Children With COVID-19 May Not Show Symptoms, Still Spread Disease to Others

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Some children with COVID-19 may experience mild illness and may not show symptoms, but they can still spread the disease to others, according to the first report from the Centers for Disease Control and Prevention (CDC) that examines data on the disease in children and published in Morbidity and Mortality Weekly Report.

The report analyzed data from 149,760 laboratory-confirmed COVID-19 cases in the U.S. occurring between Feb. 12 and April 2. Among the 149,082 (99.6%) reported cases for which age was known, 2,572 (1.7%) were among children <18 years. Information on symptoms (9.4%), underlying conditions (13%) and hospitalization status (33%) was included for only a small proportion of these patients.

The data showed that 73% of pediatric patients had symptoms of fever, cough or shortness of breath, compared with 93% of adults aged 18-64. The data also showed that 5.7% of all pediatric patients, or 20% of those for whom hospitalization status was known, were hospitalized, lower than the percentage of hospitalized adults aged 18-64 years (10%) or those with known hospitalization status (33%). Three deaths were reported among pediatric cases included in the analysis, indicating severe outcomes in children.

Nearly one third of reported pediatric cases occurred in children aged 15-17 years (32%), followed by those in children aged 10-14 (27%). Among younger children, 15% occurred in children <1 year, 11% in children aged 1-4 years and 15% in children aged 5-9 years. A majority of COVID-19 pediatric patients were male (57%).

Of the 184 cases that included known exposure information, 16 (9%) were associated with travel and 168 (91%) had exposure to a COVID-19 patient in the household or community. Of the 345 pediatric cases with information on underlying conditions, 80 (23%) had at least one underlying condition. Chronic lung disease (including asthma) was the most common underlying condition (n=40), followed by cardiovascular disease (n=25) and immunosuppression (n=10).

"Although most cases reported among children to date have not been severe, clinicians should maintain a high index of suspicion for COVID-19 infection in children and monitor for progression of illness, particularly among infants and children with underlying conditions," the report suggests.

"More systematic and detailed collection of underlying condition data among pediatric patients would be helpful to understand which children might be at highest risk for severe COVID-19 illness."

The report concludes that children who are experiencing no symptoms and mild disease are likely playing a role in transmission and spread of COVID-19 in the community.

"[Social] distancing and everyday preventative behaviors are recommended for persons of all ages to slow the spread of the virus, protect the health care system from being overloaded, and protect older adults and persons of any age with serious underlying medical conditions."

Keywords: COVID-19, severe acute respiratory syndrome coronavirus 2, Coronavirus, Coronavirus Infections, Hospitalization, Centers for Disease Control and Prevention (U.S.)


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