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Meta-Analysis Systematic Review Journal Article Epublish 7 citations

PubMed: 38419461 DOI: 10.7189/jogh.14.05003

Epidemiology and clinical features of SARS-CoV-2 infection in children and adolescents in the pre-Omicron era: A global systematic review and meta-analysis.

J Glob Health 14:05003

Authors: Durga Kulkarni, Nabihah Farhana Ismail, Fuyu Zhu, Xin Wang, Graciela Del Carmen Morales, Amit Srivastava, Kristen E Allen, Julia Spinardi, Ahmed Ehsanur Rahman, Moe H Kyaw, Harish Nair

Affiliations

  • Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom.
  • Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom. Communicable Disease Control Unit, Public Health Department, Johor State, Malaysia.
  • Schol of Public Health, Nanjing Medical University, China.
  • Pfizer, Vaccines, Emerging Markets.
  • Orbital Therapeutics, USA.
  • International Centre for Diarrhoeal Diseases Research, Bangladesh.
  • MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

Methods

We searched MEDLINE, Embase, Global Health, CINAHL, China National Knowledge Infrastructure, Wanfang, CQvip, and the World Health Organization (WHO) COVID-19 global literature databases for primary studies recruiting children aged ≤18 years with a diagnosis of SARS-CoV-2 infection confirmed either by molecular or antigen tests. We used the Joanna Briggs Institute critical appraisal tools to appraise the study quality and conducted meta-analyses using the random effects model for all outcomes except for race/ethnicity as risk factors of SARS-CoV-2 infection.

Results

We included 237 studies, each reporting at least one of the study outcomes. Based on data from 117 studies, the pooled SARS-CoV-2 positivity rate was 9.30% (95% confidence interval (CI) = 7.15-11.73). Having a comorbidity was identified as a risk factor for SARS-CoV-2 infection (risk ratio (RR) = 1.33; 95% CI = 1.04-1.71) based on data from 49 studies. Most cases in this review presented with mild disease (n = 50; 52.47% (95% CI = 44.03-60.84)). However, 20.70% of paediatric SARS-CoV-2 infections were hospitalised (67 studies), 7.19% required oxygen support (57 studies), 4.26% required intensive care (93 studies), and 2.92% required assisted ventilation (63 studies). The case fatality ratio (n = 119) was 0.87% (95% CI = 0.54-1.28), which included in-hospital and out-of-hospital deaths.

Conclusions

Our data showed that children were at risk for SARS-CoV-2 infections and severe outcomes in the pre-Omicron era. These findings underscore the need for effective vaccination strategies for the paediatric population to protect against the acute and long-term sequelae of COVID-19.

Registration

PROSPERO: CRD42022327680.

MeSH

Sars-Cov-2, Epidemiology, Global Health, Adolescent, Covid-19, Risk Factors, Severe Acute Respiratory Syndrome-Related Coronavirus, Infections, Child

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