Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA.
Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA.
Pediatr Pulmonol. 2021 Jun;56(6):1342-1356. doi: 10.1002/ppul.25344. Epub 2021 Mar 15.
Children less than 18 years of age account for an estimated 2%-5% of reported severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases globally. Lower prevalence of coronavirus disease 2019 (COVID-19) among children, in addition to higher numbers of mild and asymptomatic cases, continues to provide challenges in determining appropriate prevention and treatment courses. Here, we summarize the current evidence on the transmission, clinical presentation, complications and risk factors in regard to SARS-CoV-2 in children, and highlight crucial gaps in knowledge going forward. Based on current evidence, children are rarely the primary source of secondary transmission in the household or in child care and school settings and are more likely to contract the virus from an adult household member. Higher transmission rates are observed in older children (10-19 years old) compared with younger children ( <10 years old). While increasing incidence of COVID-19 in neonates raises the suspicion of vertical transmission, it is unlikely that breast milk is a vehicle for transmission from mother to infant. The vast majority of clinical cases of COVID-19 in children are mild, but there are rare cases that have developed complications such as multisystem inflammatory syndrome in children, which often presents with severe cardiac symptoms requiring intensive care. Childhood obesity is associated with a higher risk of infection and a more severe clinical presentation. Although immediate mortality rates among children are low, long-term respiratory, and developmental implications of the disease remain unknown in this young and vulnerable population.
儿童约占全球报告的严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）病例的 2%-5%。儿童患 2019 年冠状病毒病（COVID-19）的患病率较低，加上轻症和无症状病例较多，这在确定适当的预防和治疗方案方面仍然存在挑战。在这里，我们总结了目前关于儿童中 SARS-CoV-2 的传播、临床表现、并发症和危险因素的证据，并强调了未来知识的关键空白。基于目前的证据，儿童很少是家庭或儿童保育和学校环境中二次传播的主要来源，更有可能从成年家庭成员那里感染病毒。在年龄较大的儿童（10-19 岁）中观察到更高的传播率，与年龄较小的儿童（<10 岁）相比。虽然新生儿 COVID-19 的发病率增加引起了垂直传播的怀疑，但母乳不太可能成为母婴传播的媒介。儿童 COVID-19 的绝大多数临床病例都是轻症，但也有少数病例出现了儿童多系统炎症综合征等并发症，这些并发症常伴有严重的心脏症状，需要重症监护。儿童肥胖与感染风险增加和更严重的临床表型相关。尽管儿童的即时死亡率较低，但在这一年轻脆弱人群中，疾病对呼吸和发育的长期影响仍不清楚。
