Factors Associated with Positive SARS-CoV-2 Test Results in Outpatient Health Facilities and Emergency Departments Among Children and Adolescents Aged <18 Years - Mississippi, September-November 2020

Abstract

As of December 14, 2020, children and adolescents aged <18 years have accounted for 10.2% of coronavirus disease 2019 (COVID-19) cases reported in the United States.* Mitigation strategies to prevent infection with SARS-CoV-2, the virus that causes COVID-19, among persons of all ages, are important for pandemic control. Characterization of risk factors for SARS-CoV-2 infection among children and adolescents can inform efforts by parents, school and program administrators, and public health officials to reduce SARS-CoV-2 transmission. To assess school, community, and close contact exposures associated with pediatric COVID-19, a case-control study was conducted to compare exposures reported by parents or guardians of children and adolescents aged <18 years with SARS-CoV-2 infection confirmed by reverse transcription-polymerase chain reaction (RT-PCR) testing (case-patients) with exposures reported among those who received negative SARS-CoV-2 RT-PCR test results (control participants). Among 397 children and adolescents investigated, in-person school or child care attendance ≤14 days before the SARS-CoV-2 test was reported for 62% of case-patients and 68% of control participants and was not associated with a positive SARS-CoV-2 test result (adjusted odds ratio [aOR] = 0.8, 95% confidence interval [CI] = 0.5-1.3). Among 236 children aged ≥2 years who attended child care or school during the 2 weeks before SARS-CoV-2 testing, parents of 64% of case-patients and 76% of control participants reported that their child and all staff members wore masks inside the facility (aOR = 0.4, 95% CI = 0.2-0.8). In the 2 weeks preceding SARS-CoV-2 testing, case-patients were more likely to have had close contact with a person with known COVID-19 (aOR = 3.2, 95% CI = 2.0-5.0), have attended gatherings^† with persons outside their household, including social functions (aOR = 2.4, 95% CI = 1.1-5.5) or activities with other children (aOR = 3.3, 95% CI = 1.3-8.4), or have had visitors in the home (aOR = 1.9, 95% CI = 1.2-2.9) than were control participants. Close contacts with persons with COVID-19 and gatherings contribute to SARS-CoV-2 infections in children and adolescents. Consistent use of masks, social distancing, isolation of infected persons, and quarantine of those who are exposed to the virus continue to be important to prevent COVID-19 spread.

FIGURE

Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for close contact, school or child care, and community exposures associated with confirmed COVID-19 among children and adolescents aged <18 years (N = 397) — Mississippi, September–November 2020 Abbreviation: COVID-19 = coronavirus disease 2019. * Odds ratios were estimated using logistic regression models adjusting for sex, age group, and race/ethnicity. ^† Close contact, school or child care, and community exposure questions asked in reference to the 2 weeks before the child’s SARS-CoV-2 test were “Did the child have close contact with another person with confirmed COVID-19?”; “Did your child attend school in person (all of the week, part of the week [part time virtual], none of the week [all virtual])” (missing = 6); "Did your child wear a mask inside at daycare/school? (all the time, some of the time, none of the time)?" (missing = 15); "Did the teachers/staff at your child's daycare/school wear a mask inside (all of the time, some of the time, none of the time)?" (missing = 15); “Did your family/household attend any social gatherings with other people who do not live in your home (like weddings, funerals, parties, celebrations, etc.)?” (missing = 13); “Did your family/members of your household attend any sporting events or concerts?” (missing = 12); “Did your family/household attend meetings or religious services with 10 or more people who do not live with you?” (missing = 11); “Did your child attend any gatherings (10 or more children) outside of the home or school (like birthday parties, playdates, etc.)?” (missing = 12); “Did your family/household travel with any other people/families who do not live with you?” (missing = 8); “Did you receive visitors into your home?” (missing = 19); “Did your family/household eat in restaurants?” (missing = 19); “Are you or anyone in the household a health care provider that provides direct patient contact?” (missing = 8). For each affirmative response, respondents were asked if the activity took place inside or outside, if other persons at the event were masked (everyone, some, or no one) and if social distancing was observed. Mask use inside school by the child and all staff members was dichotomized as all the time (for both questions) versus all other responses.