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Meta-Analysis
. 2024 Mar 1:14:05003.
doi: 10.7189/jogh.14.05003.

Epidemiology and clinical features of SARS-CoV-2 infection in children and adolescents in the pre-Omicron era: A global systematic review and meta-analysis

Durga Kulkarni  1 , Nabihah Farhana Ismail  1   2 , Fuyu Zhu  3 , Xin Wang  3 , Graciela Del Carmen Morales  4 , Amit Srivastava  4   5 , Kristen E Allen  4 , Julia Spinardi  4 , Ahmed Ehsanur Rahman  1   6 , Moe H Kyaw  4 , Harish Nair  1   3   7
Affiliations
Meta-Analysis

Epidemiology and clinical features of SARS-CoV-2 infection in children and adolescents in the pre-Omicron era: A global systematic review and meta-analysis

Durga Kulkarni et al. J Glob Health. .

Abstract

Methods: We searched MEDLINE, Embase, Global Health, CINAHL, China National Knowledge Infrastructure, Wanfang, CQvip, and the World Health Organization (WHO) COVID-19 global literature databases for primary studies recruiting children aged ≤18 years with a diagnosis of SARS-CoV-2 infection confirmed either by molecular or antigen tests. We used the Joanna Briggs Institute critical appraisal tools to appraise the study quality and conducted meta-analyses using the random effects model for all outcomes except for race/ethnicity as risk factors of SARS-CoV-2 infection.

Results: We included 237 studies, each reporting at least one of the study outcomes. Based on data from 117 studies, the pooled SARS-CoV-2 positivity rate was 9.30% (95% confidence interval (CI) = 7.15-11.73). Having a comorbidity was identified as a risk factor for SARS-CoV-2 infection (risk ratio (RR) = 1.33; 95% CI = 1.04-1.71) based on data from 49 studies. Most cases in this review presented with mild disease (n = 50; 52.47% (95% CI = 44.03-60.84)). However, 20.70% of paediatric SARS-CoV-2 infections were hospitalised (67 studies), 7.19% required oxygen support (57 studies), 4.26% required intensive care (93 studies), and 2.92% required assisted ventilation (63 studies). The case fatality ratio (n = 119) was 0.87% (95% CI = 0.54-1.28), which included in-hospital and out-of-hospital deaths.

Conclusions: Our data showed that children were at risk for SARS-CoV-2 infections and severe outcomes in the pre-Omicron era. These findings underscore the need for effective vaccination strategies for the paediatric population to protect against the acute and long-term sequelae of COVID-19.

Registration: PROSPERO: CRD42022327680.

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Conflict of interest statement

Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose the following activities and/or relationships: DK reports consulting fees from Pfizer, related to the submitted work and outside the submitted work. XW received research grants from GlaxoSmithKline, Wellcome Trust, and Nanjing Medical University, outside the submitted work, and consultancy fees from Pfizer, related to the submitted work. AS, JS, and MHK are employees of Pfizer. AS was a Pfizer employee during study conduct and manuscript development and may hold stock options; he is currently employed by Orbital Therapeutics. HN reports consulting fees from Pfizer, related to the submitted work; and grants from the Innovative Medicines Initiative outside the submitted work; consulting fees from the Gates Foundation, Pfizer, and Sanofi; honoraria from AbbVie; support from Sanofi for attending meetings; and participation on advisory boards from GSK, Merck, Pfizer, Sanofi, Icosavax, Janssen, Novavax, Reviral, Resvinet, and WHO outside the submitted work.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Forest plot for subgroup analysis of SARS-CoV-2 proportion positive in people aged ≤18 years. Panel A. Children aged <5 years divided into <1-year and 1 to <5-year-old groups. Panel B. Children aged 5 to 18 years divided into 5 to <11-year and 11 to ≤18-year-old groups.
Figure 3
Figure 3
Severity of SARS-CoV-2 infection in children aged ≤18 years.
See this image and copyright information in PMC

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