Stein-Zamir Chen, Sinai-Zaken Ora, Zvulun Eti, Najajra Ghada, Pinto Rinat, Koren Shahar, Shoob Hanna, Abramson Nitza
Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel.
Faculty of Medicine, The Hebrew University of Jerusalem, The Hebrew University and Hadassah Braun School of Public Health and Community Medicine, Jerusalem, Israel.
Infect Med (Beijing). 2023 Mar;2(1):36-43. doi: 10.1016/j.imj.2023.02.003. Epub 2023 Mar 2.
SARS-CoV-2 clinical presentation is associated with the patients' age group. Overall, young individuals present higher proportions of asymptomatic or mild COVID-19 infection, compared to adults. Data on secondary COVID-19 transmission in households, according to the cases' age group, are accumulating.
We performed a follow-up cohort study including all COVID-19 real-time polymerase chain reaction (RT-PCR)-confirmed cases (adolescent students and school staff) diagnosed in an epidemiological investigation of a large high school outbreak. We compared the adolescent and adult groups regarding clinical symptoms, time to negative COVID-19 RT-PCR tests, and infection transmission in households.
The study population included 817 persons. The confirmed COVID-19 RT-PCR outbreak cases ( = 178) were followed (students aged 12-19 years, median age 14 years, = 153, school staff aged 24-67 years, median age 39 years, = 25) and the cases' household close contacts ( = 639) were tested. The adolescents had lower symptomatic infection rates, shorter time to negative COVID-19 RT-PCR tests, and lower transmission rates to household members, compared to the adults. The general transmission rate among household contacts was 13.5%, (86/639) ranging from 8.6% in asymptomatic students' contacts to 27.3% in symptomatic staff contacts. COVID-19 transmission rates were significantly higher in contacts of symptomatic cases compared to asymptomatic cases (odds ratio: 2.06, 95% CI 1.26-3.4) and higher in adults compared to adolescents (odds ratio: 2.69, 95% CI 1.43-4.89).
Adolescents and adults diagnosed in an outbreak investigation differ as to COVID-19 clinical presentation and transmission. As adolescents may show mild or no symptoms, COVID-19 prevention in school settings is challenging. Implementing nonpharmaceutical measures and promoting vaccination programs in eligible staff and students should be considered.
新型冠状病毒肺炎（SARS-CoV-2）的临床表现与患者年龄组有关。总体而言，与成年人相比，年轻人无症状或轻度新型冠状病毒肺炎（COVID-19）感染的比例更高。根据病例年龄组，家庭中COVID-19二次传播的数据正在积累。
我们进行了一项随访队列研究，纳入了在一所大型高中疫情的流行病学调查中确诊的所有COVID-19实时聚合酶链反应（RT-PCR）确诊病例（青少年学生和学校工作人员）。我们比较了青少年和成人组的临床症状、COVID-19 RT-PCR检测转阴时间以及家庭中的感染传播情况。
研究人群包括817人。对确诊的COVID-19 RT-PCR疫情病例（n = 178）进行了随访（12至19岁的学生，中位年龄14岁，n = 153，24至67岁的学校工作人员，中位年龄39岁，n = 25），并对病例的家庭密切接触者（n = 639）进行了检测。与成年人相比，青少年的症状性感染率较低，COVID-19 RT-PCR检测转阴时间较短，向家庭成员的传播率较低。家庭接触者中的总体传播率为13.5%（86/639），无症状学生接触者中的传播率为8.6%，有症状工作人员接触者中的传播率为27.3%。与无症状病例相比，有症状病例的接触者中COVID-19传播率显著更高（优势比：2.06，95%置信区间1.26 - 3.4），与青少年相比，成年人中的传播率更高（优势比：2.69，95%置信区间1.43 - 4.89）。
在疫情调查中确诊的青少年和成年人在COVID-19临床表现和传播方面存在差异。由于青少年可能表现出轻微症状或无症状，学校环境中的COVID-19预防具有挑战性。应考虑实施非药物措施并在符合条件的工作人员和学生中推广疫苗接种计划。
