tetano
Editor, Senior Moderator
JAMA Pediatr
. 2020 Sep 25.
doi: 10.1001/jamapediatrics.2020.4573. Online ahead of print.
Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults: A Systematic Review and Meta-analysis
Russell M Viner[SUP] 1 [/SUP], Oliver T Mytton[SUP] 2 [/SUP], Chris Bonell[SUP] 3 [/SUP], G J Melendez-Torres[SUP] 4 [/SUP], Joseph Ward[SUP] 1 [/SUP], Lee Hudson[SUP] 1 [/SUP], Claire Waddington[SUP] 5 [/SUP], James Thomas[SUP] 6 [/SUP], Simon Russell[SUP] 1 [/SUP], Fiona van der Klis[SUP] 7 [/SUP], Archana Koirala[SUP] 8 [/SUP], Shamez Ladhani[SUP] 9 [/SUP], Jasmina Panovska-Griffiths[SUP] 10 [/SUP], Nicholas G Davies[SUP] 3 [/SUP], Robert Booy[SUP] 8 [/SUP], Rosalind M Eggo[SUP] 3 [/SUP]
Affiliations
Abstract
Importance: The degree to which children and adolescents are infected by and transmit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear. The role of children and adolescents in transmission of SARS-CoV-2 is dependent on susceptibility, symptoms, viral load, social contact patterns, and behavior.
Objective: To systematically review the susceptibility to and transmission of SARS-CoV-2 among children and adolescents compared with adults.
Data sources: PubMed and medRxiv were searched from database inception to July 28, 2020, and a total of 13 926 studies were identified, with additional studies identified through hand searching of cited references and professional contacts.
Study selection: Studies that provided data on the prevalence of SARS-CoV-2 in children and adolescents (younger than 20 years) compared with adults (20 years and older) derived from contact tracing or population screening were included. Single-household studies were excluded.
Data extraction and synthesis: PRISMA guidelines for abstracting data were followed, which was performed independently by 2 reviewers. Quality was assessed using a critical appraisal checklist for prevalence studies. Random-effects meta-analysis was undertaken.
Main outcomes and measures: Secondary infection rate (contact-tracing studies) or prevalence or seroprevalence (population screening studies) among children and adolescents compared with adults.
Results: A total of 32 studies comprising 41 640 children and adolescents and 268 945 adults met inclusion criteria, including 18 contact-tracing studies and 14 population screening studies. The pooled odds ratio of being an infected contact in children compared with adults was 0.56 (95% CI, 0.37-0.85), with substantial heterogeneity (I2 = 94.6%). Three school-based contact-tracing studies found minimal transmission from child or teacher index cases. Findings from population screening studies were heterogenous and were not suitable for meta-analysis. Most studies were consistent with lower seroprevalence in children compared with adults, although seroprevalence in adolescents appeared similar to adults.
Conclusions and relevance: In this meta-analysis, there is preliminary evidence that children and adolescents have lower susceptibility to SARS-CoV-2, with an odds ratio of 0.56 for being an infected contact compared with adults. There is weak evidence that children and adolescents play a lesser role than adults in transmission of SARS-CoV-2 at a population level. This study provides no information on the infectivity of children.
. 2020 Sep 25.
doi: 10.1001/jamapediatrics.2020.4573. Online ahead of print.
Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults: A Systematic Review and Meta-analysis
Russell M Viner[SUP] 1 [/SUP], Oliver T Mytton[SUP] 2 [/SUP], Chris Bonell[SUP] 3 [/SUP], G J Melendez-Torres[SUP] 4 [/SUP], Joseph Ward[SUP] 1 [/SUP], Lee Hudson[SUP] 1 [/SUP], Claire Waddington[SUP] 5 [/SUP], James Thomas[SUP] 6 [/SUP], Simon Russell[SUP] 1 [/SUP], Fiona van der Klis[SUP] 7 [/SUP], Archana Koirala[SUP] 8 [/SUP], Shamez Ladhani[SUP] 9 [/SUP], Jasmina Panovska-Griffiths[SUP] 10 [/SUP], Nicholas G Davies[SUP] 3 [/SUP], Robert Booy[SUP] 8 [/SUP], Rosalind M Eggo[SUP] 3 [/SUP]
Affiliations
- PMID: 32975552
- DOI: 10.1001/jamapediatrics.2020.4573
Abstract
Importance: The degree to which children and adolescents are infected by and transmit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear. The role of children and adolescents in transmission of SARS-CoV-2 is dependent on susceptibility, symptoms, viral load, social contact patterns, and behavior.
Objective: To systematically review the susceptibility to and transmission of SARS-CoV-2 among children and adolescents compared with adults.
Data sources: PubMed and medRxiv were searched from database inception to July 28, 2020, and a total of 13 926 studies were identified, with additional studies identified through hand searching of cited references and professional contacts.
Study selection: Studies that provided data on the prevalence of SARS-CoV-2 in children and adolescents (younger than 20 years) compared with adults (20 years and older) derived from contact tracing or population screening were included. Single-household studies were excluded.
Data extraction and synthesis: PRISMA guidelines for abstracting data were followed, which was performed independently by 2 reviewers. Quality was assessed using a critical appraisal checklist for prevalence studies. Random-effects meta-analysis was undertaken.
Main outcomes and measures: Secondary infection rate (contact-tracing studies) or prevalence or seroprevalence (population screening studies) among children and adolescents compared with adults.
Results: A total of 32 studies comprising 41 640 children and adolescents and 268 945 adults met inclusion criteria, including 18 contact-tracing studies and 14 population screening studies. The pooled odds ratio of being an infected contact in children compared with adults was 0.56 (95% CI, 0.37-0.85), with substantial heterogeneity (I2 = 94.6%). Three school-based contact-tracing studies found minimal transmission from child or teacher index cases. Findings from population screening studies were heterogenous and were not suitable for meta-analysis. Most studies were consistent with lower seroprevalence in children compared with adults, although seroprevalence in adolescents appeared similar to adults.
Conclusions and relevance: In this meta-analysis, there is preliminary evidence that children and adolescents have lower susceptibility to SARS-CoV-2, with an odds ratio of 0.56 for being an infected contact compared with adults. There is weak evidence that children and adolescents play a lesser role than adults in transmission of SARS-CoV-2 at a population level. This study provides no information on the infectivity of children.