Abstract
At the beginning of the coronavirus-2019 (COVID-19) pandemic, Italy was one of the most affected countries in Europe. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is less frequent and less severe in children than in adults. This study analyzed the frequency of SARS-CoV-2 infection among all children aged <18 years in the Apulia region of southern Italy and the characteristics of the infected children. Clinical and demographic data were collected through the national platform for COVID-19 surveillance. Of the 166 infected children in the Apulia region, 104 (62.6%) were asymptomatic, 37 (22.3%) had mild infections, 22 (13.3%) had moderate infections, and 3 (1.8%) had severe infections. Only ten children (6.0%) were hospitalized, but none required intensive care support and none died. SARS-CoV-2 infection was transmitted mainly from parents or relatives to children. Because of school closure during the lockdown, infection was unlikely to have been transmitted among children. It is unclear whether school reopening would enhance virus spread, leading the Italian government to develop guidelines for safe school reopening. The actual role of children in virus transmission remains unclear. A sensitive surveillance system, prompt identification of cases, testing, and contact tracing will be key to reducing the further spread of infection.
Highlights
Was one of the most affected European countries during the first months of the coronavirus2019 (COVID-19) pandemic, and the first to institute a national lockdown to contain the spread of the virus, effective 9 March 2020 [1]
Of the 4498 confirmed cases of SARS-CoV-2 infection diagnosed in Apulia, 166 (3.7%) were in children aged
Contact tracing in 99 of these children showed that 98 acquired the infection from a family member. These findings indicate that in Apulia, SARS-CoV-2 infection was transmitted from parents or relatives to children, with about two-thirds of the latter not developing symptoms
Summary
Was one of the most affected European countries during the first months of the coronavirus. 2019 (COVID-19) pandemic, and the first to institute a national lockdown to contain the spread of the virus, effective 9 March 2020 [1]. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is less frequent and less severe in children than in adults [3,4]. The prognosis is almost invariably good and recovery is achieved usually within 1 or 2 weeks [6]. The reason for this advantage is not yet clear, epithelial shedding of angiotensin-converting enzyme-2 (ACE-2), the binding site of the virus, is reduced in children, likely because of progressive maturation during childhood [7]
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