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

Abstract

ObjectiveTo undertake a systematic review of reviews of the prevalence of symptoms and signs of COVID-19 in those aged under 20 years.DesignNarrative systematic review of reviews. PubMed, medRxiv, Europe PMC and COVID-19 Living Evidence Database were searched on 9 October 2020.SettingAll settings, including hospitalised and community settings.PatientsChildren and young people (CYP) under age 20 years with laboratory-proven COVID-19.Study review, data extraction and qualityPotentially 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 measuresPrevalence of symptoms and signs of COVID-19.Results1325 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 of asymptomatic CYP ranged from 14.6% to 42%. Fever and cough were the the most common 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 were infrequent, occurring in less than 10%–20%.ConclusionsFever 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.

Covid-19 deaths in Africa: prospective systematic postmortem surveillance study

“…Among the younger children, gastrointestinal rather than respiratory complaints predominated, which may be a factor explaining why only one had been tested for covid-19 before death. The preponderance of gastrointestinal symptoms among children with covid-19 has been described previously 31323334. Such symptoms may occur as part of a broader constellation of complaints that may include respiratory symptoms in isolation or as part of the multisystem inflammatory disorder that has been identified as a rare complication of covid-19 in children.…”

“…The preponderance of gastrointestinal symptoms among children with covid-19 has been described previously. 31 32 33 34 Such symptoms may occur as part of a broader constellation of complaints that may include respiratory symptoms in isolation or as part of the multisystem inflammatory disorder that has been identified as a rare complication of covid-19 in children. In its November 2020 update, the American Academy of Pediatrics reported that children accounted for between 0.00% and 0.23% of all covid-19 related deaths in the US, with 17 states reporting no deaths in children.…”

The Severity of COVID-19 and Its Determinants: A Systematic Review and Meta-Analysis in China

“…Cough and fever were globally regarded as main factors in previous studies [76,77]. The symptoms could be found in children, adolescents, and adults [78] in research on Europe [79], the UK [80], the United States [81], and other countries. Considering dyspnoea, infection with COVID-19 could result in severe outcomes and death from pneumonia with severe symptoms [82][83][84].…”

Asymptomatic or mild symptomatic SARS-CoV-2 infection elicits durable neutralizing antibody responses in children and adolescents

“…23 Neutralizing antibodies at a 50% inhibitory dilution (ID50) were detected in 56 of 69 (81%) serum samples collected during acute infection, 53 of 56 (95%) samples collected 2 months after acute infection, and 47 of 50 (94%) of samples collected 4 months after acute infection (Figure 2). Acute infection samples for which there was no appreciable neutralizing activity were collected earlier after symptom onset or SARS-CoV-2 diagnosis than acute infection samples with detectable neutralizing antibodies [median (IQR) of 7 (5,8) vs. 9 (7, 13) days; p=0.01]. Between acute infection and 2 months after acute infection, levels of neutralizing antibodies declined in 31 (55%) children, increased in 24 (43%) children, were stable in one (2%) child (median ID50: 577 vs. 379; p=0.04).…”

“…Epidemiological data from around the world indicate that children and adolescents with SARS-CoV-2 infection typically have milder illness courses than adults. [6][7][8] Notably, SARS-CoV-2 infection in children and adolescents is often asymptomatic or associated with such minor symptoms that children infrequently come to medical attention. 9,10 The varied clinical manifestations of SARS-CoV-2 infection among children and adults suggest that age may modify the host response to SARS-CoV-2, as has previously been demonstrated for several other viruses.…”