Middle East respiratory syndrome coronavirus disease is rare in children: An update from Saudi Arabia

Al-Tawfiq, Jaffar A; Kattan, Rana F; Memish, Ziad A

Possible explanations for the lower number of pediatric cases compared to adults include differential testing of adult patients and milder diseases in children; although, serologic testing of pediatric patients in KSA and Jordan did not reveal any positive cases [24, 25] . In the largest sero-epidemiologic survey in KSA, the study did not include children and thus it is difficult to establish the rate of sero-positivity in children [31] . The MERS-CoV infection rate in children remains low and possible explanations include: A milder disease in children, asymptomatic infection, or the presence of yet to be identified factors. The development of a shorter duration of MERS in children is another possible explanation. If this is the case, it may limit the development of a positive serology. In one study, delayed antibody responses as measured with the neutralization test was associated with severe diseases [33] . The longevity of antibodies in MERS-CoV cases might be limited as was the case with SARS [33, 34] . The only study of serology among children was done among hospitalized pediatric cases who presented with lower respiratory tract infections [25] . There is no systematic screening of exposed children using serologic testing; this limited the interpretation of available serologic studies.