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COVID-19 in Children: Where do we Stand?
Georgia B Nikolopoulou1, Helena C Maltezou2
1Department of Hepatitis, National Public Health Organization, Athens, Greece.
Insights
Children infected with SARS-CoV-2 are often asymptomatic, with anosmia/ageusia as a key indicator. While severe COVID-19 is rare in kids, multisystem inflammatory syndrome (MIS-C) can occur, and vaccination is recommended for herd immunity.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Children infected with SARS-CoV-2 (the virus causing COVID-19) are typically asymptomatic or mildly symptomatic.
- The prevalence of asymptomatic infections in children is likely underestimated due to lower testing rates.
- Anosmia/ageusia, though less common in children, strongly predicts a positive SARS-CoV-2 test.
Purpose of the Study:
- To review the epidemiologic and clinical features of COVID-19 in children.
- To understand the role of children in SARS-CoV-2 transmission dynamics, especially with new variants.
- To assess the impact of vaccination on pediatric COVID-19 and herd immunity.
Main Methods:
- Review of epidemiologic data on pediatric SARS-CoV-2 infections.
- Analysis of clinical features, including symptoms and complications like MIS-C.
- Evaluation of existing studies on school closures, transmission, and vaccine efficacy in children.
Main Results:
- Children generally have a lower risk of hospitalization and severe complications from COVID-19.
- Multisystem inflammatory syndrome in children (MIS-C) and rare neurologic complications have been described.
- School closures have a limited impact on transmission compared to other social distancing measures.
- New SARS-CoV-2 variants exhibit higher transmissibility, necessitating further study of their impact on children.
- COVID-19 vaccines show high efficacy and tolerability in children, with recommendations for those 12+ to aid herd immunity.
Conclusions:
- Children play a role in SARS-CoV-2 transmission, and their role with new variants needs further investigation.
- While severe COVID-19 is uncommon in children, MIS-C is a significant concern.
- Pediatric vaccination is crucial for individual protection and achieving broader herd immunity against COVID-19.
Abstract:
From the beginning of the coronavirus disease 2019 (COVID-19) pandemic it became evident that children infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain mostly asymptomatic or mildly symptomatic. We reviewed the epidemiologic and clinical features of children with SARS-CoV-2 infection. The true prevalence of asymptomatic SARS-CoV-2 infection is most likely underestimated, as asymptomatic children are less frequently tested. Serologic surveys indicate that half of children tested positive for SARS-CoV-2 report no symptoms. Anosmia/ageusia is not frequent in children but it is the strongest predictor of a positive SARS-CoV-2 test. In general, children with COVID-19 are at lower risk of hospitalization and life-threatening complications. Nevertheless, cases of severe disease or a post-infectious multisystem hyperinflammatory syndrome named multisystem inflammatory syndrome in children (MIS-C) have been described. Rarely children with severe COVID-19 develop neurologic complications. In addition, studies indicate that school closures have a limited impact on SARS-CoV-2 transmission, much less than other social distancing measures. The past months new SARS-CoV-2 variants emerged with higher transmissibility and an increased impact on morbidity and deaths. The role of children in the transmission dynamics of these variants must be elucidated. Lastly, preliminary results from COVID-19 vaccine trials indicate very good efficacy and tolerability in children. Very recently the United States Centers for Disease Control and Prevention and other public health authorities recommend vaccination of children 12 years or older to protect them but mostly to contribute to the achievement of herd immunity.
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