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Child transmission of SARS-CoV-2: a systematic review and meta-analysis
Sarah L Silverberg1, Bei Yuan Zhang2, Shu Nan Jessica Li2
1Department of Pediatrics, BC Children's Hospital, 4500 Oak Street, V6H 3N1, Vancouver, BC, Canada. sarah.silverberg@alumni.ubc.ca.
Insights
Children transmit COVID-19 (coronavirus disease 2019) at lower rates to other children than to adults. Infected children pose the highest transmission risk to household adults, impacting school and vaccine policies.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- Understanding child transmission of COVID-19 (coronavirus disease 2019) is crucial for policy decisions.
- Implications for school policies, childcare, and vaccine campaigns are significant.
Purpose of the Study:
- To systematically review the role of children in SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) transmission.
- To identify transmission patterns from children to other children and adults.
Main Methods:
- Systematic review of studies published before March 31, 2021.
- Inclusion of studies quantifying transmission rates from pediatric index cases in various settings.
- Adherence to PRISMA guidelines with dual reviewer data abstraction.
Main Results:
- 40 studies met inclusion criteria from over 6000 articles.
- Overall secondary attack rate was 8.4%; 26.4% for adult contacts vs. 5.7% for child contacts.
- Pooled estimate indicated a 0.10 probability of a contact being a secondary case.
Conclusions:
- Children transmit COVID-19 less effectively to other children compared to adults.
- Household adults face the highest risk of infection from a pediatric COVID-19 case.
Background:
Understanding of the role of children in COVID-19 transmission has significant implications for school and childcare policies, as well as appropriate targeting of vaccine campaigns. The objective of this systematic review was to identify the role of children in SARS-CoV-2 transmission to other children and adults.
Methods:
MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Web of Science were electronically searched for articles published before March 31, 2021. Studies of child-to-child and child-to-adult transmission and quantified the incidence of index and resulting secondary attack rates of children and adults in schools, households, and other congregate pediatric settings were identified. All articles describing confirmed transmission of SARS-CoV-2 from a child were included. PRISMA guidelines for data abstraction were followed, with each step conducted by two reviewers.
Results:
40 of 6110 articles identified met inclusion criteria. Overall, there were 0.8 secondary cases per primary index case, with a secondary attack rate of 8.4% among known contacts. The secondary attack rate was 26.4% among adult contacts versus 5.7% amongst child contacts. The pooled estimate of a contact of a pediatric index case being infected as secondary case was 0.10 (95% CI 0.03-0.25).
Conclusions:
Children transmit COVID-19 at a lower rate to children than to adults. Household adults are at highest risk of transmission from an infected child, more so than adults or children in other settings.
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