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Meta-Analysis
. 2021 Jul 17:11:05013.
doi: 10.7189/jogh.11.05013. eCollection 2021.

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

Omar Irfan  1 , Jiang Li  1 , Kun Tang  1   2 , Zhicheng Wang  2 , Zulfiqar A Bhutta  1   3
Affiliations
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

Omar Irfan et al. J Glob Health. .

Abstract

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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Conflict of interest statement

Conflict of Interest: The authors have completed the ICMJE Unified Competing Interest form (available on request from the corresponding author), and declare no conflict of interest

Figures

Figure 1
Figure 1
PRISMA flow diagram of study selection process.
Figure 2
Figure 2
Pooled risk ratio of SARS-Cov-2 infection in children vs adults in national surveillance, disaggregated by infection positivity and seroprevalence.
Figure 3
Figure 3
Pooled risk ratio of SARS-Cov-2 infection in children vs adults in subnational surveillance, sub-grouped into infection positivity and seroprevalence.
Figure 4
Figure 4
Pooled odds of children and adolescents being an infected contact in community and household family clusters Panel A. Odds of children and adolescents being infected vs adults, by school status. Panel B. Odds of children and adolescents being infected vs adults, by age group (subset of studies in Panel A).
Figure 5
Figure 5
Pooled odds ratios for children and adolescent contracting infection compared to adults, by educational setting.
See this image and copyright information in PMC

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