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Transmission of SARS-CoV-2 by children and young people in households and schools: A meta-analysis of population-based and contact-tracing studies - 02/03/22

Doi : 10.1016/j.jinf.2021.12.026 
Russell Viner a, , Claire Waddington b, Oliver Mytton b, Robert Booy c, Joana Cruz a, Joseph Ward a, Shamez Ladhani d, Jasmina Panovska-Griffiths e, Chris Bonell f, G.J. Melendez-Torres g
a Population, Policy and Practice, UCL Great Ormond St. Institute of Child Health, London, United Kingdom 
b University of Cambridge, United Kingdom 
c University of Sydney, Australia 
d Public Health England, United Kingdom 
e University of Oxford, United Kingdom 
f London School of Hygiene and Tropical Medicine, United Kingdom 
g University of Exeter Medical School, United Kingdom 

Corresponding author.

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Summary

Background

The role of children and young people (CYP) in transmission of SARS-CoV-2 in household and educational settings remains unclear. We undertook a systematic review and meta-analysis of contact-tracing and population-based studies at low risk of bias.

Methods

We searched 4 electronic databases on 28 July 2021 for contact-tracing studies and population-based studies informative about transmission of SARS-CoV-2 from 0 to 19 year olds in household or educational settings. We excluded studies at high risk of bias, including from under-ascertainment of asymptomatic infections. We undertook multilevel random effects meta-analyses of secondary attack rates (SAR: contact-tracing studies) and school infection prevalence, and used meta-regression to examine the impact of community SARS-CoV-2 incidence on school infection prevalence.

Findings

4529 abstracts were reviewed, resulting in 37 included studies (16 contact-tracing; 19 population studies; 2 mixed studies). The pooled relative transmissibility of CYP compared with adults was 0.92 (0.68, 1.26) in adjusted household studies. The pooled SAR from CYP was lower (p = 0.002) in school studies 0.7% (0.2, 2.7) than household studies (7.6% (3.6, 15.9) . There was no difference in SAR from CYP to child or adult contacts. School population studies showed some evidence of clustering in classes within schools. School infection prevalence was associated with contemporary community 14-day incidence (OR 1.003 (1.001, 1.004), p<0.001).

Interpretation

We found no difference in transmission of SARS-CoV-2 from CYP compared with adults within household settings. SAR were markedly lower in school compared with household settings, suggesting that household transmission is more important than school transmission in this pandemic. School infection prevalence was associated with community infection incidence, supporting hypotheses that school infections broadly reflect community infections. These findings are important for guiding policy decisions on shielding, vaccination school and operations during the pandemic.

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© 2021  Publié par Elsevier Masson SAS.
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Vol 84 - N° 3

P. 361-382 - mars 2022 Retour au numéro
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