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Epidemiology of COVID-19 Among Children in China

Our take —

This study leveraged data from the Chinese Center for Disease Control and Prevention between January 16 to February 8, 2020 to characterize suspected and confirmed pediatric cases of COVID-19 in China. Among 2135 pediatric patients less than 18 years old, infection did not differ by sex, occurred across all ages, and disease severity was highest among younger children. Results from this study suggest that clinical manifestations of COVID-19 among children at a population level may be less severe than among adults, but that children are susceptible to disease and severe outcomes among children may occur.

Study design

Case Series

Study population and setting

This study included 2135 pediatric patients less than 18 years old with suspected or confirmed COVID-19 that were reported to the Chinese Center for Disease Control and Prevention from January 16 to February 8, 2020. Cases were initially diagnosed based on clinical manifestations and exposure history, then subsequently recategorized as suspected cases based on specific exposure and clinical criteria, with confirmed cases also including laboratory confirmation of SARS-CoV-2 infection. Epidemic curves were constructed from these data based on dates of disease onset and case diagnosis.

Summary of Main Findings

Among pediatric patients, 34.1% (728/2135) were laboratory-confirmed cases and 65.9% (1407/2135) were suspected cases. The median age of all patients was 7 years (interquartile range: 2-13), and there was no difference in cases by sex. Asymptomatic cases made up 4.4% of the participants, mild 51.0%, and moderate cases 38.7%. Severe and critical cases by age group were 10.6%, 7.3%, 4.2%, 4.1%, and 3.0% for the age groups <1, 1-5, 6-10, 11-15, and >15 years, respectively. Notably, severity was greater among the suspected (non-laboratory confirmed) cases. One death was observed among the study sample. The epidemic curve increased quickly and then declined slowly.

Study Strengths

This study uses national surveillance data of disease onset and case diagnosis to describe the outbreak and epidemiological characteristics among pediatric cases, with case severity stratified by sex and age.

Limitations

It is possible that the suspected (non-confirmed) cases of COVID-19 that were included in this analysis may have been caused by pathogens other than SARS-Cov-2, and given the large proportion of suspected cases in this analysis misclassification of disease may overestimate cases. Further, detailed clinical characteristics and outcomes among cases were not available to be included in this analysis. Detailed exposure history was not available and therefore could not be used to estimate the incubation period.

Value added

This is the first large study to describe the epidemiological characteristics among children infected with COVID-19 in China.