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COVID-19 in children: current evidence and key questions

COVID-19 in children: current evidence and key questions
COVID-19 in children: current evidence and key questions

PURPOSE OF REVIEW: SARS-CoV-2 infection in children has been less well characterized than in adults, primarily due to a significantly milder clinical phenotype meaning many cases have gone undocumented by health professionals or researchers. This review outlines the current evidence of the epidemiology of infection in children, the clinical manifestations of disease, the role of children in transmission of the virus and the recently described hyperinflammatory syndrome observed later during the first phase of the pandemic.

RECENT FINDINGS: International seroprevalence studies have found younger children to have lower prevalence of antibodies to SARS-CoV-2, indicating they have not been infected as much as adults. This may be due to shielding by school closures, or by a reduced susceptibility to infection, as indicated by a significantly lower attack rate in children than adults in household contact tracing studies. The most well recognized symptoms in adults of cough, fever, anosmia and ageusia are less frequent in children, who may often present with mild and nonspecific symptoms, or with gastrointestinal symptoms alone. Risk factors for severe disease in children include chronic lung, cardiac or neurological disease, and malignancy. However, the absolute risk still appears very low for these cohorts. A new hyperinflammatory syndrome has emerged with an apparent immune cause.

SUMMARY: Important questions remain unanswered regarding why children have mild disease compared with adults; how children of different ages contribute to asymptomatic community transmission of the virus; and the pathophysiology of and most appropriate investigation and treatment strategies for the novel hyperinflammatory syndrome.

Adolescent, Age Factors, Asymptomatic Infections/epidemiology, Betacoronavirus/pathogenicity, Child, Child, Preschool, Comorbidity, Coronavirus Infections/epidemiology, Humans, Infant, Pandemics, Pneumonia, Viral/epidemiology, Risk Factors, Systemic Inflammatory Response Syndrome/complications, Young Adult
0951-7375
540-547
Munro, Alasdair P S
9150e088-1921-4b12-9b98-289e91fa0b2b
Faust, Saul N
f97df780-9f9b-418e-b349-7adf63e150c1
Munro, Alasdair P S
9150e088-1921-4b12-9b98-289e91fa0b2b
Faust, Saul N
f97df780-9f9b-418e-b349-7adf63e150c1

Munro, Alasdair P S and Faust, Saul N (2020) COVID-19 in children: current evidence and key questions. Current Opinion in Infectious Diseases, 33 (6), 540-547. (doi:10.1097/QCO.0000000000000690).

Record type: Review

Abstract

PURPOSE OF REVIEW: SARS-CoV-2 infection in children has been less well characterized than in adults, primarily due to a significantly milder clinical phenotype meaning many cases have gone undocumented by health professionals or researchers. This review outlines the current evidence of the epidemiology of infection in children, the clinical manifestations of disease, the role of children in transmission of the virus and the recently described hyperinflammatory syndrome observed later during the first phase of the pandemic.

RECENT FINDINGS: International seroprevalence studies have found younger children to have lower prevalence of antibodies to SARS-CoV-2, indicating they have not been infected as much as adults. This may be due to shielding by school closures, or by a reduced susceptibility to infection, as indicated by a significantly lower attack rate in children than adults in household contact tracing studies. The most well recognized symptoms in adults of cough, fever, anosmia and ageusia are less frequent in children, who may often present with mild and nonspecific symptoms, or with gastrointestinal symptoms alone. Risk factors for severe disease in children include chronic lung, cardiac or neurological disease, and malignancy. However, the absolute risk still appears very low for these cohorts. A new hyperinflammatory syndrome has emerged with an apparent immune cause.

SUMMARY: Important questions remain unanswered regarding why children have mild disease compared with adults; how children of different ages contribute to asymptomatic community transmission of the virus; and the pathophysiology of and most appropriate investigation and treatment strategies for the novel hyperinflammatory syndrome.

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More information

Accepted/In Press date: 13 November 2020
Published date: 1 December 2020
Keywords: Adolescent, Age Factors, Asymptomatic Infections/epidemiology, Betacoronavirus/pathogenicity, Child, Child, Preschool, Comorbidity, Coronavirus Infections/epidemiology, Humans, Infant, Pandemics, Pneumonia, Viral/epidemiology, Risk Factors, Systemic Inflammatory Response Syndrome/complications, Young Adult

Identifiers

Local EPrints ID: 445779
URI: http://eprints.soton.ac.uk/id/eprint/445779
ISSN: 0951-7375
PURE UUID: e91ca2ca-2a4c-4ab8-9159-98581cda6685
ORCID for Saul N Faust: ORCID iD orcid.org/0000-0003-3410-7642

Catalogue record

Date deposited: 07 Jan 2021 17:33
Last modified: 15 Sep 2021 01:51

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