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. 2021 Apr;26(14):2001248.
doi: 10.2807/1560-7917.ES.2021.26.14.2001248.

Characteristics and risk factors for SARS-CoV-2 in children tested in the early phase of the pandemic: a cross-sectional study, Italy, 23 February to 24 May 2020

Marzia Lazzerini  1 , Idanna Sforzi  2 , Sandra Trapani  3 , Paolo Biban  4 , Davide Silvagni  4 , Giovanna Villa  5 , Jessica Tibaldi  5 , Luca Bertacca  6 , Enrico Felici  7 , Giuseppina Perricone  7 , Roberta Parrino  8 , Claudia Gioè  9 , Sara Lega  1 , Mariasole Conte  1 , Federico Marchetti  10 , Annamaria Magista  11 , Paola Berlese  12 , Stefano Martelossi  12 , Francesca Vaienti  13 , Enrico Valletta  13 , Margherita Mauro  14 , Roberto Dall'Amico  14 , Silvia Fasoli  15 , Antonio Gatto  16 , Antonio Chiaretti  16 , Danica Dragovic  17 , Paola Pascolo  17 , Chiara Pilotto  18 , Ilaria Liguoro  18 , Elisabetta Miorin  19 , Francesca Saretta  19 , Gian Luca Trobia  20 , Antonella Di Stefano  20 , Azzurra Orlandi  21 , Fabio Cardinale  21 , Riccardo Lubrano  22 , Alessia Testa  22 , Marco Binotti  23 , Valentina Moressa  1 , Egidio Barbi  1   24 , Benedetta Armocida  1 , Ilaria Mariani  1 ; COVID-19 Italian Pediatric Study Network  25
Affiliations

Characteristics and risk factors for SARS-CoV-2 in children tested in the early phase of the pandemic: a cross-sectional study, Italy, 23 February to 24 May 2020

Marzia Lazzerini et al. Euro Surveill. 2021 Apr.

Abstract

BackgroundVery few studies describe factors associated with COVID-19 diagnosis in children.AimWe here describe characteristics and risk factors for COVID-19 diagnosis in children tested in 20 paediatric centres across Italy.MethodsWe included cases aged 0-18 years tested between 23 February and 24 May 2020. Our primary analysis focused on children tested because of symptoms/signs suggestive of COVID-19.ResultsAmong 2,494 children tested, 2,148 (86.1%) had symptoms suggestive of COVID-19. Clinical presentation of confirmed COVID-19 cases included besides fever (82.4%) and respiratory signs or symptoms (60.4%) also gastrointestinal (18.2%), neurological (18.9%), cutaneous (3.8%) and other unspecific influenza-like presentations (17.8%). In multivariate analysis, factors significantly associated with SARS-CoV-2 positivity were: exposure history (adjusted odds ratio (AOR): 39.83; 95% confidence interval (CI): 17.52-90.55; p < 0.0001), cardiac disease (AOR: 3.10; 95% CI: 1.19-5.02; p < 0.0001), fever (AOR: 3.05%; 95% CI: 1.67-5.58; p = 0.0003) and anosmia/ageusia (AOR: 4.08; 95% CI: 1.69-9.84; p = 0.002). Among 190 (7.6%) children positive for SARS-CoV-2, only four (2.1%) required respiratory support and two (1.1%) were admitted to intensive care; all recovered.ConclusionRecommendations for SARS-CoV-2 testing in children should consider the evidence of broader clinical features. Exposure history, fever and anosmia/ageusia are strong risk factors in children for positive SARS-CoV-2 testing, while other symptoms did not help discriminate positive from negative individuals. This study confirms that COVID-19 was a mild disease in the general paediatric population in Italy. Further studies are needed to understand risk, clinical spectrum and outcomes of COVID-19 in children with pre-existing conditions.

Keywords: COVID-19; Italy; children; risk factors.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Study flow diagram, paediatric SARS-CoV-2, Italy, 23 February–24 May 2020 (n = 2,494)
Figure 2
Figure 2
Clinical presentation of SARS-CoV-2-positive children, Italy, 23 February–24 May 2020 (n =159)
See this image and copyright information in PMC

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