Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents

Abstract

Objective To undertake a systematic review of reviews of the prevalence of symptoms and signs of COVID-19 in those aged under 20 years? Design Narrative systematic review of reviews. PubMed, medRxiv, Europe PMC and COVID-19 Living Evidence Database were searched on 9 October 2020. Setting All settings, including hospitalised and community settings. Patients CYP under age 20 years with laboratory-proven COVID-19. Study review, data extraction and quality Potentially eligible articles were reviewed on title and abstract by one reviewer. Quality was assessed using the modified AMSTARS criteria and data were extracted from included studies by two reviewers. Main outcome measures Prevalence of symptoms and signs of COVID-19 Results 1325 studies were identified and 18 reviews were included. Eight were high quality, 7 medium and 3 low quality. All reviews were dominated by studies of hospitalised children. The proportion who were asymptomatic ranged from 14.6 to 42%. Fever and cough were the commonest symptoms; proportions with fever ranged from 46 to 64.2% and with cough from 32 to 55.9%. All other symptoms or signs including rhinorrhoea, sore throat, headache, fatigue/myalgia and gastrointestinal symptoms including diarrhoea and vomiting are infrequent, occurring in less than 10-20%. Conclusions Fever and cough are the most common symptoms in CYP with COVID-19, with other symptoms infrequent. Further research on symptoms in community samples are needed to inform pragmatic identification and testing programmes for CYP.

Estimated SARS-CoV-2 Seroprevalence in Healthy Children and Those with Chronic Illnesses in The Washington Metropolitan Area as of October 2020

“…A systematic review of 18 studies on COVID-19 symptomatology in children reported fever and cough to be the most common COVID-19-related symptoms, other symptoms to be present in less than 10-20% of patients in the reported studies, and asymptomatic individuals to range from 14.6% to 42% in this age group. 7 These findings are similar to our observations. Furthermore, parallel to our previous report of higher rates of SARS-CoV-2 infection in minority children 8 , Hispanic/Latinx children had a higher seropositivity rate compared to whites which was previously reported for adults for the Baltimore-Washington, DC region.…”

Crisis within a crisis, COVID-19 knowledge and awareness among the Syrian population: a cross-sectional study

“…Many studies have assessed symptomatic clusters, transmission pathways and prevention methods; however, many aspects have yet to be studied. 2 3 …”

Clinical Characteristics of COVID-19 among Children in Sarajevo, Bosnia and Herzegovina

“…Our study was without lethal outcomes. A systematic review by Viner et al (17) that included children <20 years of age, documented that the proportion of asymptomatic infections ranged from 15 to 42% (4,16). We observed slightly more boys than girls.…”