Abstract
This systematic review sought to characterize child-to-child and child-to-adult transmission of severe acute respiratory coronavirus 2 (SARS-CoV-2). A systematic review was conducted from April 1, 2021, to December 15, 2023, to estimate secondary attack rates (SARs) and secondary infections per index case (case rate) from index cases up to age 20 years. SAR and case rate were analyzed based on age, setting, country and variant prevalence. Meta-analysis was conducted on the SAR data. Eighty-six studies were included, representing 33,674 index cases. The total pooled SAR was 0.11 (95% CI: 0.07-0.16); 0.05 (95% CI: 0.03-0.10) for child-to-child transmission and 0.15 (95% CI: 0.07-0.30) for child-to-adult transmission. Pooled SAR in households was 0.28 (95% CI: 0.24-0.34) and was 0.02 (95% CI: 0.01-0.04) in schools. The role of children in SARS-CoV-2 transmission is small, particularly in schools. This work can help inform policies that effectively reduce transmission while minimizing adverse effects on children.
Published Version
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