TY - JOUR
T1 - Susceptibility to SARS-CoV-2 Infection among Children and Adolescents Compared with Adults: A Systematic Review and Meta-Analysis: A Systematic Review and Meta-Analysis
AU - Viner, Russell M.
AU - Mytton, Oliver T.
AU - Bonell, Chris
AU - Melendez-Torres, G. J.
AU - Ward, Joseph
AU - Hudson, Lee
AU - Waddington, Claire
AU - Thomas, James
AU - Russell, Simon
AU - Van Der Klis, Fiona
AU - Koirala, Archana
AU - Ladhani, Shamez
AU - Panovska-Griffiths, Jasmina
AU - Davies, Nicholas G.
AU - Booy, Robert
AU - Eggo, Rosalind M.
PY - 2021/2/1
Y1 - 2021/2/1
N2 - 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 13926 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 41640 children and adolescents and 268945 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.
AB - 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 13926 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 41640 children and adolescents and 268945 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.
U2 - 10.1001/jamapediatrics.2020.4573
DO - 10.1001/jamapediatrics.2020.4573
M3 - Review article
SN - 2168-6203
VL - 175
SP - 143
EP - 156
JO - JAMA Pediatrics
JF - JAMA Pediatrics
IS - 2
ER -