Children are not COVID-19 super spreaders: time to go back to school

Munro, Alasdair; Faust, Saul N

doi:10.1136/archdischild-2020-319474

Cited by 197 publications

(183 citation statements)

References 16 publications

(15 reference statements)

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“…A number of authors have concluded that children and adolescents may be less susceptible to SARS-CoV-2, 2,14 although there are multiple sources of bias in each study type, which can complicate straightforward analysis. In contact-tracing studies, testing of only symptomatic contacts will introduce significant bias, as will seroprevalence studies drawn from clinical contact studies (eg, primary care) or residual laboratory sera.…”

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confidence: 99%

Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults

et al. 2021

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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 (I 2 = 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.

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confidence: 99%

Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults

et al. 2021

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“…Our infection control efforts to safely reopen schools will continue in order to protect children's rights to learn and socialise. 6 Contributors KW conceived the study, analysed the data and wrote the first draft of the manuscript. All authors contributed to the study design, revised the manuscript and approved the final version.…”

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confidence: 99%

Infection and transmission of COVID-19 among students and teachers in schools in Japan after the reopening in June 2020

Wada

Okabe

Shobugawa

2020

bmjpo

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We aimed to investigate the confirmed COVID-19 cases among students and teachers in elementary schools (ages 6–12 years) and junior high schools (ages 13–15 years) in Japan between 1 June and 31 July 2020. We requested all schools to provide reports when students or teachers tested positive for COVID-19. A total of 207 cases were reported among students. Household transmission was identified as the dominant transmission route, confirmed in 71.4% of elementary schools and 60.3% of junior high schools. A total of 39 cases were reported among teachers, of which transmission route was unknown in 72.4% of elementary schools and 90.0% of junior high schools.

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“…According to the currently available evidence, SARS-CoV-2 infection in children is rarely associated with severe disease ( 1 ), children are less likely to be infected compared with adults, and children are likely to be less infectious compared with infective adults ( 2 , 3 ). However, multiple cases of children with a new hyperinflammatory condition in children subsequent to SARS-CoV-2 infection have been reported in Europe and the United States of America ( Tables 1 , 2 ).…”

Section: Statementmentioning

confidence: 99%

Pediatric Inflammatory Multisystem Syndrome: Statement by the Pediatric Section of the European Society for Emergency Medicine and European Academy of Pediatrics

et al. 2020

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A rise in cases with a new hyperinflammatory disease in children has been reported in Europe and in the Unites States of America, named the Pediatric Inflammatory Multisystem Syndrome—temporally associated with SARS-CoV-2 (PIMS-TS). There appears to be a wide spectrum of signs and symptoms with varying degrees of severity, including a toxic shock like presentation with hypovolaemia and shock, and a Kawasaki-like presentation with involvement of the coronary arteries. Most of these children have evidence of a previous infection with SARS-CoV-2, or a history of significant exposure, but not all. Limited data exist on the incidence of PIMS-TS, but it remains a rare condition. Early recognition and escalation of care is important to prevent the development of serious sequelae, such as coronary artery aneurysms. Clinicians assessing febrile children in primary and secondary care should include PIMS-TS in their differential diagnoses. In children fulfilling the case definition, additional investigations should be undertaken to look for evidence of inflammation and multiorgan involvement. Suspected cases should be discussed with experts in pediatric infectious diseases at an early stage, and advice should be sought from critical care in more severe cases early. There is limited consensus on treatment; but most children have been treated with immunoglobulins or steroids, and with early consideration of biologicals such anti-TNF and anti-IL1 agents. Treatment should ideally be within the context of controlled treatment trials. Clinicians are encouraged to document and share their cases using research registries.

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Children are not COVID-19 super spreaders: time to go back to school

Cited by 197 publications

References 16 publications

Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults

Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults

Infection and transmission of COVID-19 among students and teachers in schools in Japan after the reopening in June 2020

Pediatric Inflammatory Multisystem Syndrome: Statement by the Pediatric Section of the European Society for Emergency Medicine and European Academy of Pediatrics

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