What is the evidence for transmission of COVID-19 by children in schools? A living systematic review

Xu, Wei; Li, Xue; Dozier, Marshall; He, Yazhou; Kirolos, Amir; Lang, Zhongyu; Mathews, Catherine; Siegfried, Nandi; Τheodoratou, Evropi; Uncover,

doi:10.7189/jogh.10.021104

Cited by 67 publications

(42 citation statements)

References 40 publications

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“…There was some evidence of robust spread of SARS-CoV-2 in secondary and high-schools (eg, high seroprevalence of anti-SARS-CoV-2 antibodies among high-school students in northern France [ 83 ], and an outbreak in an Israel high-school [ 13 ]), while the spread seemed to be more limited in primary schools [ 12 , 14 , 15 , 82 , 88 - 91 ]. Xu et al conducted a living systematic review and reported that the SARS-CoV-2 infection attack rates were 0.15% (95% CI = 0%-0.93%) among students and 0.70% (95% CI = 0%-3.56%) among school staff, respectively [ 110 ]. These findings are largely consistent with the primary finding of the present study that children are not as susceptible to SARS-CoV-2 infection as adults, and while children are known to be “super spreaders” for influenza [ 111 ] and measles viruses [ 112 ], they play only a limited role in SARS-CoV-2 transmission in various settings.…”

Section: Discussionmentioning

confidence: 99%

Risk of infection and transmission of SARS-CoV-2 among children and adolescents in households, communities and educational settings: A systematic review and meta-analysis

et al. 2021

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Background There is uncertainty with respect to SARS-CoV-2 transmission in children (0-19 years) with controversy on effectiveness of school-closures in controlling the pandemic. It is of equal importance to evaluate the risk of transmission in children who are often asymptomatic or mildly symptomatic carriers that may incidentally transmit SARS-CoV-2 in different settings. We conducted this review to assess transmission and risks for SARS-CoV-2 in children (by age-groups or grades) in community and educational-settings compared to adults. Methods Data for the review were retrieved from PubMed, EMBASE, Cochrane Library, WHO COVID-19 Database, China National Knowledge Infrastructure (CNKI) Database, WanFang Database, Latin American and Caribbean Health Sciences Literature (LILACS), Google Scholar, and preprints from medRixv and bioRixv) covering a timeline from December 1, 2019 to April 1, 2021. Population-screening, contact-tracing and cohort studies reporting prevalence and transmission of SARS-CoV-2 in children were included. Data were extracted according to PRISMA guidelines. Meta-analyses were performed using Review Manager 5.3. Results Ninety studies were included. Compared to adults, children showed comparable national (risk ratio (RR) = 0.87, 95% confidence interval (CI) = 0.71-1.060 and subnational (RR = 0.81, 95% CI = 0.66-1.01) prevalence in population-screening studies, and lower odds of infection in community/household contact-tracing studies (odds ratio (OR) = 0.62, 95% CI = 0.46-0.84). On disaggregation, adolescents observed comparable risk (OR = 1.22, 95% CI = 0.74-2.04) with adults. In educational-settings, children attending daycare/preschools (OR = 0.53, 95% CI = 0.38-0.72) were observed to be at lower-risk when compared to adults, with odds of infection among primary (OR = 0.85, 95% CI = 0.55-1.31) and high-schoolers (OR = 1.30, 95% CI = 0.71-2.38) comparable to adults. Overall, children and adolescents had lower odds of infection in educational-settings compared to community and household clusters. Conclusions Children (<10 years) showed lower susceptibility to COVID-19 compared to adults, whereas adolescents in communities and high-schoolers had comparable risk. Risks of infection among children in educational-settings was lower than in communities. Evidence from school-based studies demonstrate it is largely safe for children (<10 years) to be at schools, however older children (10-19 years) might facilitate transmission. Despite this evidence, studies focusing on the effectiveness of mitigation measures in educational settings are urgently needed to support both public health and educational policy-making for school reopening.

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Section: Discussionmentioning

confidence: 99%

Risk of infection and transmission of SARS-CoV-2 among children and adolescents in households, communities and educational settings: A systematic review and meta-analysis

et al. 2021

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“…Other common aspects of COVID-19 in the pediatric popu lation, highlighted by the available literature, include fecal shedding of the virus in children, 44,46 imaging findings, 21,35,51,67 COVID-19 in neonates and infa nts, 27,29,42,52,54,66 Kawasaki-like disease in pediatric patients, 24 laboratory abnormalities in various parameters, 60 effects of COVID-19 on the survival of children with malignancies, 69 and schooling during COVID-19. 47,70,71 Our study has several limitations. First, by virtue of this bibliometric review, the authors have attempted to give a glimpse of the highest level of evidence (Systematic Reviews and Meta-analysis) published on COVID-19 in the pediatric population.…”

Section: Discussionmentioning

confidence: 95%

Characteristics of Systematic Reviews and Meta-analysis on COVID-19 in the Pediatric Population: A Bibliometric Review With Emphasis on Top 5 Cited Articles

Singh

Kainth

Gaur

et al. 2021

Clin Pediatr (Phila)

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“…A systematic review of five cohort studies comprising 3,345 contacts with 18 transmissions in schools resulted in an overall attack rate of 0.08% (95% confidence interval [CI], 0.00-0.86%). 14 In Ireland, of 1,001 child contacts of six confirmed index cases, there were no secondary cases of COVID-19, suggesting that schools were not drivers of transmission. 15 In Germany, the reopening of schools in May 2020 showed that child-to-child transmission in schools/childcare facilities was very uncommon.…”

Section: Empirical Findings In Mitigating Outbreaksmentioning

confidence: 99%

School closures during the coronavirus disease 2019 outbreak

Cho

Choe

2021

Clin Exp Pediatr

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School closures during the coronavirus disease (COVID-19) pandemic have been outlined in studies from different disciplines, including economics, sociology, mathematical modeling, epidemiology, and public health. In this review, we discuss the implications of school closures in the context of the current COVID-19 pandemic. Modeling studies of the effects of school closures, largely derived from the pandemic influenza model, on severe acute respiratory syndrome coronavirus 2 produced conflicting results. Earlier studies assessed the risk of school reopening by modeling transmission across schools and communities; however, it remains unclear whether the risk is due to increased transmission in adults or children. The empirical findings of the impact of school closures on COVID-19 outbreaks suggest no clear effect, likely because of heterogeneity in community infection pressure, differences in school closure strategies, or the use of multiple interventions. The benefits of school closings are unclear and not readily quantifiable; however, they must be weighed against the potential high social costs, which can also negatively affect the health of this generation.

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What is the evidence for transmission of COVID-19 by children in schools? A living systematic review

Cited by 67 publications

References 40 publications

Risk of infection and transmission of SARS-CoV-2 among children and adolescents in households, communities and educational settings: A systematic review and meta-analysis

Risk of infection and transmission of SARS-CoV-2 among children and adolescents in households, communities and educational settings: A systematic review and meta-analysis

Characteristics of Systematic Reviews and Meta-analysis on COVID-19 in the Pediatric Population: A Bibliometric Review With Emphasis on Top 5 Cited Articles

School closures during the coronavirus disease 2019 outbreak

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