LAUSR

SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection responsible for COVID-19 pandemic has affected more than 100 million cases worldwide. Although fewer number of cases have been reported in children, they remain undetected as they are asymptomatic or mildly symptomatic, creating a threat of unknown SARS-CoV-2 transmission to the community [1]. One of the characteristics of pediatric SARS-CoV-2 infection is the persistent fecal viral shedding despite negative nasopharyngeal swab testing, thereby raising the possibility of feco-oral transmission [2]. Pre-existing co-morbidities and an inborn defect in immunity may contribute to a more severe course of COVID-19 in children. Inborn errors of immunity (IEI) are group of more than 400 inherited disorders and patients with some IEI are at an increased risk of developing severe COVID-19 [3]. Prolonged excretion of polioviruses in children suffering from IEI immunized with oral poliovirus vaccine (OPV) or exposed to environmental poliovirus leading to viral mutations has been reported by several studies [4]. In a similar context, these children may also act as a reservoir of SARSCoV-2 infection. Reports of prolonged viral carrier state in immunocompromised patients have underlined the risk for within-host variant generation as seen in the B.1.1.7 variant [5]. Therefore, studies on the susceptibility of individual IEI patients to COVID-19 are relevant for these patients as well as for the community. We report our findings from a study conducted in a small cohort of pediatric patients with IEI to investigate the fecal shedding of SARS-CoV-2 at a tertiary health care center in Mumbai. The stool samples from diagnosed IEI patients were tested retrospectively for SARS-CoV-2 after due approval from ethics committee of BJWHC, Mumbai, and ICMR-NIV, Pune. A total number of 68 stool samples from 34 children (collected from March to October 2020) diagnosed with 17 different IEIs were tested for SARS-CoV-2 infection (Table S1). The clinical, immunological, and molecular findings; treatment details; and symptoms at time of stool sample collection along with the results of stool and nasopharyngeal swab testing of the four patients tested positive are shown in Table 1. Patient 1 (P1) diagnosed as hyper IgM syndrome was observed to shed the virus for about 99 days from the day first tested positive. The content of nucleic acid decreased with increase in months and stopped after 99 days. The Ct values ranged from 26.97 in Orf1ab gene on day 1 to 34.19 on day 99 in the 4 samples consecutively collected with an interval of approximately a month. Patient 2 (P2) diagnosed with Wiskott-Aldrich syndrome shed the virus for nearly 53 days. The Ct value in Orf1ab target gene on day 1 was 22.98, which increased on day 21, but a significant decrease was observed on day 53. Patient 3 (P3) and patient 4 (P4) showed SARS-CoV-2 virus shedding on day 1 and later tested negative in the consecutive samples (Table 1, Fig. 1). Further extensive analysis of SARS-CoV-2 positive stool samples and respective nasal swab (NS)/throat swab (TS) samples at National Influenza Center (NIC), ICMR-NIV, Pune, confirmed SARS-CoV-2 detection in stool samples; in addition, another aliquot of the NS/TS sample of P1 was also found positive for SARS-CoV-2. The viral load for the follow-up stool samples is mentioned in Table 2. The NGS data following alignment and mapping of SARS-CoV-2 * Madhu Chhanda Mohanty [email protected]