COVID-19 in children: clinical and epidemiological spectrum in the community

Abstract

Most publications on pediatric COVID-19 in Spain were performed at the beginning of the pandemic when some diagnostic tools were not widely available. This study aims to show the real spectrum of the infection based on wide detection of cases due to symptoms and contact tracing. A descriptive and analytical observational study was performed including pediatric cases (0 to 14 years) from the region of Aragón between May 12 and October 31, 2020. Diagnostics was by PCR detection of viral RNA, rapid antigen detection test, or positive IgG serology. There were 5933 positive children included. Of them, 49.03% were women. The mean age was 7.53 ± 4.28 years. The source of infection could not be determined in 17.8% of cases. As for the rest, was determined to be within the family environment in 67.8%. The percentage of asymptomatic patients was 50.3%. Among symptomatic patients, fever (58.1%) and cough (46.7%) were the most frequent symptoms. Hospitalization was required in 0.52% of infected, intensive care unit admission was on 0.05%, and there was one death (0.02%). Children under the age of one presented some symptoms more frequently (71.6% vs 48.5%; OR 2.68; 95% CI 2.08 to 3.45; p < 0.001) and required more hospitalizations (3.9% vs 0.34%; OR 11.52; 95% CI 5.65 to 23.52; p < 0.001). Conclusion : In our environment, SARS-CoV-2 infection is like other mild respiratory viral infections in the population under the age of 15. The contagion occurs mainly in the family environment, the number of asymptomatic is high, being the symptoms mild and the complications very infrequent. What is Known: • Pediatric infection produced by SARS-CoV-2 has manifested as a mild disease in relation to adult age, although with higher affectation at the youngest ages. • Nearly all studies on epidemiology and clinical spectrum of the disease were conducted with patients diagnosed at the beginning of the pandemic. By then, diagnostic tools were only available in hospitals and in emergency units. What is New: • Once diagnostic means were available in primary care medicine and were used not only for the diagnosis of clinical symptoms of the patient, but for the tracing of case contacts, a much more precise approach to the epidemiology and clinical manifestations of the disease was allowed, as described in this study.

COVID-19 clinical features in primary care: COVIDPAP study

“…Our study, conducted in a very large sample in the community, confirms what has been described in previous publications 4 , 5 , 16 , 17 : in the paediatric population, COVID-19 is a mild and oligosymptomatic disease in the community. The salient findings were the frequent presentation with rhinorrhoea, which is not a symptom included in reference protocols 18 ; its presence should be taken into account, despite its nonspecificity (frequent in infants, associated with allergic processes…), depending on the current epidemiological context.…”

“…One of the greatest challenges in fighting this disease is the presence of asymptomatic patients and their ability to spread the infection. 22 , 23 , 24 The first studies published during the pandemic, when diagnostic tests were only available in the hospital setting, the proportion of asymptomatic patients in the paediatric population was reported to be as low as 14% 15 ; since then, other studies using data obtained in the community and from population screening found percentages of 35%–50% 13 , 17 , 25 , 26 and even as high as 71%–76.5% in the case of studies that only assessed symptoms at the time of diagnosis. 27 , 28 In our study, in which a follow-up assessment of symptoms was conducted at 15 days, the percentage of asymptomatic patients was 43%.…”

Risk of adverse events after covid-19 in Danish children and adolescents and effectiveness of BNT162b2 in adolescents: cohort study

“…22 Compared with the few previous studies providing population based data on the risk of hospital admission after SARS-CoV-2 infection, the reported risks were similar to those of Israel and Spain (0.2% to 0.5%), but lower than those reported from the UK (1.3%) and US (5.7%). 7 23 24 25 Both the case fatality rate and the risk of hospital admissions are, however, influenced by access to testing for SARS-CoV-2 and are likely to be overestimates of the true risk. Recent Danish SARS-CoV-2 seroprevalence studies have estimated that the true prevalence of SARS-CoV-2 infection among adolescents is up to threefold higher than that detected by national RT-PCR tests.…”

“… 6 Studies have, however, consistently reported that SARS-CoV-2 infection in children and adolescents is generally asymptomatic or mild, limiting the benefit of vaccination in individual. 7 …”

Factors affecting climacteric women with SARS-CoV-2 infection: A multinational Latin America study (REDLINC XI)

“…In our current study, housewife and nulliparous women were less likely to have COVID-19. Children have oligosymptomatic COVID-19 and may be potential vectors to the adult population [21]; that is why women without children could be less exposed to acquiring the disease. Similarly, women who remain at home have less chance of being in contact with infected people.…”