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- Title
Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults: A Systematic Review and Meta-analysis.
- Authors
Viner, Russell M.; Mytton, Oliver T.; Bonell, Chris; Melendez-Torres, G. J.; Ward, Joseph; Hudson, Lee; Waddington, Claire; Thomas, James; Russell, Simon; van der Klis, Fiona; Koirala, Archana; Ladhani, Shamez; Panovska-Griffiths, Jasmina; Davies, Nicholas G.; Booy, Robert; Eggo, Rosalind M.
- Abstract
Key Points: Question: What is the evidence on the susceptibility to and transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among children and adolescents compared with adults? Findings: In this systematic review and meta-analysis including 32 studies, children and adolescents younger than 20 years had 44% lower odds of secondary infection with SARS-CoV-2 compared with adults 20 years and older; this finding was most marked in those younger than 10 to 14 years. Data were insufficient to conclude whether transmission of SARS-CoV-2 by children is lower than by adults. Meaning: Preliminary evidence suggests that children have a lower susceptibility to SARS-CoV-2 infection compared with adults, but the role that children and adolescents play in transmission of this virus remains unclear. This systematic review and meta-analysis evaluates current evidence on the susceptibility to and transmission of severe acute respiratory syndrome coronavirus 2 among children and adolescents compared with adults. Importance: The degree to which children and adolescents are infected by and transmit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear. The role of children and adolescents in transmission of SARS-CoV-2 is dependent on susceptibility, symptoms, viral load, social contact patterns, and behavior. Objective: To systematically review the susceptibility to and transmission of SARS-CoV-2 among children and adolescents compared with adults. Data Sources: PubMed and medRxiv were searched from database inception to July 28, 2020, and a total of 13 926 studies were identified, with additional studies identified through hand searching of cited references and professional contacts. Study Selection: Studies that provided data on the prevalence of SARS-CoV-2 in children and adolescents (younger than 20 years) compared with adults (20 years and older) derived from contact tracing or population screening were included. Single-household studies were excluded. Data Extraction and Synthesis: PRISMA guidelines for abstracting data were followed, which was performed independently by 2 reviewers. Quality was assessed using a critical appraisal checklist for prevalence studies. Random-effects meta-analysis was undertaken. Main Outcomes and Measures: Secondary infection rate (contact-tracing studies) or prevalence or seroprevalence (population screening studies) among children and adolescents compared with adults. Results: A total of 32 studies comprising 41 640 children and adolescents and 268 945 adults met inclusion criteria, including 18 contact-tracing studies and 14 population screening studies. The pooled odds ratio of being an infected contact in children compared with adults was 0.56 (95% CI, 0.37-0.85), with substantial heterogeneity (I2 = 94.6%). Three school-based contact-tracing studies found minimal transmission from child or teacher index cases. Findings from population screening studies were heterogenous and were not suitable for meta-analysis. Most studies were consistent with lower seroprevalence in children compared with adults, although seroprevalence in adolescents appeared similar to adults. Conclusions and Relevance: In this meta-analysis, there is preliminary evidence that children and adolescents have lower susceptibility to SARS-CoV-2, with an odds ratio of 0.56 for being an infected contact compared with adults. There is weak evidence that children and adolescents play a lesser role than adults in transmission of SARS-CoV-2 at a population level. This study provides no information on the infectivity of children.
- Subjects
INFECTIOUS disease transmission; CONFIDENCE intervals; DISEASE susceptibility; MEDLINE; META-analysis; ONLINE information services; SYSTEMATIC reviews; CONTACT tracing; ODDS ratio; COVID-19; ADOLESCENCE; ADULTS; CHILDREN
- Publication
JAMA Pediatrics, 2021, Vol 175, Issue 2, p143
- ISSN
2168-6203
- Publication type
Article
- DOI
10.1001/jamapediatrics.2020.4573