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- A recent study compared the likelihood of children of different age groups transmitting SARS-CoV-2 to household members.
- The study reported that children under 4 were more likely to pass the virus to their parents and siblings than adolescents aged 14 to 17..
- Testing delays and larger household size were associated with an increased risk of children transmitting SARS-CoV-2 to family members.
- These findings can inform the behavior of household members and public policy decisions related to schools or daycares..
The reopening of schools and the rise in COVID-19 cases due to the rapid spread of the SARS-CoV-2 Delta variant have rekindled the concerns of parents and policymakers about the safety of children.
Like adults, children and adolescents are susceptible to infections with SARS-CoV-2. Although a small number of children can develop serious illness, children are more likely to be asymptomatic or have mild symptoms compared to adults.
However,
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This lack of solid evidence is in part due to the fact that some
Because children generally have milder symptoms and testing is limited to symptomatic cases, children were less likely to be screened for SARS-CoV-2 during the early stages of the pandemic. This selective screening of people with symptoms has led to an underestimation of the number of children with SARS-CoV-2.
In addition, the closures around this time likely coincided with the closure of schools and daycares. This has resulted in limited exposure of children to the virus, which has led to limited data on pediatric SARS-CoV-2 infections.
Studies have compared the ability of children to transmit the virus to that of adults. However, there is limited data on the differences in the risk of coronavirus transmission among children of different age groups.
A team of researchers from Public Health Ontario in Canada recently compared the risk of transmitting SARS-CoV-2 to household members between younger and older children.
Notably, this study took place in late summer and fall 2020, when Ontario had fewer restrictions in place and children were returning to school or daycare. As a result, there has been an increase in the number of pediatric cases during this period, making it possible to assess the ability of children to spread the virus.
The study found that young children, especially those aged 0 to 3, were more likely to pass the virus to household members than adolescents aged 14 to 17.
Study co-author Dr Kevin Schwartz, infectious disease physician at Public Health Ontario, said Medical news today: “Our study provides important information on the risk of transmission of SARS-CoV-2 in young children. Since parents cannot isolate themselves from their young children, other measures are needed to limit domestic transmission from children, especially if there are high-risk adults in the home. “
Dr Schwartz recommended that anyone over the age of 12 get vaccinated to minimize the risk of transmitting SARS-CoV-2 in the household.
The study appears in the journal
To study the ability of children of different age groups to transmit SARS-CoV-2, researchers used public health data on SARS-CoV-2 infections in Ontario collected between June 1 and June 31. December 2020.
Using this data, the researchers identified more than 6,280 households in which the index, or the first person identified as having SARS-CoV-2, was an individual between the ages of 0 and 17.
They then used this information to narrow down the 1,717 households where the index pediatric person resulted in subsequent illness in at least one household member over the next 2 weeks.
The researchers found that a larger household size and longer times for testing were associated with higher risks of the index pediatric person transmitting the virus to family members.
The team then classified the households into four groups based on the age of the child identified as the index case: 0-3, 4-8, 9-13 and 14-17 years.
The researchers found that older children were more likely to be the first identified person or index person in the household.
However, children aged 0 to 3 were more likely to pass the virus to family members than adolescents aged 14 to 17.
They also analyzed the data after controlling for variables such as household size and testing times. After adjusting their analysis for these factors, the researchers found that children aged 0-3 and 4-8 had an increased likelihood of passing the virus to household members compared to adolescents aged 14-17. .
The increased likelihood of young children transmitting the virus could be due to differences in the amount of virus in a child’s upper respiratory tract or the behavioral dynamics of family members.
There are some
However, evidence to the contrary suggests that there is no difference in viral loads between younger and older children.
These conflicting results indicate the need for more research to establish differences in viral load and transmissibility in younger and older children.
Asked about the potential reasons for the results, Dr Schwartz said: “We were initially surprised by the results because there has been previous evidence that young children are less infectious and therefore less likely to spread SARS-CoV. -2. This is probably still true. The explanation for our observations is probably linked to the parents’ difficulties in isolating themselves from their [children who have the virus]. “
“It is essentially impossible for parents to isolate themselves from their sick infants, compared to adolescents who can isolate themselves at home. Our results do not mean that children are over [likely to transmit the virus], just that once the children are younger [have contracted the virus], they have a higher risk of spreading it at home, ”explained Dr. Schwartz.
Dr Frederik Plesner Lyngse, postdoctoral researcher at the University of Copenhagen in Denmark, who was not associated with the study, said MNT: “It can be difficult for people [who have the virus] isolate themselves within the household due to lack of space, number of bathrooms or childcare needs. The latter reflects that younger children need closer care, which translates into parents or guardians [contracting the virus]. “
“Adolescents will find it easier to isolate themselves in their room, [as they can play video games, etc.]. Older children have more contact outside the home, which is why they are more likely to contract the virus in the community, ”added Dr Lyngse.
The authors noted: “The differential infectivity of pediatric age groups has implications for infection prevention controls in households, schools and daycare centers to minimize the risk of secondary transmission in the home. “
On a related note, Dr Lyngse commented, “The findings may have important implications for public health, as home transmission can serve as a bridge between otherwise separate areas of transmission, such as schools and schools. physical workplaces, despite the interventions implemented. In addition, the age profile of transmissibility may have implications for the decision to immunize children in the future. “
MNT also spoke to Dr. William Raszka, MD, a pediatric infectious disease specialist at the University of Vermont Medical Center. In a recent commentary on Coronavirus Transmission in Children and Policy Decisions, Dr Raszka wrote: “The accumulation of evidence and collective experience supports that children, especially school-aged children, are much less important drivers of SARS-CoV-2 transmission than adults. ”
In the context of political decisions regarding the reopening of schools, Dr Raszka said MNT: “I think it’s a really interesting paper. [….] At the beginning, we were very concerned about the degree of contagion of the children because it was in the context of the opening or not of the schools. But we have proven that we can open schools with the right mitigation strategies. ”
“The strength of this study was the large sample size which allowed us to assess risk among different age groups. Previous studies have grouped all children under 18 or grouped them into 0-10 years. We were able to quantify the risk between smaller groups of children, ”said Dr. Schwartz.
He continued, “We were also able to incorporate some important variables into the analysis, such as testing times and some socio-demographic variables of interest that could impact transmission, which we believe allows for greater confidence in the results. ”
“The study has some limitations because we used routinely collected public health data. Some children may not have been considered index cases if they had mild or no symptoms. Conversely, some children may have been the first case diagnosed but not the true index case in the household, ”noted Dr Schwartz.
The authors conclude that “early detection of pediatric index cases and reduction in household size / overcrowding may be useful strategies to minimize secondary transmission from households to children”.
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