A meta-analysis on the role of children in SARS-CoV-2 in household transmission clusters

Zhu, Yanshan; Bloxham, Conor J; Hulme, Katina D; Sinclair, Jane E; Tong, Zhen Wei Marcus; Steele, Lauren E; Noye, Ellesandra C; Lu, Jiahai; Xia, Yao; Chew, Keng Yih; Pickering, Janessa; Gilks, Charles; Bowen, Asha C; Short, Kirsty R

The role of children in the spread of SARS-CoV-2 remains highly controversial. To address this issue, we performed a meta-analysis of the published literature on household SARS-CoV-2 transmission clusters (n=213 from 12 countries). Only 8 (3.8%) transmission clusters were identified as having a paediatric index case. Asymptomatic index cases were associated with a lower secondary attack in contacts than symptomatic index cases (estimate risk ratio [RR], 0.17; 95% confidence interval [CI], 0.09-0.29). To determine the susceptibility of children to household infections the secondary attack rate (SAR) in paediatric household contacts was assessed. The secondary attack rate in paediatric household contacts was lower than in adult household contacts (RR, 0.62; 95% CI, 0.42-0.91). These data have important implications for the ongoing management of the COVID-19 pandemic, including potential vaccine prioritization strategies.