, Asthma, and Airway Biology Branch at NIAID, told Healio. – by Ken Downey Jr.

Disclosures: The authors report no relevant financial disclosures.

    Perspective

    Richard F. Jacobs

    The HEROS study funded by the NIH/NIAID is an integral component of understanding SARS-CoV-2. It presents a series of very interesting questions that will help better our understanding of the epidemiology of this virus and to some degree the biology of infection. Each of these aspects will help us better prepare for future outbreaks and future viral pandemics. Many respiratory viruses have been proven to have children as a significant enhancement to spread of infection in adults. It will not be surprising to find out that children are being infected. The reasons for why they have not suffered a higher rate of significant clinical disease will be fascinating and a big advance in our understanding of coronaviruses. If this study (and hopefully more to come in the near future) does show that children have an infection rate similar to adults, it adds to our ability to prepare for the future and will help direct vaccine initiatives for children.

    Disclosure: Jacobs reports no relevant financial disclosures.

    • Richard F. Jacobs, MD
    • Infectious Diseases in Children Chief Medical Editor
      Professor emeritus
      University of Arkansas for Medical Sciences

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