Coronavirus disease 2019 in healthy children: What is the effect of household contact?

Abstract

Background Coronavirus disease 2019 (COVID‐19) in children is milder than in adults. Household virus exposure may affect clinical severity. We aimed to determine the household contact history of patients and its influence on the clinical stage. Methods One hundred and seventy‐three pediatric patients with COVID‐19 as diagnosed with positive real‐time polymerase chain reaction for severe acute respiratory syndrome coronavirus‐2 aged 1 month to 18 years were included. Demographic data, laboratory and clinical findings, and the history of household contact of the patients were obtained. They were classified according to their clinical stage as mild or moderate‐severe. Results Sixty patients (34.7%) were asymptomatic, and 113 were symptomatic (65.3%). Of the 173 patients, 138 (79.8%) had at least one family member in the household who was diagnosed as having COVID‐19. Hemoglobin, absolute neutrophil count, and absolute neutrophil count /absolute lymphocyte count ratio decreased significantly in patients with household contact. The presence of a household contact did not have a significant effect on the presence of symptoms, clinical course, age, and the sex of the patients. The need for hospitalization was less in the group that had household contact. Being 0–12 months, being female, and being a patient without household contact were independent factors associated with higher hospitalization ratios in logistic regression analysis. Conclusions In this study, we found that household contact history did not significantly affect presenting symptoms and clinical course. We detected the rate of hospitalization to be less in the group with only household contact.

Author response to: Letter to Editor in Response to the association between contact with children and the clinical course of COVID-19

“…However, we would like to re-emphasize that examining the spread of SARS-CoV-2 from child to adult or vice versa was not an aim of our study. Soyemi et al reference a study (Ustundag et al) [7] in their letter that displayed different findings than our study. Ustundag et al examined if contact with a household family member with SARS-CoV-2 was associated with clinical outcomes (e.g., hospitalization) in patients aged one month to 18 years with SARS-CoV-2.…”

Using Secondary Cases to Characterize the Severity of an Emerging or Re-Emerging Infection

“…Among 10 studies reporting the hospitalization status of cases (Fig. 5A), 8 studies reported higher proportion of hospitalization for index cases than secondary cases 30,33,36,39,43,48,50,51 , and 5 studies reached statistical significance 33,43,48,50,51 . Overall, based on the secondary cases, 6.9% (95% CI: 5.7%, 8.2%) of cases were hospitalized.…”

“…Among 31 studies reporting symptom status of cases (Fig. 4), 26 studies reported higher proportion of being symptomatic for index cases than secondary cases 15,16,19,[21][22][23][24][25][26][28][29][30]32,[34][35][36][38][39][40][41][42]44,46,47,49,51 , and 15 studies reached statistical significance 15,19,22,[24][25][26][28][29][30]32,36,[38][39][40]49 . Overall, based on the secondary cases, 90.8% (95% CI: 90.3%, 91.3%) of cases were symptomatic.…”

Response to the association between contact with children and the clinical course of COVID-19

“…A study by Ustundag, et al, illustrated that hospitalization rates were higher in patients without household contact, which is different from Jannuzzi et al, findings. One of the reasons for the heterogeneity is that asymptomatic patients with a low-risk contact might not have been tested; some COVID-19 patients "without household contact" were also untested, and the actual number of the patients "without household contact" remained unknown [3]. CoV-2, and rates were lower during the school period when interactions with other children were expected to increase disease transmission [5].…”

“…findings. One of the reasons for the heterogeneity is that asymptomatic patients with a low-risk contact might not have been tested; some COVID-19 patients ‘without household contact’ were also untested, and the actual number of the patients ‘without household contact’ remained unknown [ 3 ].…”