Prevalence of Asymptomatic SARS-CoV-2 Infection in Children and Adults in Marion County, Indiana

A systematic review and meta-analysis of the epidemiological characteristics of COVID-19 in children

BACKGROUND

Several individual studies from specific countries have reported rising numbers of pediatric COVID-19 cases with inconsistent reports on the clinical symptoms including respiratory and gastrointestinal symptoms as well as diverse reports on the mean age and household exposure in children. The epidemiological characteristics of COVID-19 in children are not fully understood, hence, comprehensive meta-analyses are needed to provide a better understanding of these characteristics.

METHODS

This review was conducted in Medline, Scopus, Cochrane library, Embase, Web of Science, and published reports on COVID-19 in children. Data were extracted by two independent researchers and a third researcher resolved disputes. STATA software and the random-effect model were used in the synthesis of our data. For each model, the heterogeneity between studies was estimated using the Q Cochrane test. Heterogeneity and publication bias were calculated using the I² statistic and Egger's/Begg's tests.

RESULTS

The qualitative systematic review was performed on 32 articles. Furthermore, the meta-analysis estimated an overall rate of involvement at 12% (95% CI: 9-15%) among children, with an I² of 98.36%. The proportion of household exposure was calculated to be 50.99% (95% CI: 20.80%-80.80%) and the proportion of admitted cases was calculated to be 45% (95% CI: 24%-67%). Additionally, the prevalence of cough, fatigue, fever and dyspnea was calculated to be 25% (95% CI: 0.16-0.36), 9% (95% CI: 0.03-0.18), 33% (95% CI: 0.21-0.47) and 9% (95% CI: 0.04-0.15), respectively. It is estimated that 4% (95% CI: 1-8%) of cases required intensive care unit admission.

CONCLUSIONS

The pediatric clinical picture of COVID-19 is not simply a classic respiratory infection, but unusual presentations have been reported. Given the high incidence of household transmission and atypical clinical presentation in children, we strongly recommend their inclusion in research and population-based preventive measures like vaccination as well as clinical trials to ensure efficacy, safety, and tolerability in this age group.

Global Percentage of Asymptomatic SARS-CoV-2 Infections Among the Tested Population and Individuals With Confirmed COVID-19 Diagnosis: A Systematic Review and Meta-analysis

IMPORTANCE

Asymptomatic infections are potential sources of transmission for COVID-19.

OBJECTIVE

To evaluate the percentage of asymptomatic infections among individuals undergoing testing (tested population) and those with confirmed COVID-19 (confirmed population).

DATA SOURCES

PubMed, EMBASE, and ScienceDirect were searched on February 4, 2021.

STUDY SELECTION

Cross-sectional studies, cohort studies, case series studies, and case series on transmission reporting the number of asymptomatic infections among the tested and confirmed COVID-19 populations that were published in Chinese or English were included.

DATA EXTRACTION AND SYNTHESIS

This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Random-effects models were used to estimate the pooled percentage and its 95% CI. Three researchers performed the data extraction independently.

MAIN OUTCOMES AND MEASURES

The percentage of asymptomatic infections among the tested and confirmed populations.

RESULTS

Ninety-five unique eligible studies were included, covering 29 776 306 individuals undergoing testing. The pooled percentage of asymptomatic infections among the tested population was 0.25% (95% CI, 0.23%-0.27%), which was higher in nursing home residents or staff (4.52% [95% CI, 4.15%-4.89%]), air or cruise travelers (2.02% [95% CI, 1.66%-2.38%]), and pregnant women (2.34% [95% CI, 1.89%-2.78%]). The pooled percentage of asymptomatic infections among the confirmed population was 40.50% (95% CI, 33.50%-47.50%), which was higher in pregnant women (54.11% [95% CI, 39.16%-69.05%]), air or cruise travelers (52.91% [95% CI, 36.08%-69.73%]), and nursing home residents or staff (47.53% [95% CI, 36.36%-58.70%]).

CONCLUSIONS AND RELEVANCE

In this meta-analysis of the percentage of asymptomatic SARS-CoV-2 infections among populations tested for and with confirmed COVID-19, the pooled percentage of asymptomatic infections was 0.25% among the tested population and 40.50% among the confirmed population. The high percentage of asymptomatic infections highlights the potential transmission risk of asymptomatic infections in communities.

Atypical presentation of COVID-19 infection as acute abdomen in children: A case series

Abdominal pain in children in COVID-19 era should be carefully evaluated and weighing risk-benefit of surgical procedure in suspected cases should be more discussed. Surgery in patients with high suspicious to MIS-C should be delayed for preventing critical outcomes.

Assessment of SARS-CoV-2 Anti-Spike IgG Antibody in Women and Children in Madinah, Saudi Arabia: A Single-Center Study

BACKGROUND

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Information on the prevalence of SARS-CoV-2 antibodies in women and children in Madinah has been limited. The current study aimed to evaluate SARS-CoV-2 IgG seropositivity among women and children at Madinah Maternity and Children's Hospital.

METHODS

In this cross-sectional study, 579 participants were recruited between January and April 2021 from Madinah Maternity and Children's Hospital, Saudi Arabia. Data concerning age, sex (for children), blood group, and height and weight (for women) were collected from the hospital database. SARS-CoV-2 anti-spike (anti-S) IgG antibodies were detected by enzyme-linked immunosorbent assay (ELISA).

RESULTS

Over 58% of children (n = 195), including 60% of children ≤ 1 year (n = 75), and 50.2% (n = 124) of women were SARS-CoV-2 anti-S IgG seropositive. Significantly higher anti-S IgG levels were observed in children than in women (0.78 ± 1.05 vs. 0.65 ± 0.98, p = 0.008). Compared with women, children had higher odds of high SARS-CoV-2 anti-S IgG levels (odds ratio: 1.41; 95% confidence interval: 1.01-1.97; p = 0.041). No significant associations were observed for anti-S IgG levels with age in women or children or with body mass index among women.

CONCLUSION

Non-reported COVID-19 infections were more prevalent among children than women, and non-reported COVID-19 infections children represent a viral transmission risk; therefore, increased screening, especially among school-aged children, may represent an important COVID-19 preventive control measure.

Duration of SARS-CoV-2 sero-positivity in a large longitudinal sero-surveillance cohort: the COVID-19 Community Research Partnership

BACKGROUND

Estimating population prevalence and incidence of prior SARS-CoV-2 infection is essential to formulate public health recommendations concerning the COVID-19 pandemic. However, interpreting estimates based on sero-surveillance requires an understanding of the duration of elevated antibodies following SARS-CoV-2 infection, especially in the large number of people with pauci-symptomatic or asymptomatic disease.

METHODS

We examined > 30,000 serology assays for SARS-CoV-2 specific IgG and IgM assays acquired longitudinally in 11,468 adults between April and November 2020 in the COVID-19 Community Research Partnership.

RESULTS

Among participants with serologic evidence for infection but few or no symptoms or clinical disease, roughly 50% sero-reverted in 30 days of their initial positive test. Sero-reversion occurred more quickly for IgM than IgG and for antibodies targeting nucleocapsid protein compared with spike proteins, but was not associated with age, sex, race/ethnicity, or healthcare worker status.

CONCLUSIONS

The short duration of antibody response suggests that the true population prevalence of prior SARS-CoV-2 infection may be significantly higher than presumed based on earlier sero-surveillance studies. The impact of the large number of minimally symptomatic COVID-19 cases with only a brief antibody response on population immunity remains to be determined.

Frequency of asymptomatic carriers of SARS-CoV-2 among children and adults after school reopening

Background

Children often develop an asymptomatic form of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but it is debated if children are at higher risk than adults to be asymptomatic carriers of SARS-CoV-2, especially during the school reopening. The main aim of this study was to investigate the frequency of SARS-CoV-2 asymptomatic carriers in children and adults during the reopening of the schools in Milan, Italy.

Methods

We conducted a cross-sectional study at the pediatric and adult Emergency Department (ED) of the Ca' Granda Ospedale Maggiore Policlinico (Milan) between October 1 and 31, 2020, i.e. 3 weeks after the reopening of schools. Patients admitted to the ED short stay observation and without any sign or symptom consistent with a SARS-CoV-2 were eligible. These patients underwent a nasopharyngeal swab specimen for the detection of SARS-CoV-2. The odds ratio and its 95% confidence interval (CI) was calculated to assess the risk of asymptomatically carrying the SARS-CoV-2 infection in children and adults.

Results

A total of 69 (27 females, median age 8.7 years) children and 251 (107 females, median age 71 years) adults were enrolled. Pediatric and adult subjects tested positive for SARS-CoV-2 with a similar frequency (1/69 [1.4%] vs 4/251 [1.6%]). Children had an odds ratio to be a carrier of 0.91 (CI 0.02– 9.38) compared to adults.

Conclusions

The frequency of asymptomatic SARS-CoV-2 carriers was similar among children and adults. Considering the emerging diffusion of new SARS-CoV-2 variants, the asymptomatic spread of SARS-CoV-2 infection among children and adults should be monitored.