Pediatric Population: Proportion of Asymptomatic COVID-19 Patients

Age / pediatric population

n = all exposed / tested cases

SARS-CoV–positive cases / RT-PCR positive cases

Asymptomatic cases

Incidence rate (%) proportion of asymptomatic cases out of all SARS-CoV–positive cases

Undertake a retrospective analysis using clinical data of sixteen children (11 months-14 years) diagnosed with COVID-19 between at Xiangyang Central Hospital, Hubei province, China.[2]

children (11 months-14 years)

      16

       16

    8

        50%

Clinical features in children with documented SARS-CoV-2 infection

To evaluate children infected with SARS-CoV-2 and treated at the Wuhan Children’s Hospital [3]

1391

171

27

16%

To describe the characteristics of clinical manifestations and epidemiology of children with 2019 novel coronavirus (2019-nCoV) infection admitted to the Third People's Hospital of Shenzhen in China from January 19 to February 7, 2020.[4]

The median age was 8 years and 11 months. No patients had underlying diseases.

34

34

3

9

The clinical, laboratory, and chest CT features of 20 pediatric inpatients with COVID?19 infection confirmed by pharyngeal swab COVID?19 nucleic acid test were retrospectively analyzed during 23 January and 8 February 2020 in Wuhan Children's Hospital [5].

Patient ages ranged from 1 day to 14 years 7 months, with a median age of 2 years and 1.5 months

20

2

10

To identify the epidemiological characteristics and transmission patterns of pediatric patients with COVID-19 in China from Nationwide case series of 2143 pediatric patients with COVID-19 reported to the Chinese Center for Disease Control and Prevention from January 16 to February 8, 2020 [6].

The median age of all patients was 7 years (interquartile range: 2-13), About a half of patients were from Hubei province (984, 45.9%), while 397 (18.5%) cases were from Anhui, Henan, Hunan, Jiangxi, Shanxi and Chongqing

which border Hubei province

2143

731

94

4

To investigate the clinical and CT features in the pregnant women and children, with 4 laboratory-confirmed children in Hubei Province [7]

4

1

25

Conduct a retrospective analysis To study the clinical features and chest CT findings of coronavirus disease 2019 (COVID-19) in infants and young children [8]

9 children, aged 0 to 3 years,

9

5

56

To describe chest CT findings in children with COVID-19 including children at a large tertiary-care hospital in China,

[9]

five children from 10 months to 6 years of age (mean 3.4 years).

5

4

80

[10] Review the available data from the Hospital Papa Giovanni XXIII in Bergamo, Italy,  one of the main hospitals of Lombardy,  located in the eye of the cyclone of the outbreak, and hosts one of the largest European centers for pediatric liver transplantation.

3

3

100%

[11] report the epidemiological, clinical, laboratory, and radiological characteristics, as well as potential biomarkers for predicting disease severity in 2019-nCoV-infected patients in Shenzhen, China

1

1

100%

[12] a family of six patients who travelled to Wuhan from Shenzhen between Dec 29, 2019 and Jan 4, 2020

They presented to the University of Hong Kong-Shenzhen Hospital, Shenzhen) 6–10 days after symptom onset

1

1

100%

[13] A well 6-month-old boy was referred to KK Women’s and Children’s Hospital (KKH) on 4 February 2020. His mother and live-in helper were admitted to the Singapore General Hospital (SGH) isolation unit on 3 February 2020 for pneumonia

His mother’s occupation involved close contact with tourists from China. 

1

1

100%

[14] A retrospective analysis on clinical data and chest CT images of 15 children diagnosed with 2019-nCoV admitted to the third people's Hospital of Shenzhen

15

10

67%

[15] A retrospective analysis of the epidemiological history, clinical symptoms, signs, laboratory examinations, chest imaging, treatment, and the short-term prognosis of 31 cases of 2019-nCoV

 in children from six provinces (autonomous region) in northern China.

31

4

13%

[16] Nine infected infants were identified between December 8, 2019, and February 6, 2020.

There were 2 patients from Beijing, 2 from Hainan, and 1 each from Guangdong, Anhui, Shanghai, Zhejiang, and Guizhou.

9

1

11%

[17]

28

[18] A report of a family cluster of coronavirus disease 2019 (COVID-19) caused by a presymptomatic case.

 in Zhejiang, China, after a visit to a temple. On 19 January, a couple participated in a temple activity to celebrate the Chinese Spring Festival

8

2

25

[19] to analyze the different clinical characteristics between children and their families infected on Covid in Jinan, Shandong province

9

6

67

[20] Epidemiological and clinical investigations report of ten pediatric SARS-CoV-2 infection cases confirmed by PCR. One child was completely asymptomatic

eight children persistently tested positive on rectal swabs even after nasopharyngeal testing was negative, raising the possibility of fecal–oral transmission.

10

1

10

[21] A report an asymptomatic child who was positive for a coronavirus by reverse transcription PCR in a stool specimen 17 days after the last virus exposure. 10-year-old boy who had no fever or cough but had close contact with 2 confirmed case-patients with laboratory-confirmed COVID-19

The child was virus positive in stool specimens for at least an additional 9 days.

1

1

100

[22] A clinical characteristics report of a family cluster of SARS-CoV-2 infection.

two family members—a 33-year-old woman (patient 2) and a 3-year-old boy (patient 3)—were both asymptomatic

1

1

100

[23] prospectively followed up 31 confirmed cases < 18 years of age with SARS-CoV-2 infection in Shenzhen Third People’s Hospital between Jan 16, 2020, and Feb 19, 2020. With 29 (93.5%) children are in family clusters

31

12

39

[24] A retrospective study involving pediatric patients (aged 0–16 years) with confirmed COVID-19 from electronic medical records in three hospitals in Zhejiang, China.

the large proportion of asymptomatic children indicates the difficulty in identifying pediatric patients who do not have clear epidemiological information, leading to a dangerous situation in community-acquired infections.

The route of transmission was by close contact with family members (32 [89%]) or a history of exposure to the epidemic area (12 [33%]); eight (22%) patients had both exposures

36

10

28

[25] nine pediatric patients were identified as having 2019?nCoV infection in Changsha. Six children had a family exposure and could provide the exact dates of close contact with someone who was confirmed to have 2019?nCoV infection

A retrospective & single?center study were done at the Public Health Clinic Center of Changsha, Hunan, China.

9

2

22

[26] The Coronavirus Infection in Pediatric Emergency Departments (CONFIDENCE) study involved a cohort of 100 Italian children younger than 18 years of age with Covid-19 confirmed by reverse-transcriptase–polymerase-chain-reaction

describe the results of the CONFIDENCE study and compare them with those from three cohorts in previously published analyses

100

21

21

[27] Brief report of 4 pediatric cases of COVID-19 infection in Malaysia. 4 confirmed cases in children that were diagnosed and treated in Malaysia. The cases ranged from 20 months to 11 years of age. All four cases were likely to have contracted the virus in China.

only one was a Malaysian who had visited Wuhan for the Chinese New Year festival as his mother originated from Wuhan. Case 1 was asymptomatic until day 17 when fever and diarrhea occurred.

4

1

25

[28] 10 children with COVID-19 were recruited from January 27 to March 10, 2020, in Changsha, China. All the children tested positive for nucleic acid in throat swabs at admission. Stool swabs of three cases were positive for nucleic acid after several days of fever.

Intrafamily transmission was the main route via which children become infected. Persistent intestinal excretion virus of SARS-COV-2 can be seen in children. The stool swab tests should be included in the criteria for discharge or release.

10

2

20

[29] Retrospectively, two research centers’ case series of 67 consecutive hospitalized cases including 53 adult and 14 children cases with COVID-19 between 23 Jan 2020 and 15 Feb 2020 from Jinan and Rizhao were enrolled in this study.

14 children cases of confirmed COVID-19 from the Jinan infectious diseases hospital and Rizhao people's hospital, which were the designated hospitals in Jinan and Rizhao city, between 23 Jan 2020 and 15 Feb 2020 were enrolled in this study

14

8

57

[34] 119 studies identified across 26 countries comprising 2367 pediatric patients with 456 asymptomatic

2367

456

19.3

[35] To analyze the full clinical course and the duration of SARS-CoV-2 RNA detectability in children confirmed with COVID-19 in the Republic of Korea, Cases series of children with COVID-19 was conducted in 20 hospitals and 2 nonhospital isolation facilities across the country

Children younger than 19 years who had COVID-19 were included

91

20

22

[36] a meta-analysis of COVID-19 symptoms in children with positive RTeqPCR tests. 1600 patients identified from 26 articles, of which 16% asymptomatic

The primary objective was to describe the proportion of pediatric patients diagnosed with SARS-CoV-2 (using RTeqPCR)

1600

256

16

[37] to determine the symptoms most commonly associated with a positive result for a SARS-CoV-2 swab among community-based children.

observational study among children tested and followed for SARS-CoV-2 infection using nasal, nasopharyngeal, throat or other (e.g., nasopharyngeal aspirate or tracheal secretions, or unknown) swabs between Apr. 13 and Sept. 30, 2020, in Alberta

2463

1987

714

35.9%

[38] prospective cohort study of children and adolescents (<21 years of age) with a SARS-CoV-2-infected close contact. We collected nasopharyngeal or nasal swabs at enrollment and tested for SARS-CoV-2 using a real-time PCR assay

Children ages 6–13 years were frequently asymptomatic (38%)

382

289

110

38%

[39] Systematic Review aims to elucidate a better understanding of the global impact of COVID-19 on the pediatric population.

Ten studies including two case series and 8 retrospective chart reviews, altogether describing a total of 2914 pediatric patients with COVID-19 were included in this systematic review

2914

434

14.9%

[40] report the prevalence of positive SARS-CoV-2 test results in children without symptoms at 28 children's hospitals across the US.

 Results have been reported in children undergoing emergency surgery1 and oncologic care,2 these small studies have limited generalizability to large populations of children without symptoms

33?041

250

250

100%

[41] investigated the frequency of individuals carrying SARS-CoV-2 among children admitted for noninfectious conditions and without any SARS-CoV-2–associated symptoms or signs and compare it with the frequency of individuals carrying SARS-CoV-2 among a similar adult population.

At the Fondazione Ca’ Granda Ospedale Maggiore Policlinico in Milan, Italy, all patients who require hospitalization after accessing either the pediatric emergency department (for participants younger than 18 years) or the adult emergency department (for individuals 18 years and older) immediately undergo a nasopharyngeal swab for the detection of SARS-CoV-2, regardless of their symptoms.

881

83

1

1,2%

[42] evaluated children infected with SARS-CoV-2 and treated at the Wuhan Children’s Hospital, the only center assigned by the central government for treating infected children under 16 years of age in Wuhan

1391

171

27

15.8%

[43] Outcomes of Neonates Born to Mothers with Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City

(median gestational age, 37.9 [IQR, 37.1-38.4] vs 39.1 [IQR, 38.3-40.2] weeks

101 neonates born to mothers with perinatal SARS-CoV-2 infections at a single institution, 2 (2.0%) had positive test results for SARS-CoV-2, but none had clinical evidence of coronavirus disease 2019 (COVID-19), despite most infants rooming-in with mothers and direct breastfeeding

101

2

2

100

Bavaria, Germany, Children aged 1-18 years [44]

General Population

4859

47

22

46,8

To analyze the proportion of the number of asymptomatic COVID-19 patients chosen from six family members (mixed adults and children) who travelled to Wuhan.[45]

Reporting of clinical and laboratory findings of the family cluster who showed asymptomatic phenomena. Phylogenetic analysis was also performed.  

6

6

1

16

To analyze the epidemiological characteristics and transmission rate of the virus from asymptomatic patients (adults + children + healthcare workers).[46]

2143

2143

1929

90

To find out the prevalence of COVID-19 infection among children – asymptomatic (Children).[47]

33041

250

0.65%

0,65%

To compare the asymptomatic prevalence of COVID-19 infections among children and adults in China (children).[48]

14

14

8

57.10%

To analyze the fact that children have higher percentages of asymptomatic percentages of infection than adults (children and adults).[49]

100

100

95

95%

To analyze the total percentage of asymptomatic pediatric patients (children). [50]

500

450

20

4,4%

Infection data was collected from (82 healthcare organizations and 25 European countries) children and individuals of ages below 18. The collected data was of RT PCR. [51]

582

582

93

15,98%

Clinical features and laboratory results in newborns and infants ≤ 3 months of age with documented SARS-CoV-2 infection

[30] a case of neonatal COVID-19 infection in China with pharyngeal swabs tested positive by rRT-PCR assay 36 hours after birth. There is not enough data to determine the effect of COVID-19 infection on the fetus. Whether COVID-19 has mother-to-child vertical transmission and its short-term and long-term harm to offspring is still unclear.

However, whether

the case is a vertical transmission from mother to child remains to be confirmed. 34-year-old pregnant woman who lives near the Huanan Seafood Wholesale Market (about 1.2km walking distance) in Wuhan

1

1

100 %

[31] Three newborns have been diagnosed up to date who mainly belonged to family cluster cases. The mother was infected. in Shenzhen, China

The second newborn appeared fever on 5 days after birthing whose mother also confirmed infected. 

3

1

33 %

[32] report of a newborn with elevated IgM antibodies to SARS-CoV-2 born to a mother with coronavirus disease 2019 (COVID-19). A mother with COVID-19 and her infant delivered February 22, 2020, at Renmin Hospital, Wuhan, China. 29-year-old primiparous woman (34 weeks 2 days of gestation) suspected of being exposed to SARS-CoV-2. chest CT showed patchy ground-glass opacities in the periphery of both lungs. The RT-PCR on a nasopharyngeal swab was positive. From the baby, Results from 5 RT-PCR tests on nasopharyngeal swabs taken from 2 hours to 16 days of age were negative.

Controversy exists regarding whether SARS-CoV-2 can be transmitted in utero from an infected mother to her infant before birth. A series of 9 pregnant women found no mother-child transmission

1

1

100

[33] Two newborns were enrolled in the study. At birth and 3 days of life, newborns were negative to SARS-CoV-2. At 2-week follow-up, one newborn tested positive although asymptomatic.

To evaluate post discharge SARS-CoV-2 status of newborns to mothers with COVID-19 in pregnancy that, at birth, were negative to SARS-CoV-2.

1

1

100