COVID-19 in Children and the Dynamics of Infection in Families

Posfay‐Barbe, Klara M.; Wagner, Noémie; Gauthey, Magali; Moussaoui, Dehlia; Loevy, Natasha; Diana, Alessandro; L'Huillier, Arnaud G

doi:10.1542/peds.2020-1576

Cited by 238 publications

(238 citation statements)

References 9 publications

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“…A recent report found that in only 8% of households of 40 sick children, the child was the suspected index case. In the reminder, the child developed the symptoms following or together with a sick adult [18]. The same finding was seen in a cohort of sick children from China [19].…”

Section: Epidemiologysupporting

confidence: 61%

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COVID-19 in the Pediatric Population—Review and Current Evidence

Rabinowicz

Leshem

Pessach

2020

Curr Infect Dis Rep

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Purpose of Review Coronavirus disease 2019 (COVID-19) pandemic has major health and economic impacts. We review disease characteristics in children. Recent Findings Children comprise 1-2% of the diagnosed cases, and typically suffer mild disease. The median age of infected children is 3.3-11 years, and male/female ratio is 1.15-1.55. Common symptoms in children include upper respiratory symptoms (26-54%), cough (44-54%), fever (32-65%), and gastrointestinal (15-30%) symptoms. Substantial proportion (4-23%) are asymptomatic. Death rates are up to 0.7%. Risk factors associated with severe disease are neonatal age group, male gender, lower respiratory tract disease, and pre-existing medical conditions. Vertical transmission was reported. Multisystem inflammatory syndrome (MIS), characterized by fever, multisystem organ involvement, and laboratory markers of inflammation, causes critical illness in > 50% of cases and is increasingly reported from endemic countries. Indirect effects of the coronavirus epidemic include higher rates of psychiatric morbidities, education loss, unhealthy lifestyle changes, and increased child neglect. Vaccines are in clinical trials and immunogenicity has not yet been shown in children. Summary Overall, COVID-19 has lower incidence and causes milder disease in children compared with adult patients. MIS is a rare severe complication more common in children. More data on the efficacy and safety of antivirals in children are needed.

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Section: Epidemiologysupporting

confidence: 61%

“…In children, respiratory symptoms are the most common, followed by fever and gastrointestinal symptoms [3,[16][17][18] (Table 1). Anosmia and ageusia are commonly described in adults [26] but may be more difficult to elicit in young children and thus underreported [27].…”

Section: Clinical Presentation and Disease Coursementioning

confidence: 99%

COVID-19 in the Pediatric Population—Review and Current Evidence

Rabinowicz

Leshem

Pessach

2020

Curr Infect Dis Rep

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“…To date, children represent a small proportion of SARS-CoV-2 con rmed coronavirus disease (COVID-19) cases [1][2][3] . Children are predominantly infected from symptomatic household adult contacts 4,5 . Children have comparatively milder COVID-19 disease and up to one-third are asymptomatic 6 .…”

Section: Mainmentioning

confidence: 99%

Immune responses to SARS-CoV-2 in children of parents with symptomatic COVID-19

Tosif

Neeland

Sutton

et al. 2020

Preprint

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Compared to adults, children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have mild or asymptomatic infection, but the underlying immunological differences remain unclear. We describe clinical features, virology, longitudinal cellular and cytokine immune profile, SARS-CoV-2-specific serology and salivary antibody responses in a family of two parents with PCR-confirmed symptomatic SARS-CoV-2 infection and their three children, who were repeatedly SARS-CoV-2 PCR negative. Cellular immune profiles and cytokine responses of all children were similar to their parents at all timepoints. All family members had salivary anti-SARS-CoV-2 antibodies detected, predominantly IgA, that coincided with symptom resolution in 3 of 4 symptomatic members. Plasma from both parents and one child had IgG antibody detected against the S1 protein and virus neutralising activity ranging from just detectable to robust titers. Using a systems serology approach, we show that all family members demonstrated higher levels of SARS-CoV-2-specific antibody features than healthy controls. These data indicate that children can mount an immune response to SARS-CoV-2 without virological evidence of infection. This raises the possibility that despite chronic exposure, immunity in children prevents establishment of SARS-CoV-2 infection. Relying on routine virological and serological testing may therefore not identify exposed children, with implications for epidemiological and clinical studies across the life-span.

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“…There is also evidence that children and adolescents (at least up to 14 years) [ 25 ] transmit SARS-CoV-2 to other people less frequently than adults [ 26 ], [ 27 ], [ 28 ], [ 29 ], [ 30 ], [ 31 ], [ 32 ]. The data for children up to the age of 10 seem to indicate that their role for transmission dynamics is less important than for adolescents aged 14 and more [ 25 ], [ 33 ].…”

Section: Introductionmentioning

confidence: 99%