A Meta-analysis on the Role of Children in Severe Acute Respiratory Syndrome Coronavirus 2 in Household Transmission Clusters

  1. Yanshan Zhu
  2. Conor J Bloxham
  3. Katina D Hulme
  4. Jane E Sinclair
  5. Zhen Wei Marcus Tong
  6. Lauren E Steele
  7. Ellesandra C Noye
  8. Jiahai Lu
  9. Yao Xia
  10. Keng Yih Chew
  11. Janessa Pickering
  12. Charles Gilks
  13. Asha C Bowen
  14. Kirsty R Short

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Abstract

The role of children in the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains highly controversial. To address this issue, we performed a meta-analysis of the published literature on household SARS-CoV-2 transmission clusters (n = 213 from 12 countries). Only 8 (3.8%) transmission clusters were identified as having a pediatric index case. Asymptomatic index cases were associated with a lower secondary attack in contacts than symptomatic index cases (estimate risk ratio [RR], 0.17; 95% confidence interval [CI], 0.09-0.29). To determine the susceptibility of children to household infections the secondary attack rate in pediatric household contacts was assessed. The secondary attack rate in pediatric household contacts was lower than in adult household contacts (RR, 0.62; 95% CI, 0.42-0.91). These data have important implications for the ongoing management of the COVID-19 pandemic, including potential vaccine prioritization strategies.

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  1. ScreenIT

    SciScore for 10.1101/2020.03.26.20044826: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Information was accessed from the World Health Organization news11, Google Scholar, PubMed, the Lancet COVID-19 resource centre12, Clinical Infectious Disease Journal and New England Journal of Medicine.
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    PubMed
    suggested: (PubMed, RRID:SCR_004846)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The present study was subject to several important limitations. Firstly, as we were conservative during the data collection only a limited number of studies were included, potentially contributing to the high I2 value observed. This study also assumes that SARS-CoV-2 infections in the household contacts of infected individual were the result of a direct transmission event. However, it is possible that the household contact acquired the virus from another source (e.g. from community exposure) and that the first in the family to develop symptoms was not necessarily the index case. We were also unable to control for the chance of a ‘common exposure’ where two individuals were infected by the same source at the same time, but one individual was incorrectly identified as the sole index case of the cluster as they were the first to develop symptoms. Indeed, this appears to have confounded the analysis of a series of family clusters identified in South Korea [5, 15]. It is also important to note that we were unable to differentiate between pre-symptomatic and asymptomatic infections and therefore the number of identified asymptomatically infected individuals may be overestimated. Finally, it is important to note that these data should not be extrapolated to SARS-CoV-2 transmission outside the home where children tend to make more social contacts than adults[18]. This could significantly influence transmission dynamics in the community setting, although our data are congruent with th...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1093/cid/ciaa1825
  3. Version published to 10.1101/2020.03.26.20044826v2 on medRxiv
  4. ScreenIT

    SciScore for 10.1101/2020.03.26.20044826: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Information was accessed from World Health Organization news11, local health authority's news releases, Google Scholar, PubMed, the Lancet COVID-19 resource centre12, Clinical Infectious Disease Journal, New England Journal of Medicine, and three Chinese databases (CNKI, Wanfang, and CQVIP).
    Google Scholar
    suggested: (Google Scholar, SCR_008878)
          <div style="margin-bottom:8px">
        <div><b>PubMed</b></div>
        <div>suggested: (PubMed, <a href="https://scicrunch.org/resources/Any/search?q=SCR_004846">SCR_004846</a>)</div>
      </div>
    </td></tr><tr><td style="min-width:100px;vertical-align:top;border-bottom:1px solid lightgray">Information was accessed from World Health Organization news11, local health authority's news releases, Google Scholar, PubMed, the Lancet COVID-19 resource centre12, Clinical Infectious Disease Journal, New England Journal of Medicine, and three Chinese databases (CNKI, Wanfang, and CQVIP).</td><td style="min-width:100px;border-bottom:1px solid lightgray">
      <div style="margin-bottom:8px">
        <div><b>Google Scholar</b></div>
        <div>suggested: (Google Scholar, <a href="https://scicrunch.org/resources/Any/search?q=SCR_008878">SCR_008878</a>)</div>
      </div>
    
      <div style="margin-bottom:8px">
        <div><b>PubMed</b></div>
        <div>suggested: (PubMed, <a href="https://scicrunch.org/resources/Any/search?q=SCR_004846">SCR_004846</a>)</div>
      </div>
    </td></tr><tr><td style="min-width:100px;vertical-align:top;border-bottom:1px solid lightgray">We performed the searching and reviewing using the terms (“severe acute respiratory syndrome coronavirus 2”[All Fields]) OR ("SARS-CoV-2"[All Fields]) OR (“COVID-19” [All Fields]) AND ("Children"[All Fields] OR "Paediatric"[All Fields]) OR ("Family"[MeSH Terms] OR "Family"[All Fields])”.</td><td style="min-width:100px;border-bottom:1px solid lightgray">
      <div style="margin-bottom:8px">
        <div><b>MeSH</b></div>
        <div>suggested: (MeSH, <a href="https://scicrunch.org/resources/Any/search?q=SCR_004750">SCR_004750</a>)</div>
      </div>
    </td></tr></table>

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.

  5. Version published to 10.1101/2020.03.26.20044826v1 on medRxiv