DIAGNOSIS AND MANAGEMENT OF COVID-19 INFECTION
IN CHILDREN

Sri Lanka College of Paediatricians, Family Health Bureau and

World Health Organisation (WHO)- Sri Lanka

5. Case Definition And Diagnosis

5.1. Case definitions

Suspected Case:
A child with acute illness (at least one sign/ symptom, e.g., cough, shortness of breath with/without fever, AND having been in contact with a confirmed or probable patient with COVID-19 infection during the last 14 days,
OR
A child with an acute illness as above is a resident in an area with the high transmission or traveled to an area with high prevalence or arrived from overseas during the previous 14 days before the onset of symptoms
OR
A child with severe acute respiratory illness AND the absence of an alternative diagnosis that fully explains the clinical condition.
However, a high degree of suspicion is important as there are atypical presentations reported in children, particularly in the presence of close contacts or from an area with a high prevalence rate.

Probable Case:
A suspected case for whom RAT or RT-PCR testing for SARS CoV-2 virus is inconclusive.
OR
A suspected case for whom RAT or RT-PCR test could not be performed for any reason.

Confirmed Case:
A child with laboratory confirmation of Covid-19 infection by a positive RAT or RT-PCR irrespective of clinical signs and symptoms.

5.2 Choice of testing for a suspected case
Rapid antigen test (RAT) would be preferred as the first test in symptomatic patients. It is cheap and has a reasonable sensitivity and specificity. It correctly identifies COVID-19 in an average of 72% of people with symptoms than 58% of people without symptoms. It is most accurate when used within the first week after the onset of symptoms).
If the rapid antigen test is negative and still, there is a high index of suspicion of COVID-19, a PCR test should be performed.
A second PCR may be performed in a symptomatic child in whom the initial test was negative to confirm the diagnosis.