家庭和学校中儿童和青少年传播 SARS-CoV-2：基于人群和接触者追踪研究的荟萃分析。

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

机构信息

Population, Policy and Practice, UCL Great Ormond St. Institute of Child Health, London, United Kingdom.

University of Cambridge, United Kingdom.

出版信息

J Infect. 2022 Mar;84(3):361-382. doi: 10.1016/j.jinf.2021.12.026. Epub 2021 Dec 22.

DOI:10.1016/j.jinf.2021.12.026

PMID:34953911

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8694793/

Abstract

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.

摘要

背景

儿童和青少年（CYP）在家庭和教育环境中传播 SARS-CoV-2 的作用仍不清楚。我们对低偏倚风险的接触者追踪和基于人群的研究进行了系统评价和荟萃分析。

方法

我们于 2021 年 7 月 28 日在 4 个电子数据库中搜索了有关家庭或教育环境中 0 至 19 岁儿童和青少年传播 SARS-CoV-2 的接触者追踪研究和基于人群的研究。我们排除了高偏倚风险的研究，包括对无症状感染的不完全发现。我们对二级攻击率（SAR：接触者追踪研究）和学校感染流行率进行了多层次随机效应荟萃分析，并使用荟萃回归来研究社区 SARS-CoV-2 发病率对学校感染流行率的影响。

结果

共审查了 4529 篇摘要，最终纳入了 37 项研究（16 项接触者追踪研究；19 项人群研究；2 项混合研究）。在调整后的家庭研究中，与成年人相比， CYP 的相对传染性为 0.92（0.68，1.26）。在学校研究中， CYP 的 SAR 较低（p=0.002）为 0.7%（0.2，2.7），而家庭研究中为 7.6%（3.6，15.9）。 CYP 对儿童或成人接触者的 SAR 无差异。学校人群研究表明，在学校班级内存在聚类现象。学校感染流行率与同期社区 14 天发病率相关（OR 1.003（1.001，1.004），p<0.001）。

解释

我们发现 CYP 与成年人相比，在家庭环境中传播 SARS-CoV-2 没有差异。与家庭环境相比，SAR 在学校环境中明显较低，这表明在本次大流行中，家庭传播比学校传播更为重要。学校感染流行率与社区感染发病率相关，支持了学校感染广泛反映社区感染的假设。这些发现对于指导大流行期间的保护、疫苗接种、学校和运营政策决策具有重要意义。