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. 2021 Apr 9:9:613292.
doi: 10.3389/fped.2021.613292. eCollection 2021.

Intra-Household and Close-Contact SARS-CoV-2 Transmission Among Children - a Systematic Review

Benedikt D Spielberger  1 , Tessa Goerne  1   2 , Anne Geweniger  1 , Philipp Henneke  1   2 , Roland Elling  1   2
Affiliations

Intra-Household and Close-Contact SARS-CoV-2 Transmission Among Children - a Systematic Review

Benedikt D Spielberger et al. Front Pediatr. .

Abstract

Introduction: The outbreak of the novel coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a range of emergency measures worldwide. Early in the pandemic, children were suspected to act as drivers of the COVID-19 spread in the population, which was based on experiences with influenza virus and other respiratory pathogens. Consequently, closures of schools and kindergartens were implemented in many countries around the world, alongside with other non-pharmaceutical interventions for transmission control. Given the grave and multifaceted consequences of contact restriction measures for children, it is crucial to better understand the effect size of these incisive actions for the COVID-19 pandemic. Therefore, we systematically review the current evidence on transmission of SARS-CoV-2 to and by children. Data Sources: PubMed and preprints uploaded on medRxiv. Study Selection: Original research articles, case reports, brief communications, and commentaries were included into the analysis. Each title or abstract was independently reviewed to identify relevant articles. Studies in other languages than English were not included. Data Extraction: Two reviewers independently reviewed the selected studies. Extracted data included citation of each study, type of healthcare setting, location of the study, characteristics of patient population, and reported outcomes. Results: Data on transmission of SARS-CoV-2 on or by children is scarce. Several studies show a lower seropositivity of children compared to adults, suggesting a lower susceptibility of especially younger children. Most insight currently comes from household studies suggesting, that children are predominantly infected by their household contacts. The contagiousness however, seems to be comparable between children and adults, based on our meta-analysis of included studies. Conclusions: Larger and systematic studies are urgently needed to better understand the age dependent patterns of SARS-CoV-2 transmission and thereby design more effective non-pharmaceutical interventions to reduce disease transmission.

Keywords: COVID-19; SAR; SARS-CoV-2; child; household; secondary attack rate; transmission.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram for search.
Figure 2
Figure 2
Overview of the origin of studies included in this review.
Figure 3
Figure 3
Studies included in meta-analysis and their study start (indicated by vertical bar) in proportion to incidence of new infections with SARS-CoV-2 per 100.000 per day (y-axis) and changes over time (x-axis). Local response reactions to reduce spread of SARS-CoV-2 are shown below the x-axis in colored bars. Green bars mean no restrictions, red fullrestrictions, e.g., shut down of transport, no gatherings. Dataset of the figure is available in the Supplementary Material.
Figure 4
Figure 4
Studies included in qualitative analysis and their study start (indicated by vertical bar) in proportion to incidence of new infections with SARS-CoV-2 per 100.000 per day (y-axis) and changes over time (x-axis). Local response reactions to reduce spread of SARS-CoV-2 are shown below the x-axis in colored bars. Green bars mean no restrictions, red full restrictions, e.g., shut down of transport, no gatherings. Dataset of the figure is available in the Supplementary Material.
Figure 5
Figure 5
Seroprevalence studies and their start (indicated by vertical bar) in proportion to incidence of new infections with SARS-CoV-2 per 100.000 per day (y-axis) and changes over time (x-axis). Local response reactions to reduce spread of SARS-CoV-2 are shown below the x-axis in colored bars. Green bars mean no restrictions, red fullrestrictions, e.g. shut down of transport, no gatherings. Dataset of the figure is available in the Supplementary Material.
Figure 6
Figure 6
PCR-prevalence studies and their start (indicated by vertical bar) in proportion to incidence of new infections with SARS-CoV-2 per 100.000 per day (y-axis) and changes over time (x-axis). Local response reactions to reduce spread of SARS-CoV-2 are shown below the x-axis in colored bars. Green bars mean no restrictions, red fullrestrictions, e.g., shut down of transport, no gatherings. Dataset of the figure is available in the Supplementary Material.
Figure 7
Figure 7
Forest plot of meta-analysis of secondary attack rates of child (Left) and adult (Right) index persons.
See this image and copyright information in PMC

References

    1. Zimmermann P, Curtis N. COVID-19 in children, pregnancy and neonates: a review of epidemiologic and clinical features. Pediatr Infect Dis J. (2020) 39:469–77. 10.1097/INF.0000000000002700 - DOI - PMC - PubMed
    1. Gaunt ER, Hardie A, Claas ECJ, Simmonds P, Templeton KE. Epidemiology and clinical presentations of the four human coronaviruses 229E, HKU1, NL63, and OC43 detected over 3 years using a novel multiplex real-time PCR method. J Clin Microbiol. (2010) 48:2940–7. 10.1128/JCM.00636-10 - DOI - PMC - PubMed
    1. Varghese L, Zachariah P, Vargas C, LaRussa P, Demmer RT, Furuya YE, et al. . Epidemiology and clinical features of human coronaviruses in the pediatric population. J Pediatr Infect Dis Soc. (2018) 7:151–8. 10.1093/jpids/pix027 - DOI - PMC - PubMed
    1. Chiu SS, Hung Chan K, Wing Chu K, Kwan SW, Guan Y, Man Poon LL, et al. . Human coronavirus NL63 infection and other coronavirus infections in children hospitalized with acute respiratory disease in Hong Kong, China. Clin Infect Dis. (2005) 40:1721–9. 10.1086/430301 - DOI - PMC - PubMed
    1. Memish ZA, Perlman S, Van Kerkhove MD, Zumla A. Middle East respiratory syndrome. Lancet. (2020) 395:1063–77. 10.1016/S0140-6736(19)33221-0 - DOI - PMC - PubMed

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