Skip to main content
Top
Published in: BMC Medical Research Methodology 1/2020

Open Access 01-12-2020 | SARS-CoV-2 | Research article

Establishment of a pediatric COVID-19 biorepository: unique considerations and opportunities for studying the impact of the COVID-19 pandemic on children

Authors: Rosiane Lima, Elizabeth F. Gootkind, Denis De la Flor, Laura J. Yockey, Evan A. Bordt, Paolo D’Avino, Shen Ning, Katerina Heath, Katherine Harding, Jaclyn Zois, Grace Park, Margot Hardcastle, Kathleen A. Grinke, Sheila Grimmel, Susan P. Davidson, Pamela J. Forde, Kathryn E. Hall, Anne M. Neilan, Juan D. Matute, Paul H. Lerou, Alessio Fasano, Jessica E. Shui, Andrea G. Edlow, Lael M. Yonker

Published in: BMC Medical Research Methodology | Issue 1/2020

Login to get access

Abstract

Background

COVID-19, the disease caused by the highly infectious and transmissible coronavirus SARS-CoV-2, has quickly become a morbid global pandemic. Although the impact of SARS-CoV-2 infection in children is less clinically apparent, collecting high-quality biospecimens from infants, children, and adolescents in a standardized manner during the COVID-19 pandemic is essential to establish a biologic understanding of the disease in the pediatric population. This biorepository enables pediatric centers world-wide to collect samples uniformly to drive forward our understanding of COVID-19 by addressing specific pediatric and neonatal COVID-19-related questions.

Methods

A COVID-19 biospecimen collection study was implemented with strategic enrollment guidelines to include patients seen in urgent care clinics and hospital settings, neonates born to SARS-CoV-2 infected mothers, and asymptomatic children. The methodology described here, details the importance of establishing collaborations between the clinical and research teams to harmonize protocols for patient recruitment and sample collection, processing and storage. It also details modifications required for biobanking during a surge of the COVID-19 pandemic.

Results

Considerations and challenges facing enrollment of neonatal and pediatric cohorts are described. A roadmap is laid out for successful collection, processing, storage and database management of multiple pediatric samples such as blood, nasopharyngeal and oropharyngeal swabs, sputum, saliva, tracheal aspirates, stool, and urine. Using this methodology, we enrolled 327 participants, who provided a total of 972 biospecimens.

Conclusions

Pediatric biospecimens will be key in answering questions relating to viral transmission by children, differences between pediatric and adult viral susceptibility and immune responses, the impact of maternal SARS-CoV-2 infection on fetal development, and factors driving the Multisystem Inflammatory Syndrome in Children. The specimens in this biorepository will allow necessary comparative studies between children and adults, help determine the accuracy of current pediatric viral testing techniques, in addition to, understanding neonatal exposure to SARS-CoV-2 infection and disease abnormalities. The successful establishment of a pediatric biorepository is critical to provide insight into disease pathogenesis, and subsequently, develop future treatment and vaccination strategies.
Appendix
Available only for authorised users
Literature
3.
go back to reference Boyum A. Isolation of lymphocytes, granulocytes and macrophages. Scand J Immunol. 1976;5(Suppl 5):9–15.. Boyum A. Isolation of lymphocytes, granulocytes and macrophages. Scand J Immunol. 1976;5(Suppl 5):9–15..
4.
go back to reference Druce J, Garcia K, Tran T, Papadakis G, Birch C. Evaluation of swabs, transport media, and specimen transport conditions for optimal detection of viruses by PCR. J Clin Microbiol. 2012;50(3):1064–5.CrossRef Druce J, Garcia K, Tran T, Papadakis G, Birch C. Evaluation of swabs, transport media, and specimen transport conditions for optimal detection of viruses by PCR. J Clin Microbiol. 2012;50(3):1064–5.CrossRef
5.
go back to reference Kam KQ, Yung CF, Cui L, Lin Tzer Pin R, Mak TM, Maiwald M, Li J, Chong CY, Nadua K, NWH T, et al. A well infant with coronavirus disease 2019 (COVID-19) with high viral load. Clin Infect Dis. 2020;71(15):847–9. Kam KQ, Yung CF, Cui L, Lin Tzer Pin R, Mak TM, Maiwald M, Li J, Chong CY, Nadua K, NWH T, et al. A well infant with coronavirus disease 2019 (COVID-19) with high viral load. Clin Infect Dis. 2020;71(15):847–9.
6.
go back to reference Han MS, Seong MW, Kim N, Shin S, Cho SI, Park H, Kim TS, Park SS, Choi EH. Viral RNA load in mildly symptomatic and asymptomatic children with COVID-19, Seoul. Emerg Infect Dis. 2020;26(10). Online, ahead of print. Han MS, Seong MW, Kim N, Shin S, Cho SI, Park H, Kim TS, Park SS, Choi EH. Viral RNA load in mildly symptomatic and asymptomatic children with COVID-19, Seoul. Emerg Infect Dis. 2020;26(10). Online, ahead of print.
7.
go back to reference Yonker LM, Neilan AM, Bartsch Y, Patel AB, Regan J, Arya P, Gootkind E, Park G, Hardcastle M, St John A, et al. Pediatric SARS-CoV-2: clinical presentation, infectivity, and immune responses. J Pediatr. 2020;S0022-3476(20):31023–4. Yonker LM, Neilan AM, Bartsch Y, Patel AB, Regan J, Arya P, Gootkind E, Park G, Hardcastle M, St John A, et al. Pediatric SARS-CoV-2: clinical presentation, infectivity, and immune responses. J Pediatr. 2020;S0022-3476(20):31023–4.
8.
go back to reference Shi F, Wu T, Zhu X, Ge Y, Zeng X, Chi Y, Du X, Zhu L, Zhu F, Zhu B, et al. Association of viral load with serum biomakers among COVID-19 cases. Virology. 2020;546:122–6.CrossRef Shi F, Wu T, Zhu X, Ge Y, Zeng X, Chi Y, Du X, Zhu L, Zhu F, Zhu B, et al. Association of viral load with serum biomakers among COVID-19 cases. Virology. 2020;546:122–6.CrossRef
9.
go back to reference Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, Yu J, Kang M, Song Y, Xia J, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382(12):1177–9.CrossRef Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, Yu J, Kang M, Song Y, Xia J, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382(12):1177–9.CrossRef
10.
go back to reference Fialkowski A, Gernez Y, Arya P, Weinacht KG, Kinane TB, Yonker LM. Insight into the pediatric and adult dichotomy of COVID-19: age-related differences in the immune response to SARS-CoV-2 infection. Pediatr Pulmonol. 2020. https://doi.org/10.1002/ppul.24981. Fialkowski A, Gernez Y, Arya P, Weinacht KG, Kinane TB, Yonker LM. Insight into the pediatric and adult dichotomy of COVID-19: age-related differences in the immune response to SARS-CoV-2 infection. Pediatr Pulmonol. 2020. https://​doi.​org/​10.​1002/​ppul.​24981.
11.
go back to reference Team CC-R. Coronavirus disease 2019 in children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(14):422–6.CrossRef Team CC-R. Coronavirus disease 2019 in children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(14):422–6.CrossRef
12.
go back to reference Thomas P, Alexander PE, Ahmed U, Elderhorst E, El-Khechen H, Mammen MJ, Debono VB, Aponte Torres Z, Aryal K, Brocard E, et al. Vertical transmission risk of SARS-CoV-2 infection in the third trimester: a systematic scoping review. J Matern Fetal Neonatal Med. 2020:1–8. Thomas P, Alexander PE, Ahmed U, Elderhorst E, El-Khechen H, Mammen MJ, Debono VB, Aponte Torres Z, Aryal K, Brocard E, et al. Vertical transmission risk of SARS-CoV-2 infection in the third trimester: a systematic scoping review. J Matern Fetal Neonatal Med. 2020:1–8.
13.
go back to reference Bunyavanich S, Do A, Vicencio A. Nasal gene expression of angiotensin-converting enzyme 2 in children and adults. JAMA. 2020;323(23):2427–9. Bunyavanich S, Do A, Vicencio A. Nasal gene expression of angiotensin-converting enzyme 2 in children and adults. JAMA. 2020;323(23):2427–9.
14.
go back to reference Aw D, Silva AB, Palmer DB. Immunosenescence: emerging challenges for an ageing population. Immunology. 2007;120(4):435–46.CrossRef Aw D, Silva AB, Palmer DB. Immunosenescence: emerging challenges for an ageing population. Immunology. 2007;120(4):435–46.CrossRef
15.
go back to reference Cheung EW, Zachariah P, Gorelik M, Boneparth A, Kernie SG, Orange JS, Milner JD. Multisystem inflammatory syndrome related to COVID-19 in previously healthy children and adolescents in New York City. JAMA. 2020. Cheung EW, Zachariah P, Gorelik M, Boneparth A, Kernie SG, Orange JS, Milner JD. Multisystem inflammatory syndrome related to COVID-19 in previously healthy children and adolescents in New York City. JAMA. 2020.
16.
go back to reference Al-Haddad BJS, Jacobsson B, Chabra S, Modzelewska D, Olson EM, Bernier R, Enquobahrie DA, Hagberg H, Ostling S, Rajagopal L, et al. Long-term risk of neuropsychiatric disease after exposure to infection in utero. JAMA Psychiatry. 2019;76(6):594–602.CrossRef Al-Haddad BJS, Jacobsson B, Chabra S, Modzelewska D, Olson EM, Bernier R, Enquobahrie DA, Hagberg H, Ostling S, Rajagopal L, et al. Long-term risk of neuropsychiatric disease after exposure to infection in utero. JAMA Psychiatry. 2019;76(6):594–602.CrossRef
17.
go back to reference Al-Haddad BJS, Oler E, Armistead B, Elsayed NA, Weinberger DR, Bernier R, Burd I, Kapur R, Jacobsson B, Wang C, et al. The fetal origins of mental illness. Am J Obstet Gynecol. 2019;221(6):549–62.CrossRef Al-Haddad BJS, Oler E, Armistead B, Elsayed NA, Weinberger DR, Bernier R, Burd I, Kapur R, Jacobsson B, Wang C, et al. The fetal origins of mental illness. Am J Obstet Gynecol. 2019;221(6):549–62.CrossRef
18.
go back to reference Kepinska AP, Iyegbe CO, Vernon AC, Yolken R, Murray RM, Pollak TA. Schizophrenia and influenza at the centenary of the 1918-1919 Spanish influenza pandemic: mechanisms of psychosis risk. Front Psychiatry. 2020;11:72.CrossRef Kepinska AP, Iyegbe CO, Vernon AC, Yolken R, Murray RM, Pollak TA. Schizophrenia and influenza at the centenary of the 1918-1919 Spanish influenza pandemic: mechanisms of psychosis risk. Front Psychiatry. 2020;11:72.CrossRef
19.
go back to reference Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395(10237):1607–8.CrossRef Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395(10237):1607–8.CrossRef
20.
go back to reference Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, Newburger JW, Kleinman LC, Heidemann SM, Martin AA, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020;383(4):334–46. Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, Newburger JW, Kleinman LC, Heidemann SM, Martin AA, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020;383(4):334–46.
Metadata
Title
Establishment of a pediatric COVID-19 biorepository: unique considerations and opportunities for studying the impact of the COVID-19 pandemic on children
Authors
Rosiane Lima
Elizabeth F. Gootkind
Denis De la Flor
Laura J. Yockey
Evan A. Bordt
Paolo D’Avino
Shen Ning
Katerina Heath
Katherine Harding
Jaclyn Zois
Grace Park
Margot Hardcastle
Kathleen A. Grinke
Sheila Grimmel
Susan P. Davidson
Pamela J. Forde
Kathryn E. Hall
Anne M. Neilan
Juan D. Matute
Paul H. Lerou
Alessio Fasano
Jessica E. Shui
Andrea G. Edlow
Lael M. Yonker
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Medical Research Methodology / Issue 1/2020
Electronic ISSN: 1471-2288
DOI
https://doi.org/10.1186/s12874-020-01110-y

Other articles of this Issue 1/2020

BMC Medical Research Methodology 1/2020 Go to the issue