This summary was produced in partnership with The Don’t Forget the Bubbles team, and based on published and pre-print studies identified in our rapid review. We completed the final update to this summary on 22 July 2021, according to the published date on 28 June 2021 and JCVI guidance from 19 July 2021.
From now, we will add details of key studies only in the section, Notable evidence.
The initial phase of this rapid review, which begain in April 2020, involved a comprehensive look at all studies regarding COVID-19 in children and young people. On 1 July 2020 we refined our search process to update the summary with studies considered to be good quality or of high impact. A full summary of all the papers identified on COVID-19 and children published to date is hosted by Don’t Forget the Bubbles.
The evidence found during the initial six-month period can be downloaded below together with search strategies and inclusion criteria used to identify papers during both periods.
Some included studies, indicated in the reference list [*], provide preliminary findings that were not certified by peer review; these findings should be treated with due caution.
To get an email notification of updates to this page, log in and click or tap on the pink button in the grey box above, 'Notify me when updated'.
Can children and young people suffer from COVID-19 disease?
COVID-19 disease has been reported in children and young people of all ages, including shortly after birth.1 2 3 There have been far fewer confirmed cases of COVID-19 disease in children than adults (children consistently make up 1-5% of total case numbers in reports).4 5 6 7 8 9 10 11 12
Publications about acute infection suggest that there are comparatively few children infected by SARS-CoV-2 and thus suffering from COVID-19 disease in the community.4 12 13 14 15 Community surveillance systems suggest teenagers are more susceptible to COVID-19 disease than younger children.12 16
Does COVID-19 affect children and young people in the same way as adults?
Infection with SARS-CoV-2 appears to take a milder course in children than in adults: most infected children present with mild symptoms or are asymptomatic,1 4 8 12 17 18 19 20 21 22 23 and very few (c. 1%) develop severe or life threatening disease.9 24 25 26 27 28 In the absence of widespread community or serological testing, it is uncertain what the proportion with sub-clinical symptoms is.
Within households, secondary attack rates in children have generally been shown to be lower than in adults, suggesting that they have a reduced susceptibility to infection.29 30 31 32 It is speculated that differences in the expression of Angiotensin Converting Enzyme 2 Receptor may play a role in altering the susceptibility of children to infection.33 34
More recently, understanding of the innate and adaptive immune response to SARS-CoV-2 has been progressed. Australian and American studies have demonstrated a reduction in monocyte and dendritic cells after SARS-CoV-2 infection in children, which recover in convalescence.35 36 Interestingly, they also showed that there is a significant increase in CD63+ neutrophils (which are associated with the release of pro-inflammatory mediators) which has not been shown in adult studies, suggesting that there may be differences in the innate immune response to infection in adults and children.35
A UK study has shown that children not previously infected with SARS-CoV-2 have much higher levels of cross-reactive IgG antibodies between “common cold” human coronaviruses and SARS-CoV-2 compared to young adults.37 Differences in antibody response to SARS-CoV-2 infection have been shown with young children having higher anti-S IgG antibodies compared to teens (the S protein of SARS-CoV-2 binds to the cellular receptor for viral entry to the cell) and increasing levels of anti-N IgG antibody with age.38 N protein release requires lysis of infected cells so lower levels of anti-N antibody may reflect the milder disease course in children. Understanding the antibody response in different age groups is important when considering how to screen for previous exposure to SARS-CoV-2 and to gain more complete understanding of the epidemiology of the disease, as demonstrated in a large serosurveillance study from the Netherlands.39 An Italian study has looked at the relationship between the presence of neutralising antibodies (NAbs) with viral load of SARS-CoV-2 and viral clearance in children. NAbs are not found in all children with SARS-CoV-2, but when present a lower viral load is found, along with more rapid viral clearance.40 At this point in time the clinical utility of antibody testing is unclear.
What role does ethnicity have in COVID-19 infection?
The impact of ethnicity in COVID-19 infection has not been fully elucidated. However, it has been noted that a high proportion of neonates affected by COVID-19 infection are from Black, Asian or minority ethnic groups.41 The largest UK study of children with COVID-19 in hospital found that children of Black ethnicity were over-represented compared to the population representation and that Black ethnicity was associated with an increased likelihood of requiring critical care admission.42 A school-based UK study has also found that children of non-white ethnicity had a higher rate of seropositivity for SARS-CoV-2 antibodies.43 A US study 0f 135 800 children found that whilst children of black and Hispanic ethnicity were less likely to have undergone testing for SARS-CoV-2 than Caucasian children, when they were tested they were more likely to be SARS-CoV-2 positive, which has been corroborated in other large series.44 45 46 It was found that 69% of children with Paediatric Inflammatory Multisystem Syndrome (PIMS-TS) in the UK were of Black or Asian race.47 The reasons for these differences are not clear, either within the context of the UK or globally. Further work to understand the role of ethnicity is required.
Are children as likely as adults to acquire COVID-19?
Evidence suggests that children may be less likely to acquire the disease.4 13 14 24 39 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 This is supported in countries that have undertaken widespread community testing, where lower case numbers in children than adults have been found.4 14 16 63 64 65 Between 16 January and 3 May 2020, 35,200 children in England were swabbed for SARS-CoV-2 and 1408 (4%) were positive. Children under 16 years old accounted for only 1.1% of positive cases.60 Previous infection with other types of coronaviruses has not been shown to be protective against SARS-CoV-2.66
Can children transmit the virus?
The importance of children in transmitting the virus is difficult to establish, particularly because of the number of asymptomatic cases,65 67 68 but there is some evidence that their role in transmitting the virus is limited16 62 69 70 71 72 73 74 and older ‘index case’ age has been associated with an increased rate of secondary infections.29 75 Early studies of multiple family clusters have revealed children were unlikely to be the index case, in Guangzhou, China, Israel and other countries.54 76 77 78 79 80 81 A SARS-CoV-2 positive child in a cluster in the French Alps did not transmit the virus to anyone else, despite exposure to more than 100 people.82
In the Netherlands, separate data from primary care and household studies suggests SARS-CoV-2 is mainly spread between adults and from adult family members to children, this is supported by a similar Greek study.15 30 A family-based Norwegian study has shown that whilst adults are most often the index case within a family, the onward transmission of SARS-CoV-2 within a family is highest when the index case is an adult or a child aged 0-6 years, possibly due to the close contact that occurs between younger children and others in the family.83 An American study has analysed variables which may be associated with a higher secondary household attack rate and has found that higher living density, being a partner of the index case, having a BMI >30Kg/m2 and the index case being non-white are significantly associated with higher secondary attack rates.84
In an epidemiological study where 1155 contacts of six COVID-19 positive cases in an Irish school were screened, there was no or minimal evidence of secondary transmission of COVID-19 from children to other children or adults, with the findings mirrored in studies from Singapore, Germany and the USA.85 86 87 88 89 90 A German study screened contacts of 137 children who attended school for at least one day when presumed infective (i.e. one day before symptoms started), before the child isolated. Six index cases were found to have infected 11 additional pupils, with no onward transmission identified for the other 131 children who attended school.91
However, viable SARS-CoV-2 virus has been isolated from symptomatic children with COVID-1992 and there is some evidence of transmission from asymptomatic children to others.13 54 Analysis of large outbreaks of COVID-19 disease in summer camps were unable to differentiate between transmission from adults to children and between children themselves, but up to 90% of exposed attendees who had not previously had COVID-19 contracted the virus.93 94 It is likely that multiple chains of contact account for the high infection rates and supports the notion of limiting contact outside classrooms and having “bubbles” for schools, to reduce the exposure of individuals to the virus.
Fastidious additional measures including daily temperature checks, face-masks at all times, desk spacing, half-day schooling and staggered arrival and departure time have been cited as interventions which may have resulted in low transmission rates in Hong Kong.95 This is supported by an Israeli study into a secondary school outbreak of two separate cases of COVID-19 in students, 13.2% of students and 16.6% of staff subsequently tested positive for SARS-CoV-2. Untangling the modes of transmission (increased community spread due to loosening of lockdown restrictions vs school contact) was not possible but avoiding poorly ventilated closed spaces, crowded areas and close-contact settings is recommended.96 97 98 99 100
An Australian study in secondary schools shows a low rate of child to child transmission (0.3-1.2%), with adult to child (1.5%) and adult to adult (4.4%) transmission being more common,101 something which is reflected in other transmission studies.102 Low community prevalence levels in combination with effective contact tracing enabled a rapid response, which may explain why the levels of onward infection appear to be much lower in this study.
Public Health England collected data on transmission related to school settings during June 2020, when a limited number of school years were invited to return to school. Nationally there were 198 confirmed cases related to educational settings and 1.6 million (mainly primary school aged) children were reported to have returned to school. When the index case was a child the maximum number of secondary cases was two, compared to nine when the index case was a staff member. When outbreaks were reported this was significantly associated with increased rates of regional prevalence and clustering was seen in staff members but not students.43 103 A US study reported that index cases are more commonly staff than secondary students and that secondary attack rates are higher after members of staff are the index case, when indoor sports settings are included. However, indoor sports were associated with the highest rate of secondary cases,104 and caution around sports training and transport to and from matches should be taken.105
The data that continue to be published throughout the world demonstrate that children are unlikely to contract COVID-19 from contact within schools and that household transmission is the mode of contact which is most likely to result in the spread of COVID-19.106 107 108 109 110 111 112 Overall this is very reassuring for children returning to school but highlights the importance of household isolation when a person within the household is positive for COVID-19. Maintaining interventions including social distancing, hand washing and, when appropriate, wearing masks, appear to be effective measures to reduce in-school transmission of COVID-19.88 89 109 113 114 115 116
A US study comparing the change in overall incidence of COVID-19 in children between ongoing remote teaching and a return to in-person teaching of children of all ages found an increase in incidence 20 days after schools re-opened for in-person teaching.117 This was more marked for children in high school. There are several confounders within the study which may impact the results (higher starting incidence of COVID-19 in areas with in-person teaching, community rates not described, different public health policies).
Importantly for adults aged 65 years and under, living with children of any age is associated with a lower risk of dying from COVID-19 and for adults over 65 years there is no effect on mortality. There is a slight increased risk of developing COVID-19 infection for adults 65 years and under when living with children aged 12-18 years old but this is not associated with needing admission to hospital, ICU or death.118
This summary is based on published and pre-print literature. For up to date ONS data on community prevalence levels please see the Office of National Statistics. These data will be included in the summary if published and added to the medical databases.
What is the duration of viral shedding in nasopharyngeal or throat swabs?
The duration of viral shedding (in naso-pharyngeal or throat swabs) has been reported in children to range from 6-22 days,119 120 with mean reported at 12 days119 vs. median eight days.120 121 Saliva has been assessed as an alternative method of SARS-CoV-2 detection but is found to be less sensitive than nasopharyngeal or throat swabs.122
Can children transmit the virus through their stool?
Several studies have now shown that SARS-CoV-2 can be detected by PCR in the stool of affected infants for several weeks after symptoms have resolved; faecal swabs have been found to be positive for a longer duration than nasal swabs,120 123 124 with stool shedding reported to be more than 30 days.125 126 127 This has raised the possibility of faecal-oral transmission. Research from Germany did not identify any live, culturable virus in stool despite viral RNA being detectable, suggesting this represents viral debris rather than active virus.128
Subsequent reports, however, indicate that there has been infectious virus in stool identified,129 but how much and how infectious is not yet clear as it is not quantified. This would suggest that faecal-oral transmission theoretically is possible, but we would need more evidence to really know the ramifications of this. Hand hygiene remains essential to reduce the spread of the virus from droplets arising from either the respiratory or GI tract. Further studies are needed.
How do new variants of COVID-19 affect children?
Early population data suggest that the SARS-CoV-2 variants are more infectious to the general population, including children.130 131 132 133 However, there is no evidence of children being at increased susceptibility to new variants compared to adults, or to be more severely affected by new variants,134 nor of any associated increased risk of developing PIMS-TS. The evidence base around this is rapidly growing. For up-to-date information on trends in England please see the ONS website.
What is the role of testing in children?
Until recently, testing in children has been focussed on diagnosis of the presence or absence of SARS-CoV-2 using nose and throat swabs in children who are symptomatic. Rapid diagnostic tests, either based on the presence or absence of a SARS-CoV-2 antigen (e.g. lateral flow device) or on rapidly expanded viral RNA (loop mediated isothermal amplification - LAMP) have started to be considered for use in screening, rather than diagnosis. The asymptomatic testing that has been undertaken in Liverpool excluded children under the age of 11 years so few data are available from this group, and children have not been included in the NIHR funded COVID-19 National DiagnOstic Research and Evaluation Platform (CONDOR).
A Swiss study has evaluated a rapid diagnostic antigen test using Buccal swabs compared to Buccal PCR. There was a low prevalence of 0.2% (assessed using PCR) during the study period. The specificity of the rapid antigen test was 99.4% in children and the low level of PCR positive children meant that the sensitivity could not be determined.135 A Spanish study demonstrates that whilst the sensitivity of a rapid antigen test performed in children is lower than PCR, when this is put into the context of low to moderate prevalence of COVID-19, the positive and negative predictive value of the test remains very good (100% PPV and 99% NPV).136
A study from Hong Kong suggests that the viral load of SARS-CoV-2 in children’s saliva correlates better with the presence of symptoms and immunological markers of COVID-19 than the viral load detected by nasopharyngeal swabbing.137
Further data on children are required to determine the use of rapid diagnostic tests in hospital and community settings and to determine the optimal method of sampling in children.
Clinical features and investigations
What are the symptoms of COVID-19 disease?
Disease presentation can range from no symptoms (asymptomatic) in approximately a third of children to severe pneumonia requiring ITU admission.20 57 58 138 139 140 141 142 143 When there are clinical features, they are non-specific and similar to other viral respiratory infections. The most common presenting features, present in more than 50% of cases, are cough and fever; upper respiratory tract symptoms (such as sore throat and rhinorrhoea) occur in 30-40% of patients; diarrhoea and vomiting present in approximately 10% of cases.1 5 26 27 45 119 120 126 128 138 141 144 145 146 147 148 149 150 151 152 153 154 155 156 There are reports of infants presenting with fever but no respiratory symptoms.157 Less commonly reported symptoms include thoracic pains, somnolence, febrile convulsions, lower limb pains,22 cutaneous manifestations,158 ocular manifestations consistent with viral conjunctivitis159 and thrombotic sequalae. 160 A higher than expected rate of appendicitis has been noted in patients with SARS-CoV-2 in small case series, warranting further evaluation of any potential association.45 161
Please see 'What is PIM-TS' below for further information about the symptoms of the hyper-inflammatory response syndrome.
Are there any signs that could help differentiate COVID-19 from other childhood respiratory viral infections?
There appears to be little in the way of clinical signs in children to differentiate COVID-19 from other childhood respiratory virus infections,163 and COVID-19 has been detected in combination with other viral and bacterial infections.164
There are some cases indicating possible association with skin manifestations165 in patients with suspected or confirmed COVID-19 (but please note, this case series does not describe the age of patients so includes adults), which may persist for some time once other symptoms have resolved and include acral areas of erythema oedema with some vesicles or pustules, other vesicular eruptions, urticarial lesions, other maculopapular lesions, livedo or necrosis. Dermatological exanthem,166 maculopapular167 and chilblain like lesions associated with COVID-19 have also been reported in children.168 169 170 The finding of the presence of SARS-CoV-2 in the endothelium of dermal vessels in skin biopsies of children and adolescents with acute chillblains confirms that these (chillblain) lesions are a manifestation of COVID-19.171
What is PIMS-TS?
An emerging phenomenon of a hyperinflammatory response syndrome, resembling Kawasaki Disease Shock Syndrome (KDSS), was reported in a case study describing a six month old who was treated for Kawasaki Disease (KD) and then subsequently was found to test positive for SARS-CoV-2.172 Further studies were reported in the UK,173 174 including a case series indicating that it can mimic appendicitis, with inflammation of the terminal ileum,175 Italy176 177 and France,178 as well as the US153 179 180 181 182 183 and Luxembourg.184
The RCPCH have produced a case definition for the Paediatric inflammatory multisystem syndrome - temporally associated with SARS-CoV-2 (PIMS-TS) which can be found here. The CDC have subsequently named the same syndrome Multisystem Inflammatory Syndrome in children (MIS-C) with a slightly different case definition.
Symptoms reported include abdominal pain, vomiting and diarrhoea, with persistent high-grade fever and frequently progress to shock with cardiac involvement requiring ICU admission for inotropic support, mechanical ventilation and, in a small number of patients, ECMO.47 181 185 186 187 188 189 190 Children tend to have high inflammatory markers, cardiac involvement,188 189 191 e.g. myocarditis,192 maculopapular rashes, non-suppurative conjunctivitis and encephalopathy.47 193 194 There have been a handful of fatalities reported.188 195
Children with PIMS-TS/MIS-C have been treated with supportive care only, IVIg, IV corticosteroids, anakinra, infliximab, tocilizumab, siltuximab and rituximab but the current indications for each therapy are not currently clear.47 181 182 196 197 Coronary artery aneurysms have been described in up to 40% of children with PIMS-TS,47 181 188 with this appearing to be more common in children admitted to PICU.196 Routine screening for coronary artery aneurysms is recommended at one to two weeks and four to six weeks after presentation.181
A possible temporal association with SARS-CoV-2 infection has been hypothesised because many children that were tested for SARS-CoV-2 infection were either positive by PCR or serology.196 The first epidemiological surveillance study of PIMS-TS in France supports a casual link with COVID-19 following four-five weeks behind the clinical illness198 and a further analysis of temporal causality suggests that viral infections including SARS-CoV-2 are associated with the diagnosis of KD.199 Geographic and temporal trends in the USA have demonstrated an association between the incidence of SARS-CoV-2 and the incidence of MIS-C, strengthening the argument for causality.200
One of the most detailed reports of 58 children diagnosed with PIMS-TS demonstrate that it can have a wide spectrum of symptoms, signs and severity and overlap with KD, KDSS and toxic shock syndrome (TSS). Differences in clinical and laboratory profile compared with KD, KDSS and TSS suggest that PIMS-TS is a unique entity, potentially arising from a maladaptive acquired immune response to the SARS-CoV-2 infection.47 201
The centre for disease control analysed 570 patients with MIS-C and, using latent class analysis to group the patients according to their symptoms, found three clusters. The first (36%) were an older group (median age nine years) with multi-organ involvement, particularly cardiovascular and gastro-intestinal, with very few fulfilling the diagnostic criteria for Kawasaki Disease. There was a high proportion of children with shock in this group and there was a mortality rate of 0.5%. The second (30%) had primarily respiratory symptoms in-keeping with acute COVID-19 infection and there was a case fatality rate of 5.8%. The third cluster (35%) were younger (median six years) and predominately associated with mucocutaneous lesions and rash. These children were less likely to have cardiovascular involvement.202 Coronary artery dilatation or aneurysms were seen in all three groups, highlighting the need for echocardiogram as part of the assessment of these children. Routine cardiac MRI after recovery from PIMS-TS did not show persistent myocardial dysfunction in a small study of five patients203 and children appear to return to their baseline functional levels by 30 days after discharge.204 Within the USA, MIS-C has been observed to disproportionately affect Hispanic and Black children and young people, the reasons for which aren't fully understood but are likely to be multifactorial.200
Further information can be found on the management of children presenting in this manner. The document details information on how to include cases you might be managing into research studies, including ISARIC-CPP/UK, DIAMONDS and the RECOVERY trial.
Are children from a BAME background at a higher risk of severe disease from acute COVID-19 infection?
Children from a BAME background seem to be at higher risk of severe disease from acute COVID-19,42 205 which is consistent with adult literature. BAME children are significantly over-represented in case reports/series of PIMS-TS.47 177 206 Also see the Epidemiology section to see the role of ethnicity in infection.
How long after being exposed to SARS-CoV-2 does a child develop symptoms?
The assumed incubation period (time from exposure to index case to developing symptoms) varies in different studies: it has been reported to be between 2-10 days, with median (and mode) of seven days,125 vs. 24h – 28d,151 vs. mean of 10 days (IQR 7.75 – 25.25).150
Can a child be asymptomatic but still have COVID-19?
Yes, there are reports of asymptomatic cases with positive laboratory confirmed COVID-19.12 17 23 26 76 145 207 208 In the absence of widespread community or serological data, the proportion of children who do not have any symptoms or have sub-clinical symptoms is unclear, but it is likely to be around a third of infected children.68 209 Testing of 120 asymptomatic cancer patients in a US cancer centre revealed 2.5% to be positive (vs. 14.7% of their care givers).53
What are blood and imaging tests of children with COVID-19 likely to show?
Laboratory findings are non-specific, and often normal. They may include slightly elevated inflammatory markers including c-reactive protein,26 and raised liver transaminases.119 145 210 Lymphocytopenia is seen,3 151 211 but more children appear to have raised or normal lymphocyte counts.77 119 140 141 145 212 213
Radiological investigations in infected children can be normal in up to 10%, and is associated with mild disease not requiring PICU.119 149 152 Common abnormal findings include increased peribronchovascular markings, bronchial thickening (58%), consolidation (35%), ground glass opacities (19%) and interstitial changes (16%). Pleural effusion, pneumothorax and atelectasis are uncommon features of COVID-19.22 119 144 145 152 211 214 215 216 217 218 These findings are non-specific and do not enable radiological differentiation between COVID-19 and other respiratory viruses, which have a similar picture.219
Computed Tomography (CT) of the chest has been used as a rapid diagnostic tool by some centres and, when performed, over 90% are reported to have features of lower lobe ground glass opacification (88%) and consolidation (58%). It is worthwhile noting that CTs were performed on a selective group of patients, are not recommended as a method of diagnosing COVID-19 and should be reserved for complex cases.218 CT changes have been reported in asymptomatic positive children.212
There are several cases of reported co-infection of SARS-CoV-2 and other respiratory viruses, which illustrates that the identification of another respiratory pathogen should not preclude SARS-CoV-2 testing in children.
If a swab is negative for COVID-19 infection is it possible that a child has COVID-19 infection?
We know that virtually no test is perfectly sensitive (correctly picks up all people with the disease) or specific (correctly picks up all people who don’t have the disease) and the same is true for COVID-19.220 The test that is used to confirm whether someone has COVID-19 infection or not uses swabs from the back of the nose and throat. These are used to look for COVID-19 genetic material in the cells that have been picked up, using a technique called reverse transcriptase polymerase chain reaction (RT-PCR). It is possible to still have COVID-19 infection even if the RT-PCR does not detect COVID-19 genetic material, particularly very early or very late in the disease.221
At risk groups
Are there any groups that are at higher risk of developing severe COVID-19 illness?
Whilst children with comorbidities are still at low risk of developing severe disease after SARS-CoV-2 infection compared to adults, there is evidence that children with co-morbidity have a higher risk of developing severe disease compared to children without co-morbidity.222 223 224 225 226 A national Italian study of 3836 cases reports a mortality rate of 0.1% with all children who died having co-morbidities.12 In reports of children with immunosuppression, cancer therapy have not shown it to be a significant risk factor for severe disease.227 228 229 230 231 232 233 234 235 236 237 238 Contact tracing on a dialysis unit who had contact with a member of staff who tested positive found three children to be positive, but only one had symptoms.239 A case report of a child with cystic fibrosis who contracted COVID-19 from his grandfather, identified though contact tracing, also remained asymptomatic.240 There is a case report of COVID-19 pneumonia triggering acute chest syndrome in an adolescent with known sickle cell disease on daily hydroxyurea.241
A European study of 37 asthma centres reported no children with severe asthma being admitted to hospital with COVID-19. Four of the countries included in the study, including the UK, had recommended shielding for a very small minority of children with the most severe asthma, however the other twenty-one countries had not, suggesting that severe asthma is not a risk factor for severe COVID-19 infection.242 A multinational study of 105 children with Cystic Fibrosis (95 with confirmed SARS-CoV-2 on RT-PCR) found that almost a third were asymptomatic and 70% were managed in the community. Those who were admitted to hospital required supplemental oxygen and tended to be the children with reduced lung function or reduced body mass index, compared to children in the community. One child required care in PICU and one child died approximately six weeks after being diagnosed with COVID-19 due to worsening underlying lung disease.243
On screening patients and caregivers with cancer in one of the largest paediatric cancer centres in the US, 20 of 178 paediatric patients tested positive. Only one (5%) required hospitalisation for symptoms of COVID-19, with none requiring critical care.53
CDC data from the USA reports that a high proportion of cases needing admission had at least one co-morbidity (most commonly respiratory).5 Further data from Italy20 and the US153 244 also finds that children with co-morbidities are over represented in those admitted to hospital, though most were reported to have mild illness. Children under one year of age appear to be more likely to be admitted to hospital with COVID-19 than those in older age groups.5 12 208 245 246
The USA has reported only 121 out of a total of 190,000 deaths associated with SARS-CoV-2 in people under 21 years of age until 31 July 2020. Of these 121, 70% occurred in children aged 10-20 years old (41% of the total were 18 years and above); with 74% in children of Hispanic or Black ethnicity. It was found that 75% of the children who died had co-morbidities which included asthma, obesity, neurological and cardiac conditions.247 The contribution of SARS-CoV-2 to death is unclear in this study, 35% of the total deaths occurred before the child or young person/adult could be admitted to the Hospital. There were 15 cases which met the definition for the multisystem inflammatory syndrome in children.
A UK study of 651 hospitalised children with COVID-19 found that six children died and all had significant severe co-morbidities.42 Studies have looked at other individual co-morbidities such as the impact of learning difficulties, however a lack of focus on children means that the application of the findings to children and young people is not possible.248 Further data on the impact of co-morbidities in a robust comparative way that is specific to children is required to understand the impact of co-morbidities in developing severe disease after SARS-CoV-2 infection.
In a US study of 20714 children with confirmed SARS-CoV-2, 2430 (11.7%) were admitted to hospital with COVID-19. 31% of those admitted to hospital and 3.7% of all recorded children had severe disease (requiring ICU, mechanical ventilation or causing death) and there were increased odds of severe disease in children aged 2-11 compared to children over the age of 12 years. The presence of co-morbidity was also identified as a risk factor for severe disease.249
The RCPCH have provided guidance on clinically extremely vulnerable children and young people. This guidance continues to be reviewed as new evidence emerges.
What are the characteristics of children admitted to PICU?
Severe illness is far less frequent in children than adults, but it is still significant in a very small number of children and young people.42 250 Most studies describing severely unwell children combine those who are on PICU with either SARS-CoV-2 infection with those who have PIMS-TS. Approximately 20% of hospitalised children with COVID-19 require PICU admission, 8% require inotropic support and 9% require respiratory support.42 Extra-corporeal membrane oxygenation has been used in a very small number of children with COVID-19 (approximately 2% of children admitted to PICU).251
Age: Children who have been admitted to PICU have been seen in two peaks - premature babies and those under one month of age and older children who are more commonly diagnosed with PIMS-TS.42
Co-morbidities: up to three quarters of children admitted to PICU have a co-morbidity and children with co-morbidities are more likely to require ventilation.139 252 The literature suggests that children may be at higher risk of requiring PICU admission if they are medically complex; have long-term dependence on technological support including tracheostomy; have developmental delay; have genetic abnormalities; have respiratory co-morbidity; have cardiac co-morbidity or are obese.42 251 Children who are positive for SARS-CoV-2 have also been admitted to PICU for potential sequelae of the infection including diabetic ketoacidosis and status epilepticus.253
Ethnicity: Children of black ethnicity have been noted as being over-represented compared to the general population for both the requirement to be admitted to hospital and the requirement for PICU care.42 The reasons for this are not clear.
Presentation: Children presenting to hospital with pyrexia, symptoms and signs of lower respiratory tract infection, acute respiratory distress syndrome or radiological evidence of pneumonia are noted to be more likely to require PICU admission.27
Co-infections: Viral co-infection has been cited as a potential risk factor for PICU admission.27
The overall English mortality rate in children with confirmed SARS-CoV-2 on RT-PCR is 0.3% (eight children), half of whom who had multiple co-morbidities and the other half who died of other causes with SARS-CoV-2 as an incidental or indirect contributor to death.60
In summary, studies from PICU admissions in Europe and the USA have found that those with comorbidities are over-represented, most commonly respiratory, complex neurodisability – groups which are otherwise at increased risk of complications from all respiratory viruses.254 It is not clear if the SARS-CoV-2 infection was causal, contributory or incidental to the ICU admission (or even acquired after PICU admission). The rates of complications from SARS-CoV-2 infection do not appear disproportionate to those from other respiratory viruses in this early data.255
Are neonates at increased risk of severe disease?
Many case reports/series have been published looking at the outcomes of pregnant mothers with COVID-19 and their newborn babies. Mothers and their babies in general appear to do well, with few reports of neonates requiring NICU admission.256 257 Early studies suggested that neonates without comorbidities are not at an increased risk of severe disease.258 259 260 However, recent European and UK studies have reported that age under one month and prematurity are risk factors for PICU admissions.27 41 42 It is noted in a series of four neonates infected after birth that half had additional infections and highlights the importance of screening for additional infections.261
Can COVID-19 increase the risk of pre-term birth, if the mother acquires it in the late second or third trimester?
There is a small increase in the rates of preterm or earlier birth262 and signals of an increase in the rates of foetal loss/stillborn delivery.263 264 265 266 267 A small case series suggests that SARS-CoV-2 at high viral loads may affect the placenta of late third trimester pregnancies but the evidence for this is very weak.268 A meta-analysis has found that the rate of maternal death and stillbirth has increased during the pandemic but that a change in the rate of pre-term birth has not been observed.269
Can the virus be transmitted vertically?
The vast majority of newborns have not acquired COVID-19 themselves and not had adverse outcomes after maternal COVID-19.228 229 265 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 However, a systematic review reveals that SARS-CoV-2 has been isolated from the placenta, cord blood, rectal and nasopharyngeal swabs of a small proportion of babies born to mothers with 3rd trimester COVID-19,287 suggesting that vertical transmission, whilst rare, can occur.288 289
There are a few cases of infants delivered to COVID-19 positive mothers, who have elevated SARS-CoV-2 IgM after birth, which may indicate intrauterine transmission but this is not clear because these babies tested negative on swab PCR and false positives with IgM are not uncommon.290 291 There have also been cases of newborns and very young infants testing positive shortly after birth (including several263 292 293 at or before 12 hours of age)2 259 294 however they have not suffered any known significant complications of the disease and mostly required minimal respiratory support. There is evolving evidence that neonates born to mothers who have had COVID-19 in the last two months of pregnancy have both passive and active immunity to SARS-CoV-2 but this may only last for a few weeks after birth.295 296 297 Current evidence supports the WHO guidance that babies born to mothers who have COVID-19 are very unlikely to contract the virus or to develop severe illness if they do so.298 It is therefore recommended that mothers should be supported to have skin-to-skin contact with their baby and to share a room.41
Can the virus be transmitted or through breast milk?
There are a small number of reports of viral RNA being found in breast milk,302 303 but it is unclear if this positive result reflects live, infectious virus and whether the source was the mother or infant who subsequently tested positive for the virus.
Subsequent data suggests pasteurisation eliminates the virus from breast milk and also that PCR positive breast milk does not seem to represent live, replicating virus.304 Further large-scale studies are needed to draw firm conclusions.
Interestingly, antibody testing of breastmilk collected in 2018 has shown cross-reactivity with SARS-CoV-2 antibody and mothers who have had symptoms of COVID-19 have higher levels of SARS-CoV-2 S1+S2 reactive IgA and IgM in their breastmilk. Mothers who were vaccinated and are vaccinated against Influenza have also been shown higher antibody levels.305 The protective implications of this are not yet clear for neonates but the data supports encouraging breastfeeding and highlights the importance of maternal vaccination.306 307 308 309
Does having COVID-19 in pregnancy cause any long-term problems for the baby?
We do not currently have sufficient evidence to draw conclusions on this.
What treatments are available for children with COVID-19?
For those without severe disease, which will be most children, supportive management (ensuring oxygenation, hydration and nutrition) is appropriate. For more information, please see the RCPCH guidance on the clinical management of children admitted to hospital with suspected COVID-19.
There are many ongoing studies; within the UK, there is the RECOVERY trial which is now recruiting neonates and children who are severely unwell with COVID-19.
Currently, children with an acute respiratory presentation of COVID-19 can be recruited to arms of ‘no additional treatment’ or Azithromycin and/or convalescent plasma. Children can then go on to be randomised in the second stage intervention of Tocilizumab or no additional treatment if they do not improve.
The RECOVERY trial is now also open for children with PIMS-TS. There are two tiers of randomisation. The first allows the comparison of high dose steroids to no additional treatment (in the presence and absence of IVIg) and IVIg to no additional treatment (in the presence and absence of steroids). This will enable investigators to use steroids or IVIg as standard care if necessary, but also recruit children with moderate disease who may not require additional treatment. The second tier of randomisation compares Tocilizumab to no additional treatment for children deemed eligible for biological therapy. As the trial is open label, children who do not receive Tocilizumab can be given another biological agent such as Anakinra or Infliximab.
What studies are enrolling children currently to therapeutic trials?
For any child either with PIMS-TS of COVID-19 infection causing more severe or critical illness (RCPCH treatment criteria), please consider enrolment in the RECOVERY trial. This study is open at many sites including hospitals with and without on-site PICU, and from 11 May 2020 has included children down to those just born.
If you are considering entering a child to RECOVERY, we suggest you check with your Regional Infectious Disease team and watch the relevant video(s) and view the FAQs on the study website. Please note that there are separate training videos in respect to children and infants of less than 29 days of age. If you are still uncertain about eligibility, there is the possibility for you to contact an 'on-call' member of the study team to discuss further, but please only do this if you are particularly uncertain.
If you think entry into RECOVERY is indicated, it can take place in the hospital where the child is admitted - you don't have to wait for them to be transferred to a regional centre.
Is it safe to give ibuprofen to a child who has tested positive for COVID-19 or is highly likely to be positive?
There is currently insufficient evidence to establish a link between use of ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), and contracting or worsening of COVID-19. Whilst an early report suggested ibuprofen was associated with poorer outcomes, subsequent work has not supported this. The RCPCH has made a statement about the use of ibuprofen in suspected/confirmed COVID-19. It remains a very powerful, safe and effective medicine for reducing fever and pain in infants, children and young people and adults.
Is there an effective vaccine?
Three vaccines have now been licenced for use. The majority of studies supporting their use have only been completed in adults. One vaccine (Pfizer-BioNTech OCID-19, mRNA Vaccine BNT162b2) is licensed for those 12 years and over. It is recommended by the JCVI for children aged 12-15 years with severe neurodisabilities, Down’s syndrome, immunosuppression and multiple or severe learning difficulties. In addition, children aged 12-17 years should be offered the vaccine if they live with an immunosuppressed person and young people aged 16-17 with a condition that puts them at higher risk of serious COVID-19 should also be offered the vaccine. The JCVI advice on who should receive vaccinations is available here. Other countries including the USA and Israel have been vaccinating teenagers using the Pfizer-BioNTech vaccine. Reports of perimyocarditis in children receiving the vaccine are still under review310 but given that children in the vast majority suffer only mild disease after SARS-CoV-2 infection, consideration of the safety of the vaccine is imperative around decision making for vaccination of children. Clinical trials of vaccines for SARS-CoV-2 are currently being undertaken in children in the UK.
What is the prognosis of a child who has had COVID-19?
The short-term prognosis in those who recover appears to be good with both infants311 and children largely appearing to make a full recovery.26 312 There is growing evidence that children develop an antibody response to SARS-CoV-2 infection, even when mild, which persists up to six months after infection in the majority of children.112 313
Are there any long-term complications (in specific groups) such as reduced exercise tolerance, developmental delay, or worsening of cardiac function?
A small publication of children without serological evidence of SARS-CoV-2 infection has suggested that some children may go on to have long-term effects after COVID-19.314 The research base on ‘long COVID’ in children is growing but not conclusive. A study of children admitted to hospital with SARS-CoV-2 has shown that children can complain of fatigue, sleep disturbance, sensory problems and GI disturbance after infection.315 However, without a control group it is difficult to draw conclusions on this. UK surveillance studies have demonstrated a higher prevalence of persistent symptoms up to a median of 46 days after infection with SARS-CoV-2, particularly fatigue, compared to those without.316
In children, the evidence is now clear that COVID-19 is associated with a considerably lower burden of morbidity and mortality compared to that seen in the elderly. There is evidence of critical illness and death in children, but it is rare.
There is also some evidence that children may be less likely to acquire the infection. The role of children in transmission, once they have acquired the infection, is unclear, although there is no clear evidence that they are any more infectious than adults.
Symptoms are non-specific and most commonly cough and fever. Laboratory and radiological investigations may be normal or mildly altered.
There is some possible evidence of infection in newborns which could indicate vertical transmission, but it is not clear if this is intrauterine or perinatal. Early evidence suggests both infected mothers and newborns are not particularly more severely affected than other groups.
Children with co-morbidities, notably respiratory and complex neurodisability, appear more likely to suffer complications and need hospital +/- PICU admission, but not obviously more than would be expected from infection with other respiratory viruses.
Long COVID symptoms in SARS-CoV-2-positive adolescents and matched controls (LongCOVIDKidsDK): a national, cross-sectional study. Kikkenborg Berg, S., S. Dam Nielsen, U. Nygaard, H. Bundgaard, P. Palm, C. Rotvig and A. Vinggaard Christensen. The Lancet Child and Adolescent Health 6(4): 240-248 2022. https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00004-9/fulltext
Risk of adverse events after covid-19 in Danish children and adolescents and effectiveness of BNT162b2 in adolescents: cohort study. Kildegaard, H., L. C. Lund, M. Højlund, L. G. Stensballe and A. Pottegård. BMJ (Clinical research ed.) 377: e068898 2022. https://www.bmj.com/content/bmj/377/bmj-2021-068898.full.pdf
Effectiveness of 2-Dose BNT162b2 (Pfizer BioNTech) mRNA Vaccine in Preventing SARS-CoV-2 Infection Among Children Aged 5–11 Years and Adolescents Aged 12–15 Years — PROTECT Cohort, July 2021–February 2022. Fowlkes, A. L., S. K. Yoon, K. Lutrick, L. Gwynn, J. Burns, L. Grant, A. L. Phillips, K. Ellingson, M. V. Ferraris, L. B. LeClair, C. Mathenge, Y. M. Yoo, M. S. Thiese, L. B. Gerald, N. S. Solle, Z. Jeddy, L. Odame-Bamfo, J. Mak, K. T. Hegmann, J. K. Gerald, J. S. Ochoa, M. Berry, S. Rose, J. M. Lamberte, P. Madhivanan, F. A. Pubillones, R. P. Rai, K. Dunnigan, J. T. Jones, K. Krupp, L. J. Edwards, E. J. Bedrick, B. E. Sokol, A. Lowe, H. McLeland-Wieser, K. S. Jovel, D. E. Fleary, S. M. Khan, B. Poe, J. Hollister, J. Lopez, P. Rivers, S. Beitel, H. L. Tyner, A. L. Naleway, L. E. W. Olsho, A. J. Caban-Martinez, J. L. Burgess, M. G. Thompson and M. Gaglani. MMWR Recommendations and Reports 71(11): 422-428 2022. https://www.cdc.gov/mmwr/volumes/71/wr/mm7111e1.htm
Effectiveness of COVID-19 Pfizer-BioNTech BNT162b2 mRNA Vaccination in Preventing COVID-19–Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Nonimmunocompromised Children and Adolescents Aged 5–17 Years — VISION Network, 10 States, April 2021–January 2022. Klein, N. P., M. S. Stockwell, M. Demarco, M. Gaglani, A. B. Kharbanda, S. A. Irving, S. Rao, S. J. Grannis, K. Dascomb, K. Murthy, E. A. Rowley, A. F. Dalton, M. B. DeSilva, B. E. Dixon, K. Natarajan, E. Stenehjem, A. L. Naleway, N. Lewis, T. C. Ong, P. Patel, D. Konatham, P. J. Embi, S. E. Reese, J. Han, N. Grisel, K. Goddard, M. A. Barron, M. Dickerson, I. C. Liao, W. F. Fadel, D. H. Yang, J. Arndorfer, B. Fireman, E. P. Griggs, N. R. Valvi, C. Hallowell, O. Zerbo, S. Reynolds, J. Ferdinands, M. H. Wondimu, J. Williams, C. H. Bozio, R. Link-Gelles, E. Azziz-Baumgartner, S. J. Schrag, M. G. Thompson and J. R. Verani. MMWR Recommendations and Reports 71(9): 352-358 2022. https://www.cdc.gov/mmwr/volumes/71/wr/mm7110a4.htm
Comparison of UK paediatric SARS-CoV-2 admissions across the first and second pandemic waves. Swann, O. V., L. Pollock, K. A. Holden, A. P. S. Munro, A. Bennett, T. C. Williams, L. Turtle, C. J. Fairfield, T. M. Drake, S. N. Faust, I. P. Sinha, D. Roland, E. Whittaker, S. N. Ladhani, J. S. Nguyen-Van-Tam, M. Girvan, C. Donohue, C. Donegan, R. G. Spencer, H. E. Hardwick, P. J. M. Openshaw, J. K. Baillie, E. M. Harrison, A. B. Docherty, M. G. Semple and I. C. I. on behalf of. Pediatric Research 2022. https://www.nature.com/articles/s41390-022-02052-5
Lower Risk of Multisystem Inflammatory Syndrome in Children (MIS-C) with the Delta and Omicron variants of SARS-CoV-2, Jonathan M Cohen, Michael J Carter, C Ronny Cheung, Shamez Ladhani, Evelina PIMS-TS Study Group, medRxiv 2022.03.13.22272267; doi: https://doi.org/10.1101/2022.03.13.22272267
Vaccination against SARS-CoV-2 in UK school-aged children and young people decreases infection rates and reduces COVID-19 symptoms, Erika Molteni, Liane S. Canas, Kerstin Kläser, Jie Deng, Sunil S. Bhopal, Robert C. Hughes, Liyuan Chen, Benjamin Murray, Eric Kerfoot, Michela Antonelli, Carole H. Sudre, Joan Capdevila Pujol, Lorenzo Polidori, Anna May, Alexander Hammers, Jonathan Wolf, Tim D. Spector, Claire J. Steves, Sebastien Ourselin, Michael Absoud, Marc Modat, Emma L. Duncan, medRxiv 2022.03.13.22272176; doi: https://doi.org/10.1101/2022.03.13.22272176
Effectiveness of Maternal Vaccination with mRNA COVID-19 Vaccine During Pregnancy Against COVID-19–Associated Hospitalization in Infants Aged < 6 Months — 17 States, July 2021–January 2022. Halasa, N. B., S. M. Olson, M. A. Staat, M. M. Newhams, A. M. Price, J. A. Boom, L. C. Sahni, M. A. Cameron, P. S. Pannaraj, K. E. Bline, S. S. Bhumbra, T. T. Bradford, K. Chiotos, B. M. Coates, M. L. Cullimore, N. Z. Cvijanovich, H. R. Flori, S. J. Gertz, S. M. Heidemann, C. V. Hobbs, J. R. Hume, K. Irby, S. Kamidani, M. Kong, E. R. Levy, E. H. Mack, A. B. Maddux, K. N. Michelson, R. A. Nofziger, J. E. Schuster, S. P. Schwartz, L. Smallcomb, K. M. Tarquinio, T. C. Walker, M. S. Zinter, S. M. Gilboa, K. N. Polen, A. P. Campbell, A. G. Randolph and M. M. Patel. MMWR Recommendations and Reports 71(7): 264-270 2022. https://www.cdc.gov/mmwr/volumes/71/wr/mm7107e3.htm
Risk factors for long covid in previously hospitalised children using the ISARIC Global follow-up protocol: A prospective cohort study. Osmanov, I. M., E. Spiridonova, P. Bobkova, A. Gamirova, A. Shikhaleva, M. Andreeva, O. Blyuss, Y. El-Taravi, A. DunnGalvin, P. Comberiati, D. G. Peroni, C. Apfelbacher, J. Genuneit, L. Mazankova, A. Miroshina, E. Chistyakova, E. Samitova, S. Borzakova, E. Bondarenko, A. A. Korsunskiy, I. Konova, S. W. Hanson, G. Carson, L. Sigfrid, J. T. Scott, M. Greenhawt, E. A. Whittaker, E. Garralda, O. Swann, D. Buonsenso, D. E. Nicholls, F. Simpson, C. Jones, M. G. Semple, J. O. Warner, T. Vos, P. Olliaro and D. Munblit. European Respiratory Journal 59(2) 2022 https://erj.ersjournals.com/content/early/2021/06/10/13993003.01341-2021
Persistent symptoms following SARS-CoV-2 infection amongst children and young people: A meta-analysis of controlled and uncontrolled studies. Behnood, S. A., R. Shafran, S. D. Bennett, A. X. D. Zhang, L. L. O'Mahoney, T. J. Stephenson, S. N. Ladhani, B. L. De Stavola, R. M. Viner and O. V. Swann. Journal of Infection 2022. https://www.journalofinfection.com/article/S0163-4453(21)00555-7/fulltext
Long COVID symptoms and duration in SARS-CoV-2 positive children — a nationwide cohort study. Borch, L., M. Holm, M. Knudsen, S. Ellermann-Eriksen and S. Hagstroem. European Journal of Pediatrics 2022.https://link.springer.com/article/10.1007/s00431-021-04345-z
Population-based Incidence of Myopericarditis after COVID-19 Vaccination in Danish Adolescents. Nygaard, U., M. Holm, C. Bohnstedt, Q. Chai, L. S. Schmidt, U. B. Hartling, J. J. H. Petersen, J. Thaarup, J. Bjerre, N. G. Vejlstrup, K. Juul and L. G. Stensballe. Pediatric Infectious Disease Journal 41(1): E25-E28 2022. https://journals.lww.com/pidj/Fulltext/2022/01000/Population_based_Incidence_of_Myopericarditis.26.aspx
Evaluation of the BNT162b2 Covid-19 Vaccine in Children 5 to 11 Years of Age. Walter, E. B., K. R. Talaat, C. Sabharwal, A. Gurtman, S. Lockhart, G. C. Paulsen, E. D. Barnett, F. M. Muñoz, Y. Maldonado, B. A. Pahud, J. B. Domachowske, E. A. F. Simões, U. N. Sarwar, N. Kitchin, L. Cunliffe, P. Rojo, E. Kuchar, M. Rämet, I. Munjal, J. L. Perez, R. W. Frenck, Jr., E. Lagkadinou, K. A. Swanson, H. Ma, X. Xu, K. Koury, S. Mather, T. J. Belanger, D. Cooper, Ö. Türeci, P. R. Dormitzer, U. Şahin, K. U. Jansen and W. C. Gruber. N Engl J Med 386(1): 35-46 2022. https://www.nejm.org/doi/full/10.1056/nejmoa2116298
Waning Effectiveness of the BNT162b2 Vaccine Against Infection in Adolescents. Ottavia Prunas, Daniel M. Weinberger, Virginia E. Pitzer, Sivan Gazit, Tal Patalon. medRxiv 2022 https://www.medrxiv.org/content/10.1101/2022.01.04.22268776v1
Transmission of SARS-CoV-2 by children and young people in households and schools: A meta-analysis of population-based and contact-tracing studies. Viner, R., C. Waddington, O. Mytton, R. Booy, J. Cruz, J. Ward, S. Ladhani, J. Panovska-Griffiths, C. Bonell and G. J. Melendez-Torres. Journal of Infection 2022. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3883209
Persistent symptoms among children and adolescents with and without anti-SARS-CoV-2 antibodies: a population-based serological study in Geneva, Switzerland. Roxane Dumont, Mayssam Nehme, Elsa Lorthe, Carlos de Mestral, Viviane Richard, Hélène Baysson, Francesco Pennacchio, Julien Lamour, Claire Semaani, María-Eugenia Zaballa, Nick Pullen, Anne Perrin, Arnaud G. L’Huillier, Klara M. Posfay-Barbe, Idris Guessous, Silvia Stringhini. medRxiv 2021 https://www.medrxiv.org/content/10.1101/2021.12.23.21268298v1
COVID-19 Vaccine Safety in Children Aged 5-11 Years - United States, November 3-December 19, 2021. Hause, A. M., J. Baggs, P. Marquez, T. R. Myers, J. Gee, J. R. Su, B. Zhang, D. Thompson, T. T. Shimabukuro and D. K. Shay. MMWR. Morbidity and mortality weekly report 70(5152): 1755-1760 2021. https://www.cdc.gov/mmwr/volumes/70/wr/mm705152a1.htm?s_cid=mm705152a1_w
Factors Associated With COVID-19 Disease Severity in US Children and Adolescents. Antoon, J. W., C. G. Grijalva, C. Thurm, T. Richardson, A. B. Spaulding, R. J. Teufel, 2nd, M. A. Reyes, S. S. Shah, J. E. Burns, C. C. Kenyon, A. L. Hersh and D. J. Williams. Journal of hospital medicine 16(10): 603-610 2021. https://www.journalofhospitalmedicine.com/jhospmed/article/245964/hospital-medicine/factors-associated-covid-19-disease-severity-us-children
Demographic and Clinical Factors Associated with Death among Persons <21 Years Old with Multisystem Inflammatory Syndrome in Children-United States, February 2020-March 2021. Bowen, A., A. D. Miller, L. D. Zambrano, M. J. Wu, M. E. Oster, S. Godfred-Cato, E. D. Belay and A. P. Campbell. Open Forum Infectious Diseases 8(8) 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8364981/
Covid-19 in children with down syndrome: Data from the trisomy 21 research society survey. Emes, D., A. Hüls, N. Baumer, M. Dierssen, S. Puri, L. Russell, S. L. Sherman, A. Strydom, S. Bargagna, A. C. Brandão, A. C. S. Costa, P. T. Feany, B. A. Chicoine, S. Ghosh, A. S. Rebillat, G. Sgandurra, D. Valentini, T. R. Rohrer, J. Levin, M. Lakhanpaul and M. F. D. o. b. o. T. T. R. S. C.-I. S. Group. Journal of Clinical Medicine 10(21) 2021. https://www.mdpi.com/2077-0383/10/21/5125
COVID-19-Associated Case Fatality Rate in Subjects Under 18 Years Old in Mexico, up to December 31, 2020. Navarro-Olivos, E., N. Padilla-Raygoza, G. Flores-Vargas, M. D. J. Gallardo-Luna, M. G. León-Verdín, E. Lara-Lona, F. J. Magos-Vázquez and D. A. Díaz-Martínez Frontiers in Pediatrics 9 2021. https://www.frontiersin.org/articles/10.3389/fped.2021.696425/full
Comparison of Mid-Turbinate and Nasopharyngeal Specimens for Molecular Detection of SARS-CoV-2 among Symptomatic Outpatients at a Pediatric Drive-Through Testing Site. Sahni, L. C., V. Avadhanula, C. S. Ortiz, K. E. Feliz, R. E. John, C. A. Brown, J. Y. Lively, B. Rha, F. M. Munoz, P. A. Piedra, J. J. Dunn and J. A. Boom. Journal of the Pediatric Infectious Diseases Society 10(8): 872-879 2021. https://academic.oup.com/jpids/article/10/8/872/6309959
A need of COVID19 vaccination for children aged <12 years: Comparative evidence from the clinical characteristics in patients during a recent Delta surge. (B.1.617.2). Hongru Li, Haibin Lin, Xiaoping Chen, Hang Li, Hong Li, Sheng Lin, Liping Huang, Gongping Chen, Guilin Zheng, Shibiao Wang, Xiaowei Hu, Handong Huang, Haijian Tu, Xiaoqin Li, Yuejiao Ji, Wen Zhong, Qing li, Jiabin Fang, Qunying Lin, Rongguo Yu, Baosong Xie. medRxiv 2021.https://www.medrxiv.org/content/10.1101/2021.11.05.21265712v1
Severity of Illness Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Variants of Concern in Children: A Single-Center Retrospective Cohort Study. Priya R. Edward, Ramon Lorenzo-Redondo, Megan E. Reyna, Lacy M. Simons, Judd F. Hultquist, Ami B. Patel, Egon A. Ozer, William J. Muller, Taylor Heald-Sargent, Matthew McHugh, Taylor J. Dean, Raj M. Dalal, Jordan John, Shannon C. Manz, Larry K. Kociolek. medRxiv 2021. https://www.medrxiv.org/content/10.1101/2021.10.23.21265402v1
Post COVID-19 in children, adolescents, and adults: results of a matched cohort study including more than 150,000 individuals with COVID-19. Martin Roessler, Falko Tesch, Manuel Batram, Josephine Jacob, Friedrich Loser, Oliver Weidinger, Danny Wende, Annika Vivirito, Nicole Toepfner, Martin Seifert, Oliver Nagel, Christina König, Roland Jucknewitz, Jakob Peter Armann, Reinhard Berner, Marina Treskova-Schwarzbach, Dagmar Hertle, Stefan Scholz, Stefan Stern, Pedro Ballesteros, Stefan Baßler, Barbara Bertele, Uwe Repschläger, Nico Richter, Cordula Riederer, Franziska Sobik, Anja Schramm, Claudia Schulte, Lothar Wieler, Jochen Walker, Christa Scheidt-Nave, Jochen Schmitt. medRxiv 2021. https://www.medrxiv.org/content/10.1101/2021.10.21.21265133v1
Cardiac manifestations in children with sars-cov-2 infection: 1-year pediatric multicenter experience. Cantarutti, N., V. Battista, R. Adorisio, M. Cicenia, C. Campanello, E. Listo, A. Campana, G. Trocchio and F. Drago. Children 8(8) 2021. https://www.mdpi.com/2227-9067/8/8/717
Characteristics and outcomes of acute COVID-19 infection in paediatric and young adult patients with underlying cardiac disease. Fisher, J. M., S. Badran, J. T. Li, J. K. Votava-Smith and P. M. Sullivan. Cardiology in the Young 2021. https://www.cambridge.org/core/journals/cardiology-in-the-young/article/abs/characteristics-and-outcomes-of-acute-covid19-infection-in-paediatric-and-young-adult-patients-with-underlying-cardiac-disease/D060E23787DC2B557569BD62509A340D
Emergence of SARS-CoV-2 Alpha (B.1.1.7) variant, infection rates, antibody seroconversion and seroprevalence rates in secondary school students and staff: Active prospective surveillance, December 2020 to March 2021, England. Ladhani, S. N., G. Ireland, F. Baawuah, J. Beckmann, I. O. Okike, S. Ahmad, J. Garstang, A. J. Brent, B. Brent, F. Aiano, Z. Amin-Chowdhury, M. Kall, R. Borrow, E. Linley, M. Zambon, J. Poh, L. Warrener, A. Lackenby, J. Ellis, G. Amirthalingam, K. E. Brown and M. E. Ramsay. Journal of Infection 2021. https://www.journalofinfection.com/article/S0163-4453(21)00401-1/fulltext
Long COVID - the physical and mental health of children and non-hospitalised young people 3 months after SARS-CoV-2 infection; a national matched cohort study (The CLoCk) Study. Nature Portfolio Journal 2021 (Preprint). https://www.researchsquare.com/article/rs-798316/v1
SARS-CoV-2 mRNA Vaccination-Associated Myocarditis in Children Ages 12-17: A Stratified National Database Analysis. medRxiv 2021 (Preprint). https://www.medrxiv.org/content/10.1101/2021.08.30.21262866v1
COVID-19 vaccine safety in adolescents aged 12-17 years - United States, December 14, 2020-July 16, 2021. Hause, A. M., J. Gee, J. Baggs, W. E. Abara, P. Marquez, D. Thompson, J. R. Su, C. Licata, H. G. Rosenblum, T. R. Myers, T. T. Shimabukuro and D. K. Shay. Morbidity and Mortality Weekly Report 70(31): 1053-1058. 2021. https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7031e1-H.pdf
Seizures as the main presenting manifestation of acute SARS-CoV-2 infection in children. Kurd, M., S. Hashavya, S. Benenson and T. Gilboa. Seizure 92: 89-93. 2021. https://www.seizure-journal.com/article/S1059-1311(21)00295-8/fulltext
Diagnostic accuracy of sars-cov-2 rapid antigen detection testing in symptomatic and asymptomatic children in the clinical setting. L'Huillier, A. G., M. Lacour, D. Sadiku, M. A. Gadiri, L. De Siebenthal, M. Schibler, I. Eckerle, S. Pinösch, L. Kaiser, A. Gervaix, A. Glangetas, A. Galetto-Lacour and L. Lacroix. Journal of Clinical Microbiology 59(9). 2021. https://journals.asm.org/doi/10.1128/JCM.00991-21
Epidemiology and Clinical Features of Myocarditis/Pericarditis before the Introduction of mRNA COVID-19 Vaccine in Korean Children: a Multicenter Study. Park, H., K. W. Yun, K. R. Kim, S. H. Song, B. Ahn, D. R. Kim, G. B. Kim, J. Huh, E. H. Choi and Y. J. Kim. Journal of Korean Medical Science 36(32): 1-11. 2021. https://jkms.org/DOIx.php?id=10.3346/jkms.2021.36.e232
SARS-CoV-2 persistence in immunocompromised children. Dolan, S. A., J. Mulcahy Levy, A. Moss, K. Pearce, M. Butler, S. Jung, S. R. Dominguez, E. Mwangi, K. Maloney and S. Rao. Pediatric Blood and Cancer 2021. https://onlinelibrary.wiley.com/doi/10.1002/pbc.29277
Association of Myocarditis With BNT162b2 Messenger RNA COVID-19 Vaccine in a Case Series of Children. A Dionne , F Sperotto, S Chamberlain S, et al. JAMA Cardiology. 2021. https://jamanetwork.com/journals/jamacardiology/fullarticle/2783052
Deaths in Children and Young People in England after SARS-CoV-2 infection during the first pandemic year. C Smith, D Odd, R Harwood, J Ward, M Linney, M Clark, D Hargreaves, SN Ladhani, E Draper, PJ Davis, SE Kenny, E Whittaker, K Luyt, RM Viner, LK Fraser. nature medicine. https://www.nature.com/articles/s41591-021-01578-1
Which children and young people are at higher risk of severe disease and death after SARS-CoV-2 infection: a systematic review and individual patient meta-analysis. R Harwood, H Yan, N Talawila Da Camara, C Smith, J Ward, C Tudur-Smith, M Linney, M Clark, E Whittaker, D Saatci, PJ Davis, K Luyt, ES Draper, S Kenny, L K Fraser, R.M Viner. medRxiv 2021. (Preprint). https://www.medrxiv.org/content/10.1101/2021.06.30.21259763v1
Risk factors for intensive care admission and death amongst children and young people admitted to hospital with COVID-19 and PIMS-TS in England during the first pandemic year. J Ward, R Harwood, C Smith, S Kenny, M Clark, PJ Davis, ES Draper, D Hargreaves, S Ladhani, M Linney, K Luyt, S Turner, E Whittaker, L K Fraser, R.M Viner. medRxiv 2021. (Preprint). https://www.medrxiv.org/content/10.1101/2021.07.01.21259785v1
- 1 a b c Qiu H, Wu J, Hong L, et al. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. The Lancet Infectious Diseases. 2020. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30198-5/fulltext
- 2 a b Yu N, Li W, Kang Q, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. The Lancet Infectious Diseases. 2020. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30176-6/fulltext
- 3 a b c Zeng L, Xia S, Yuan W, et al. Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China. JAMA Pediatrics. 2020. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2763787
- 4 a b c d e Choe YJ. Coronavirus disease-19: The First 7,755 Cases in the Republic of Korea. Osong Public Health and Research Perspectives. 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104685/
- 5 a b c d CDC COVID-19 Response Team. Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020. MMWR Morbidity and mortality weekly report. Centers for Disease Control and Prevention. 2020. https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e4.htm
- 6Tagarro A, Epalza C, Santos M, et al. Screening and Severity of Coronavirus Disease 2019 (COVID-19) in Children in Madrid, Spain. JAMA Pediatrics. 2020. jamanetwork.com/journals/jamapediatrics/fullarticle/2764394
- 7Livingston E, Bucher K. Coronavirus Disease 2019 (COVID-19) in Italy. Jama. 2020. jamanetwork.com/journals/jama/fullarticle/2763401
- 8 a b World Health Organisation. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). 2020. https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
- 9 a b Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020. https://jamanetwork.com/journals/jama/fullarticle/2762130
- 10Xiao Z, Xie X, Guo W, et al. Examining the incubation period distributions of COVID-19 on Chinese patients with different travel histories. The Journal of Infection in Developing Countries. 2020. jidc.org/index.php/journal/article/view/12718
- 11de Lusignan S, Dorward J, Correa A, et al. Risk factors for SARS-CoV-2 among patients in the Oxford Royal College of General Practitioners Research and Surveillance Centre primary care network: a cross-sectional study. The Lancet Infectious Diseases. 2020. www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30371-6/fulltext
- 12 a b c d e f g h Bellino S, Punzo O, Rota MC, et al. COVID-19 Disease Severity Risk Factors for Pediatric Patients in Italy. Pediatrics. 2020. https://pediatrics.aappublications.org/content/pediatrics/early/2020/07/16/peds.2020-009399
- 13 a b c Lavezzo E, Franchin E, Ciavarella C, et al. Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo’. Nature Medicine. 2020. https://www.nature.com/articles/s41586-020-2488-1
- 14 a b c Gudbjartsson D, Helgason A, Jonsson H, et al. Spread of SARS-CoV-2 in the Icelandic Population. The New England Journal of Medicine. 2020. https://www.nejm.org/doi/full/10.1056/NEJMoa2006100
- 15 a b National Institute for Public Health and the Environment. Children and COVID-19. 2020. https://www.rivm.nl/en/novel-coronavirus-covid-19/children-and-covid-19
- 16 a b c Sun K, Wang W, Gao L, et al. Transmission heterogeneities, kinetics, and controllability of SARS-CoV-2. Science. 2020. https://science.sciencemag.org/content/sci/early/2020/11/23/science.abe2424
- 17 a b c Bi Q, Wu Y, Mei S, et al. Epidemiology and Transmission of COVID-19 in Shenzhen China: Analysis of 391 cases and 1,286 of their close contacts. Lancet Infectious Diseases. 2020. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30287-5/fulltext
- 18Kam KQ, Yung CF et al. A well infant with coronavirus disease 2019 (COVID-19) with high viral load. Clinical Infectious Diseases. 2020. academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa201/5766416
- 19*Tang A, Xu W, Shen M, et al. A retrospective study of the clinical characteristics of COVID-19 infection in 26 children. medRxiv. 2020. www.medrxiv.org/content/10.1101/2020.03.08.20029710v1
- 20 a b c Parri N, Lenge M, Buonsenso D. Children with Covid-19 in Pediatric Emergency Departments in Italy. The New England Journal of Medicine. 2020. https://www.nejm.org/doi/full/10.1056/NEJMc2007617
- 21Wu Q, Xing Y, Shi L, et al. Co-infection and Other Clinical Characteristics of COVID-19 in Children. Paediatrics. 2020. pediatrics.aappublications.org/content/early/2020/05/04/peds.2020-0961
- 22 a b c Parri N, Magistà AM, Marchetti F, et al. Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks. European Journal of Pediatrics. 2020. https://link.springer.com/article/10.1007/s00431-020-03683-8
- 23 a b Milani G, Bottino I, Rocchi A, et al. Frequency of Children vs Adults Carrying Severe Acute Respiratory Syndrome Coronavirus 2 Asymptomatically. JAMA Pediatrics. 2020. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2770117
- 24 a b c Davies NG, Klepac P, Liu Y, et al. Age-dependent effects in the transmission and control of COVID-19 epidemics. Nature Medicine. 2020. https://www.nature.com/articles/s41591-020-0962-9
- 25Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020. jamanetwork.com/journals/jama/fullarticle/2765184
- 26 a b c d e Garazzino S, Montagnani C, Donà D, et al. Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020. Eurosurveillance. 2020. https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.18.2000600
- 27 a b c d e Götzinger F, Santiago-García B, Noguera-Julián A, et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. The Lancet Child & Adolescent Health. 2020. https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30177-2/fulltext
- 28Bhopal SS, Bagaria J, Olabi B, et al. Children and young people remain at low risk of COVID-19 mortality. The Lancet Child & adolescent health. 2021. www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00066-3/fulltext
- 29 a b Madewell ZJ, Yang Y, Longini IM, et al. Household transmission of SARS-CoV-2: a systematic review and meta-analysis of secondary attack rate. JAMA. 2020. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774102
- 30 a b Maltezou HC, Vorou R, Papadima K, et al. Transmission dynamics of SARS-CoV-2 within families with children in Greece: A study of 23 clusters. Journal of Medical Virology. 2020. https://onlinelibrary.wiley.com/doi/abs/10.1002/jmv.26394
- 31Buonsenso D, Valentini P, De Rose C, et al. Seroprevalence of anti-SARS-CoV-2 IgG antibodies in children with household exposure to adults with COVID-19: Preliminary findings. Paediatric Pulmonology. 2020. onlinelibrary.wiley.com/doi/10.1002/ppul.25280
- 32Galow L, Haag L, Kahre E, et al. Lower household transmission rates of SARS-CoV-2 from children compared to adults. Journal of Infection. 2021. www.journalofinfection.com/article/S0163-4453(21)00209-7/fulltext
- 33Pavel AB, Wu J, Renert-Yuval Y, et al. SARS-CoV-2 receptorACE2 protein expression in serum is significantly associated with age. Allergy. 2020. onlinelibrary.wiley.com/doi/abs/10.1111/all.14522
- 34Yonker LM, Neilan AM, Bartsch Y, et al. Pediatric SARS-CoV-2: Clinical Presentation, Infectivity, and Immune Responses. The Journal of Pediatrics. 2020. www.jpeds.com/article/S0022-3476(20)31023-4/fulltext
- 35 a b c Neeland MR, Bannister S, Clifford V, et al. Innate cell profiles during the acute and convalescent phase of SARS-CoV-2 infection in children. Nature Communications. 2021. https://www.nature.com/articles/s41467-021-21414-x
- 36Cooper DM, Zulu MZ, Jankeel A, et al. SARS-CoV-2 acquisition and immune pathogenesis among school-aged learners in four diverse schools. Pediatric Research. 2021. www.nature.com/articles/s41390-021-01660-x
- 37Ng KW, Faulkner N, Cornish GH, et al. Preexisting and de novo humoral immunity to SARS-CoV-2 in humans. Science. 2020. science.sciencemag.org/content/sci/early/2020/11/05/science.abe1107
- 38Weisberg SP, Connors T, Zhu Y, et al. Distinct antibody responses to SARS-CoV-2 in children and adults across the COVID-19 clinical spectrum. Nature Immunology. 2020. www.nature.com/articles/s41590-020-00826-9
- 39 a b Vos ERA, den Hartog G, Schepp RM, et al. Nationwide seroprevalence of SARS-CoV-2 and identification of risk factors in the general population of the Netherlands during the first epidemic wave. Journal of Epidemiology and Community Health. 2020. https://jech.bmj.com/content/jech/early/2020/11/28/jech-2020-215678
- 40Cotugno N, Ruggiero A, Bonfante F, et al. Virological and immunological features of SARS-CoV-2-infected children who develop neutralizing antibodies. Cell Reports. 2021. www.cell.com/cell-reports/fulltext/S2211-1247(21)00166-2?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2211124721001662%3Fshowall%3Dtrue
- 41 a b c Gale C, Quigley MA, Placzek A, et al. Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance. The Lancet Child & Adolescent Health. 2020. https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30342-4/fulltext
- 42 a b c d e f g h i Swann OV, Holden KA, Turtle L, et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. British Medical Journal. 2020. https://www.bmj.com/content/bmj/370/bmj.m3249
- 43 a b Ladhani SN, Baawuah F, Beckmann J, et al. SARS-CoV-2 infection and transmission in primary schools in England in June-December, 2020 (sKIDs): an active, prospective surveillance study. The Lancet Child & adolescent health. 2021. https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00061-4/fulltext
- 44Bailey LC, Razzaghi H, Burrows EK, et al. Assessment of 135 794 Pediatric Patients Tested for Severe Acute Respiratory Syndrome Coronavirus 2 Across the United States. JAMA Pediatrics. 2020. jamanetwork.com/journals/jamapediatrics/fullarticle/2773298
- 45 a b c Foster CE, Marquez L, Davis AL, et al. A Surge in Pediatric Coronavirus Disease 2019 Cases: The Experience of Texas Children’s Hospital From March to June 2020. Journal of the Pediatric Infectious Diseases Society. 2020. https://academic.oup.com/jpids/advance-article/doi/10.1093/jpids/piaa164/6029978
- 46Hobbs CV, Drobeniuc J, Kittle T, et al. Estimated SARS-CoV-2 Seroprevalence Among Persons Aged <18 Years — Mississippi, May–September 2020. Morbidity and Mortality Weekly Report. 2021. www.cdc.gov/mmwr/volumes/70/wr/mm7009a4.htm
- 47 a b c d e f g Whittaker E, Bamford A, Kenny J, et al. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA. 2020. https://jamanetwork.com/journals/jama/fullarticle/2767209
- 48Jing QL, Lui MJ, Yuan J, et al. Household secondary attack rate of COVID-19 and associated determinants in Guangzhou, China: a retrospective cohort study. The Lancet Infectious Diseases. 2020. www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30471-0/fulltext#:~:text=In%20a%20study%20of%20the,of%20primary%20cases%20was%20examined.
- 49*Mizumoto K, Omori R, Nishiura H. Age specificity of cases and attack rate of novel coronavirus disease (COVID-19). medRxiv. 2020. www.medrxiv.org/content/10.1101/2020.03.09.20033142v1
- 50Zhang J, Litvinova M, Liang Y, et al. . Changes in contact patterns shape the dynamics of the cOVID-19 outbreak in China. Science. 2020. science.sciencemag.org/content/early/2020/05/04/science.abb8001
- 51Wang Z, Ma W, Zheng X, et al. Household transmission of SARS-CoV-2. Journal of Infection. 2020. www.sciencedirect.com/science/article/pii/S0163445320301699
- 52COVID-19 National Emergency Response Center. Coronavirus Disease-19: Summary of 2,370 Contact Investigations of the First 30 Cases in the Republic of Korea. Osong Public Health and Research Perspectives. 2020. www.ncbi.nlm.nih.gov/pmc/articles/PMC7104686/
- 53 a b c Boulad F, Kamboj M, Bouvier N, et al. COVID-19 in Children With Cancer in New York City. Jama. 2020. https://jamanetwork.com/journals/jamaoncology/fullarticle/2766112
- 54 a b c Li W, Zhang B, Lu J, et al. The characteristics of household transmission of COVID 19. Clinical Infectious Diseases. 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184465/
- 55National Centre for Immunisation Research and Surveillance. COVID-19 in schools – the experience in NSW. 2020. www.ncirs.org.au/covid-19-in-schools
- 56Rosenberg ES, Dufort EM, Blog DS, et al. COVID-19 Testing, Epidemic Features, Hospital Outcomes, and Household Prevalence, New York State-March 2020. Clinical Infectious Diseases. 2020. www.ncbi.nlm.nih.gov/pmc/articles/PMC7239264/
- 57 a b Yung CF, Kam K, Chong CY, et al. Household Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 from Adults to Children. The Journal of Pediatrics. 2020. https://www.jpeds.com/article/S0022-3476(20)30852-0/fulltext
- 58 a b Torres JP, Piñera C, De La Maza V, et al. SARS-CoV-2 antibody prevalence in blood in a large school community subject to a Covid-19 outbreak: a cross-sectional study. Clinical Infectious Diseases. 2020. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa955/5869860
- 59Ding Y, Yan H, Guo W. Clinical Characteristics of Children With COVID-19: A Meta-Analysis. Frontiers in Pediatrics. 2020. www.frontiersin.org/article/10.3389/fped.2020.00431
- 60 a b c Ladhani SN, Amin-Chowdhury Z, Davies HG, et al. COVID-19 in children: analysis of the first pandemic peak in England. Archives of Disease in Childhood. 2020. https://adc.bmj.com/content/archdischild/early/2020/07/28/archdischild-2020-320042
- 61Sisk B, Cull W, Harris JM, et al. National Trends of Cases of COVID-19 in Children Based on US State Health Department Data. Pediatrics. 2020. pediatrics.aappublications.org/content/pediatrics/146/6/e2020027425
- 62 a b Lachassinne E, de Pontual L, Caseris M, et al. SARS-CoV-2 transmission among children and staff in daycare centres during a nationwide lockdown in France: a cross-sectional, multicentre, seroprevalence study. The Lancet Child & adolescent health. 2021. https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00024-9/fulltext
- 63Pagani G, Conti F, Giacomelli A, et al. Seroprevalence of SARS-CoV-2 significantly varies with age: Preliminary results from a mass population screening. Journal of Infection. 2020. www.journalofinfection.com/article/S0163-4453(20)30629-0/fulltext
- 64Pollán M, Pérez-Gómez B, Pastor-Barriuso R, et al. Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study. The Lancet. 2020. www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31483-5/fulltext
- 65 a b Hu S, Wang W, Wang Y, et al. Infectivity, susceptibility, and risk factors associated with SARS-CoV-2 transmission under intensive contact tracing in Hunan, China. Nature Communications. 2021. https://www.nature.com/articles/s41467-021-21710-6
- 66Sermet-Gaudelus I, Temmam S, Huon C, et al. Prior infection by seasonal coronaviruses, as assessed by serology, does not prevent SARS-CoV-2 infection and disease in children, France, April to June 2020. Eurosurveillance. 2021. www.eurosurveillance.org/content/10.2807/1560-7917.ES.2021.26.13.2001782
- 67Zimmerman P, Curtis N. Coronavirus infections in children including COVID-19. An overview of the epidemiology, clinical features, diagnosis and prevention options in children. The Pediatric Infectious Disease Journal. 2020. journals.lww.com/pidj/Abstract/onlinefirst/Coronavirus_Infections_in_Children_Including.96251.aspx
- 68 a b Kam K-q, Thoon KC, Maiwald M, et al. SARS-CoV-2 Viral RNA Load Dynamics in the Nasopharynx of Infected Children. Epidemiology. 2020. https://www.cambridge.org/core/journals/epidemiology-and-infection/article/sarscov2-viral-rna-load-dynamics-in-the-nasopharynx-of-infected-children/A39B28335AD8E76D09C48E8C2F82FB03
- 69Lee EJ, Kim DH, Chang SH, et al. Absence of SARS-CoV-2 Transmission from Children in Isolation to Guardians, South Korea. Emerging Infectious Disease Journal. 2020. wwwnc.cdc.gov/eid/article/27/1/20-3450_article
- 70Maltezou HC, Magaziotou I, Dedoukou X, et al. Children and Adolescents With SARS-CoV-2 Infection: Epidemiology, Clinical Course and Viral Loads. The Pediatric Infectious Disease Journal. 2020. journals.lww.com/pidj/Fulltext/2020/12000/Children_and_Adolescents_With_SARS_CoV_2.1.aspx
- 71Pitman-Hunt C, Leja J, Jiwani ZM, et al. SARS-CoV-2 Transmission in an Urban Community: The Role of Children and Household Contacts. Journal of the Pediatric Infectious Diseases Society. 2020. academic.oup.com/jpids/advance-article/doi/10.1093/jpids/piaa158/6007439
- 72Zhu Y, Bloxham CJ, Hulme KD, et al. A meta-analysis on the role of children in SARS-CoV-2 in household transmission clusters. Clinical Infectious Diseases. 2020. academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1825/6024998
- 73Soriano-Arandes A, Gatell A, Serrano P, et al. Household SARS-CoV-2 transmission and children: a network prospective study. Clinical Infectious Diseases. 2021. academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab228/6168547
- 74Bellon M, Baggio S, Jacquerioz Bausch F, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Viral Load Kinetics in Symptomatic Children, Adolescents, and Adults. Clinical Infectious Diseases. 2021. academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab396/6265276
- 75Link-Gelles R, DellaGrotta AL, Molina C, et al. Limited Secondary Transmission of SARS-CoV-2 in Child Care Programs — Rhode Island, June 1–July 31, 2020. Morbidity and Mortality Weekly Report. 2020. www.cdc.gov/mmwr/volumes/69/wr/mm6934e2.htm?s_cid=mm6934e2_w#contribAff
- 76 a b Pan X, Chen D, Xia Y, et al. Asymptomatic cases in a family cluster with SARS-CoV-2 infection. The Lancet Infectious Diseases. 2020. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30114-6/fulltext
- 77 a b Ji LN, Chao S, Want Y, et al. Clinical features of pediatric patients with COVID-19: a report of two family cluster cases. World Journal of Pediatrics. 2020. https://link.springer.com/article/10.1007/s12519-020-00356-2
- 78Song R, Han B, Song M, et al. Clinical and epidemiological features of COVID-19 family clusters in Beijing, China. Journal of Infection. 2020. www.ncbi.nlm.nih.gov/pmc/articles/PMC7177072/
- 79Zhu Y, Bloxham CJ, Hulme KD, et al. A Meta-analysis on the Role of Children in Severe Acute Respiratory Syndrome Coronavirus 2 in Household Transmission Clusters. Clinical Infectious Diseases. 2020. academic.oup.com/cid/article/72/12/e1146/6024998
- 80Posfay-Barbe KM, Wagner N, Gauthey M, et al. COVID-19 in Children and the Dynamics of Infection in Families. Pediatrics. 2020. pediatrics.aappublications.org/content/early/2020/05/22/peds.2020-1576
- 81Somekh E, Gleyzer A, Heller E, et al. The Role of Children in the Dynamics of Intra Family Coronavirus 2019 Spread in Densely Populated Area. The Pediatric Infectious Disease Journal. 2020. journals.lww.com/pidj/Fulltext/9000/The_Role_of_Children_in_the_Dynamics_of_Intra.96128.aspx
- 82Danis K, Epaulard O, Benet T, et al. Cluster of coronavirus disease 2019 (Covid-19) in the French Alps, 2020. Clinical Infectious Diseases. 2020. academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa424/5819060
- 83Telle K, Jørgensen SB, Hart R, et al. Secondary attack rates of COVID-19 in Norwegian families: A nation-wide register-based study. European Journal of Epidemiology. 2021. link.springer.com/article/10.1007/s10654-021-00760-6
- 84Cerami C, Popkin-Hall ZR, Rapp T, et al. Household Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in the United States: Living Density, Viral Load, and Disproportionate Impact on Communities of Color. Clinical Infectious Diseases. 2021. academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab701/6349288
- 85Heavey L, Casey G, Kelly C, et al. No evidence of secondary transmission of COVID-19 from children attending school in Ireland, 2020. Euro surveillance. 2020. www.ncbi.nlm.nih.gov/pmc/articles/PMC7268273/
- 86Yung CF, Kam K-q, Nadua KD, et al. Novel Coronavirus 2019 Transmission Risk in Educational Settings. Clinical Infectious Diseases. 2020. academic.oup.com/cid/article/doi/10.1093/cid/ciaa794/5862649
- 87Armann JP, Kirsten C, Galow L, et al. SARS-CoV-2 transmissions in students and teachers: seroprevalence follow-up study in a German secondary school in November and December 2020. BMJ Paediatrics Open. 2021. bmjpaedsopen.bmj.com/content/bmjpo/5/1/e001036
- 88 a b *Doron S, Ingalls RR, Beauchamp A, et al. Weekly SARS-CoV-2 screening of asymptomatic students and staff to guide and evaluate strategies for safer in-person learning. medRxiv. 2021. https://www.medrxiv.org/content/medrxiv/early/2021/03/22/2021.03.20.21253976
- 89 a b Doyle T, Kendrick K, Troelstrup T, et al. COVID-19 in Primary and Secondary School Settings During the First Semester of School Reopening — Florida, August–December 2020. Morbidity and Mortality Weekly Report. 2021. https://www.cdc.gov/mmwr/volumes/70/wr/mm7012e2.htm?s_cid=mm7012e2_w
- 90Hershow R, Wu K, Lewis N, et al. Low SARS-CoV-2 Transmission in Elementary Schools — Salt Lake County, Utah, December 3, 2020–January 31, 2021. Morbidity and Mortality Weekly Report. 2021. www.cdc.gov/mmwr/volumes/70/wr/mm7012e3.htm?s_cid=mm7012e3_w
- 91Ehrhardt J, Ekinci A, Krehl H, et al. Transmission of SARS-CoV-2 in children aged 0 to 19 years in childcare facilities and schools after their reopening in May 2020, Baden-Württemberg, Germany. Eurosurveillance. 2020. www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.36.2001587
- 92L’Huillier A, Torriani G, Pigny F, et al. Culture-Competent SARS-CoV-2 in Nasopharynx of Symptomatic Neonates, Children, and Adolescents. Emerging Infectious Disease Journal. 2020. wwwnc.cdc.gov/eid/article/26/10/20-2403_article
- 93Szablewski CM, Chang KT, Brown MM, et al. SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight Camp — Georgia, June 2020. Morbidity and Mortality Weekly Report. 2020. www.cdc.gov/mmwr/volumes/69/wr/mm6931e1.htm?s_cid=mm6931e1_w
- 94Pray IW, Gibbons-Burgener SN, Rosenberg AZ, et al. COVID-19 Outbreak at an Overnight Summer School Retreat ― Wisconsin, July–August 2020. Morbidity and Mortality Weekly Report. 2020. www.cdc.gov/mmwr/volumes/69/wr/mm6943a4.htm?s_cid=mm6943a4_w
- 95Fong M, Cowling B, Leung G, et al. Letter to the editor: COVID-19 cases among school-aged children and school-based measures in Hong Kong, July 2020. Eurosurveillance. 2020. www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.37.2001671
- 96Stein-Zamir C, Abramson N, Shoob H, et al. A large COVID-19 outbreak in a high school 10 days after schools’ reopening, Israel, May 2020. Eurosurveillance. 2020. www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.29.2001352
- 97Jordan I, de Sevilla MF, Fumado V, et al. Transmission of SARS-CoV-2 infection among children in summer schools applying stringent control measures in Barcelona, Spain. Clinical Infectious Diseases. 2021. academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab227/6168543
- 98*Cordery R, Reeves L, Zhou J, et al. Transmission of SARS-CoV-2 by children attending school. Interim report on an observational, longitudinal sampling study of infected children, contacts, and the environment. medRxiv. 2021. www.medrxiv.org/content/medrxiv/early/2021/03/09/2021.03.08.21252839
- 99Fontanet A, Tondeur L, Grant R, et al. SARS-CoV-2 infection in schools in a northern French city: a retrospective serological cohort study in an area of high transmission, France, January to April 2020. Eurosurveillance. 2021. www.eurosurveillance.org/content/10.2807/1560-7917.ES.2021.26.15.2001695
- 100Thielecke M, Theuring S, van Loon W, et al. SARS-CoV-2 infections in kindergartens and associated households at the start of the second wave in Berlin, Germany — a cross sectional study. European Journal of Public Health. 2021. academic.oup.com/eurpub/advance-article/doi/10.1093/eurpub/ckab079/6270920
- 101Macartney K, Quinn HE, Pillsbury AJ, et al. Transmission of SARS-CoV-2 in Australian educational settings: a prospective cohort study. The Lancet Child & Adolescent Health. 2020. www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30251-0/fulltext
- 102Lopez A, Hill M, Antezano J, et al. Transmission Dynamics of COVID-19 Outbreaks Associated with Child Care Facilities — Salt Lake City, Utah, April–July 2020. MMWR Morbidity Mortality Weekly Report. 2020. www.cdc.gov/mmwr/volumes/69/wr/mm6937e3.htm?s_cid=mm6937e3_w
- 103Ismail SA, Saliba V, Lopez Bernal JA, et al. SARS-CoV-2 infection and transmission in educational settings: a prospective, cross-sectional analysis of infection clusters and outbreaks in England. The Lancet Infectious Diseases. 2020. www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30882-3/fulltext
- 104Gettings JR, Gold JAW, Kimball A, et al. SARS-CoV-2 transmission in a Georgia school district — United States, December 2020–January 2021. Clinical Infectious Diseases. 2021. academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab332/6232104
- 105Siegal M, Kloppenburg B, Woerle S, et al. Notes from the Field: SARS-CoV-2 Transmission Associated with High School Football Team Members — Florida, September–October 202. Morbidity and Mortality Weekly Report. 2021. www.cdc.gov/mmwr/volumes/70/wr/mm7011a3.htm
- 106Wada K, Okabe N, Shobugawa Y. Infection and transmission of COVID-19 among students and teachers in schools in Japan after the reopening in June 2020. BMJ Paediatrics Open. 2020. bmjpaedsopen.bmj.com/content/bmjpo/4/1/e000854
- 107Yoon Y, Kim K-R, Park H, et al. Stepwise School Opening and an Impact on the Epidemiology of COVID-19 in the Children. Journal of Korean Medical Science. 2020. jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e414
- 108Wang M, Nie X, Huang S, et al. Epidemiological characteristics and transmission dynamics of paediatric cases with coronavirus disease 2019 in Hubei province, China. Journal of Paediatrics and Child Health. 2020. onlinelibrary.wiley.com/doi/abs/10.1111/jpc.15287
- 109 a b Zimmerman KO, Akinboyo IC, Brookhart MA, et al. Incidence and Secondary Transmission of SARS-CoV-2 Infections in Schools. Pediatrics. 2021. https://pediatrics.aappublications.org/content/pediatrics/early/2021/01/06/peds.2020-048090
- 110Lugon P, Fuller T, Damasceno L, et al. SARS-CoV-2 Infection Dynamics in Children and Household Contacts in a Slum in Rio de Janeiro. Pediatrics. 2021. pediatrics.aappublications.org/content/pediatrics/early/2021/04/14/peds.2021-050182
- 111Mossong J, Mombaerts L, Veiber L, et al. SARS-CoV-2 transmission in educational settings during an early summer epidemic wave in Luxembourg, 2020. BMC Infectious Diseases. 2021. bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06089-5
- 112 a b *Verberk J, de Hoog M, Westerhof I, et al. Transmission of SARS-CoV-2 within households: a prospective cohort study in the Netherlands and Belgium – Interim results. medRxiv. 2021. https://www.medrxiv.org/content/medrxiv/early/2021/05/10/2021.04.23.21255846
- 113Kim EY, Ryu B, Kim EK, et al. Children with COVID-19 after Reopening of Schools, South Korea. Pediatric Infection and Vaccine. 2020. piv.or.kr/DOIx.php?id=10.14776/piv.2020.27.e23
- 114Dawson P, Worrell M, Malone S, et al. Pilot Investigation of SARS-CoV-2 Secondary Transmission in Kindergarten Through Grade 12 Schools Implementing Mitigation Strategies — St. Louis County and City of Springfield, Missouri, December 2020. Morbidity and Mortality Weekly Report. 2021. www.cdc.gov/mmwr/volumes/70/wr/mm7012e4.htm?s_cid=mm7012e4_w
- 115Haag L, Blankenburg J, Unrath M, et al. Prevalence and Transmission of Severe Acute Respiratory Syndrome Coronavirus Type 2 in Childcare Facilities: A Longitudinal Study. The Journal of Pediatrics. 2021. www.jpeds.com/article/S0022-3476(21)00746-0/fulltext
- 116Volpp K, Kraut B, Ghosh S, et al. Minimal SARS-CoV-2 Transmission After Implementation of a Comprehensive Mitigation Strategy at a School — New Jersey, August 20–November 27, 2020. Morbidity and Mortality Weekly Report. 2021. www.cdc.gov/mmwr/volumes/70/wr/mm7011a2.htm?s_cid=mm7011a2_w
- 117Miron O, Yu K-H, Wilf-Miron R, et al. COVID-19 infections following physical school reopening. Archives of Disease in Childhood. 2020. adc.bmj.com/content/archdischild/early/2020/12/06/archdischild-2020-321018
- 118Forbes H, Morton CE, Bacon S, et al. Association between living with children and outcomes from COVID-19: an OpenSAFELY cohort study of 12 million adults in England. The British Medical Journal. 2020. www.bmj.com/content/372/bmj.n628
- 119 a b c d e f g Cai J, Xu J, Lin D, et al. A Case Series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clinical Infectious Diseases. 2020. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa198/5766430
- 120 a b c d De Ioris MA, Scarselli A, Ciofi degli Atti ML, et al. Dynamic viral SARS-CoV-2 RNA shedding in in children: preliminary data and clinical consideration of Italian regional center. Journal of the Pediatric Infectious Diseases Society. 2020. https://academic.oup.com/jpids/advance-article/doi/10.1093/jpids/piaa065/5842265
- 121Han MS, Choi EH, Chang SH, et al. Clinical Characteristics and Viral RNA Detection in Children With Coronavirus Disease 2019 in the Republic of Korea. JAMA Pediatrics. 2020. jamanetwork.com/journals/jamapediatrics/fullarticle/2770150
- 122Chong C, Kam K-Q, Li J, et al. Saliva is not a useful diagnostic specimen in children with Coronavirus Disease 2019. Clinical Infectious Diseases. 2020. academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1376/5905581
- 123Han MS, Seong MW, Heo EY, et al. Sequential Analysis of Viral Load in a Neonate and Her Mother Infected With Severe Acute Respiratory Syndrome Coronavirus 2. Clinical Infectious Diseases. 2020. academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa447/5820869
- 124Zhang B, Liu S, Dong Y, et al. Positive rectal swabs in young patients recovered from coronavirus disease 2019 (COVID-19). Journal of Infection. 2020. www.journalofinfection.com/article/S0163-4453(20)30233-4/fulltext
- 125 a b Cruz AT, Zeichner SL. COVID-19 in Children: Initial Characterization of the Pediatric Disease. Pediatrics. 2020. https://pediatrics.aappublications.org/content/early/2020/03/16/peds.2020-0834.1
- 126 a b Xu, Y., Li, X., Zhu, B. et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nature Medicine. 2020. https://www.nature.com/articles/s41591-020-0817-4
- 127Cai J, Wang X, Zhao J, et al. Comparison of Clinical and Epidemiological Characteristics of Asymptomatic and Symptomatic SARS-CoV-2 Infection in Children. Virologica Sinica. 2020. link.springer.com/article/10.1007/s12250-020-00312-4
- 128 a b Wölfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Müller MA, et al. Virological assessment of hospitalized patients with COVID-2019. Nature Medicine. 2020. https://www.nature.com/articles/s41586-020-2196-x
- 129Xiao F, Sun J, Xu Y, et al. Infectious SARS-CoV-2 in Feces of Patient with Severe COVID-19. Emerging Infectious Disease Journal. 2020. wwwnc.cdc.gov/eid/article/26/8/20-0681_article
- 130Davies NG, Barnard RC, Jarvis CI, et al. Estimated transmissibility and impact of SARS-CoV-2 lineage B.1.1.7 in England. Science. 2020. science.sciencemag.org/content/372/6538/eabg3055
- 131*Lyngse FP, Mølbak K, Skov RL, et al. Increased Transmissibility of SARS-CoV-2 Lineage B.1.1.7 by Age and Viral Load: Evidence from Danish Households. medRxiv. 2021. www.medrxiv.org/content/medrxiv/early/2021/04/19/2021.04.16.21255459
- 132Loenenbach A, Markus I, Lehfeld A-S, et al. SARS-CoV-2 variant B.1.1.7 susceptibility and infectiousness of children and adults deduced from investigations of childcare centre outbreaks, Germany, 2021. Eurosuveillance. 2021. www.eurosurveillance.org/content/10.2807/1560-7917.ES.2021.26.21.2100433
- 133Somekh I, Sharabi A, Dory Y, et al. Intrafamilial Spread and Altered Symptomatology of SARS-CoV-2, During Predominant Circulation of Lineage B.1.1.7 Variant in Israel. The Pediatric Infectious Disease Journal. 2021. journals.lww.com/pidj/Fulltext/2021/08000/Intrafamilial_Spread_and_Altered_Symptomatology_of.21.aspx
- 134Brookman S, Cook J, Zucherman M, et al. Effect of the new SARS-CoV-2 variant B.1.1.7 on children and young people. The Lancet Child & adolescent health. 2021. www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00030-4/fulltext
- 135Kriemler S, Ulyte A, Ammann P, et al. Surveillance of acute SARS-CoV-2 infections in school children and point-prevalence during a time of high community transmission in Switzerland. Frontiers in Pediatrics. 2020. www.frontiersin.org/articles/10.3389/fped.2021.645577/full
- 136González-Donapetry P, García-Clemente P, Bloise I, et al. Think of the Children: Evaluation of SARS-CoV-2 Rapid Antigen Test in Pediatric Population. The Pediatric Infectious Disease Journal. 2021. journals.lww.com/pidj/Fulltext/9000/Think_of_the_Children__Evaluation_of_SARS_CoV_2.95859.aspx
- 137Chua GT, Wong JSC, To KKW, et al. Saliva viral load better correlates with clinical and immunological profiles in children with coronavirus disease 2019. Emerging Microbes & Infections. 2021. www.tandfonline.com/doi/full/10.1080/22221751.2021.1878937
- 138 a b Lu X, Zhang L, Du H, et al. SARS-CoV-2 Infection in Children. New England Journal of Medicine. 2020. https://www.nejm.org/doi/full/10.1056/NEJMc2005073
- 139 a b Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. Jama. 2020. https://jamanetwork.com/journals/jama/fullarticle/2764365
- 140 a b Canarutto D, Priolo A, Russo G, et al. COVID-19 infection in a paucisymptomatic infant: Raising the index of suspicion in epidemic settings. Pediatric Pulmonology. 2020. https://onlinelibrary.wiley.com/doi/full/10.1002/ppul.24754
- 141 a b c Zhu L, Wang J, Huang R, et al. Clinical characteristics of a case series of children with coronavirus disease 2019. Pediatric Pulmonology. 2020. https://onlinelibrary.wiley.com/doi/full/10.1002/ppul.24767
- 142Wei M, Yuan J, Liu Y, et al. Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China. JAMA. 2020. jamanetwork.com/journals/jama/fullarticle/2761659
- 143Hurst JH, Heston SM, Chambers HN, et al. Severe Acute Respiratory Syndrome Coronavirus 2 Infections Among Children in the Biospecimens from Respiratory Virus-Exposed Kids (BRAVE Kids) Study. Clinical Infectious Diseases. 2020. academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1693/5952826
- 144 a b Chen C. Coronavirus Disease-19 Among Children outside Wuhan, China [Internet]. Lancet Child and Adolescent medicine. 2020. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3546071
- 145 a b c d e Shen Q, Guo W, Guo T, et al. Novel coronavirus infection in children outside of Wuhan, China. Pediatric Pulmonology. 2020. https://onlinelibrary.wiley.com/doi/10.1002/ppul.24762
- 146Lou XX, Shi CX, Zhou CC, Tian YS. Three children who recovered from novel coronavirus 2019 pneumonia. Journal of Paediatrics and Child Health. 2020. onlinelibrary.wiley.com/doi/10.1111/jpc.14871
- 147Han YN, Feng ZW, Sun LN, et al. A comparative-descriptive analysis of clinical characteristics in 2019-Coronavirus-infected children and adults. Journal of Medical Virology. 2020. onlinelibrary.wiley.com/doi/10.1002/jmv.25835
- 148Zheng F, Liao C, Fan Q-H, et al. Clinical Characteristics of Children with Coronavirus Disease 2019 in Hubei, China. Current Medical Science. 2020. link.springer.com/article/10.1007/s11596-020-2172-6
- 149 a b Liu W, Zhang Q, Chen J, et al. Detection of Covid-19 in Children in Early January 2020 in Wuhan, China. The New England Journal of Medicine. 2020. https://www.nejm.org/doi/full/10.1056/NEJMc2003717
- 150 a b Su L, Ma X, Yu H, et al. The different clinical characteristics of corona virus disease cases between children and their families in China - the character of children with COVID-19. Emerging Microbes and Infections. 2020. https://www.ncbi.nlm.nih.gov/pubmed/32208917
- 151 a b c Xia W, Shao J, Guo Y, et al. Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults. Pediatric Pulmonology. 2020. https://onlinelibrary.wiley.com/doi/full/10.1002/ppul.24718
- 152 a b c *Zhang C, Gu J, Chen Q, et al. Clinical and epidemiological characteristics of pediatric SARS-CoV-2 infections in China: A multicenter case series. PLOS Medicine. 2020. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003130
- 153 a b c DeBiasi RL, Song X, Delaney M, et al. Severe COVID-19 in Children and Young Adults in the Washington, DC Metropolitan Region. The Journal of Pediatrics. 2020. https://www.jpeds.com/article/S0022-3476(20)30581-3/fulltext
- 154Lu Y, Li Y, Deng W, et al. Symptomatic Infection is Associated with Prolonged Duration of Viral Shedding in Mild Coronavirus Disease 2019: A Retrospective Study of 110 Children in Wuhan. The Pediatric Infectious Disease Journal. 2020. journals.lww.com/pidj/Abstract/9000/Symptomatic_Infection_is_Associated_with_Prolonged.96181.aspx
- 155Mizrahi B, Shilo S, Rossman H, et al. Longitudinal symptom dynamics of COVID-19 infection. Nature Communications. 2020. www.nature.com/articles/s41467-020-20053-y
- 156Chua GT, Wong JSC, Lam I, et al. Clinical Characteristics and Transmission of COVID-19 in Children and Youths During 3 Waves of Outbreaks in Hong Kong. JAMA Network Open. 2021. jamanetwork.com/journals/jamanetworkopen/fullarticle/2779416
- 157Paret M, Lighter J, Pellett Madan R, et al. SARS-CoV-2 infection (COVID-19) in febrile infants without respiratory distress. Clinical Infectious Diseases. 2020. academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa452/5821305
- 158Metbulut AP, Özkaya Parlakay A, Bayhan Gİ, et al. Evaluation of cutaneous symptoms in children infected with COVID-19. Pediatric Allergy and Immunology. 2021. onlinelibrary.wiley.com/doi/abs/10.1111/pai.13467
- 159Valente P, Iarossi G, Federici M, et al. Ocular manifestations and viral shedding in tears of pediatric patients with coronavirus disease 2019: a preliminary report. Journal of the American Association for Pediatric Ophthalmology and Strabismus. 2020. www.ncbi.nlm.nih.gov/pmc/articles/PMC7282793/
- 160Aguilera-Alonso D, Murias S, Martínez-de-Azagra Garde A, et al. Prevalence of thrombotic complications in children with SARS-CoV-2. Archives of Disease in Childhood. 2021. adc.bmj.com/content/archdischild/early/2021/05/24/archdischild-2020-321351
- 161Malhotra A, Sturgill M, Whitley-Williams P, et al. Pediatric COVID-19 and Appendicitis: A Gut Reaction to SARS-CoV-2? Pediatric Infectious Disease Journal. 2021. pubmed.ncbi.nlm.nih.gov/33298761/
- 162Li H, Chen K, Liu M, et al. The profile of peripheral blood lymphocyte subsets and serum cytokines in children with 2019 novel coronavirus pneumonia. Journal of Infection. 2020. www.sciencedirect.com/science/article/pii/S0163445320302073?via%3Dihub
- 163Ulyte A, Radtke T, Abela I, et al. Variation in SARS-CoV-2 seroprevalence across districts, schools and classes: baseline measurements from a cohort of primary and secondary school children in Switzerland. BMJ Open. 2020. bmjopen.bmj.com/content/11/7/e047483
- 164Acker KP, Schertz K, Abramson EL, et al. Infectious Diseases Diagnoses of Children Admitted With Symptoms of Coronavirus Disease 2019 During an Outbreak in New York City. Clinical Pediatrics. 2020. journals.sagepub.com/doi/abs/10.1177/0009922820944399
- 165Galván Casas C, Català A, Carretero Hernández G, et al. Classification of the cutaneous manifestations of COVID‐19: a rapid prospective nationwide consensus study in Spain with 375 cases. British Journal of Dermatology. 2020. onlinelibrary.wiley.com/doi/10.1111/bjd.19163
- 166Genovese G, Colonna C, Marzano AV. Varicella‐like exanthem associated with COVID‐19 in an 8‐year‐old girl: A diagnostic clue? Pediatric Dermatology. 2020. onlinelibrary.wiley.com/doi/abs/10.1111/pde.14201
- 167Recalcati S, Barbagallo T, Frasin LA, et al. Acral cutaneous lesions in the Time of COVID‐19. Journal of the European Academy of Dermatology and Venereology. 2020. onlinelibrary.wiley.com/doi/10.1111/jdv.16533
- 168Landa N, Mendieta-Eckert M, Fonda-Pascual P, Aguirre T. Chilblain‐like lesions on feet and hands during the COVID‐19 Pandemic. International Journal of Dermatology. 2020. onlinelibrary.wiley.com/doi/full/10.1111/ijd.14937
- 169Piccolo V, Neri I, Filippeschi C, et al. Chilblain‐like lesions during COVID‐19 epidemic: a preliminary study on 63 patients. Journal of the European Academy of Dermatology and Venereology. 2020. onlinelibrary.wiley.com/doi/10.1111/jdv.16526
- 170Locatelli AG, Robustelli Test E, Vezzoli P, et al. Histologic features of long lasting chilblain‐like lesions in a pediatric COVID‐19 patient. Journal of the European Academy of Dermatology and Venereology. 2020. onlinelibrary.wiley.com/doi/abs/10.1111/jdv.16617?af=R
- 171Colmenero I, Santonja C, Alonso-Riaño M, et al. SARS-CoV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultraestructural study of 7 paediatric cases. British Journal of Dermatology. 2020. onlinelibrary.wiley.com/doi/abs/10.1111/bjd.19327
- 172Jones VG, Mills M, Suarez D, et al. COVID-19 and Kawasaki Disease: Novel Virus and Novel Case. Hospital Pediatrics. 2020. www.ncbi.nlm.nih.gov/pubmed/32265235
- 173Cook J, Harman K, Zoica B, et al. Horizontal transmission of severe acute respiratory syndrome coronavirus 2 to a premature infant: multiple organ injury and association with markers of inflammation. The Lancet Child & Adolescent Health. 2020. www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30166-8/fulltext
- 174Pain CE, Felsenstein S, Cleary G, et al. Novel paediatric presentation of COVID-19 with ARDS and cytokine storm syndrome without respiratory symptoms. The Lancet Rheumatology. 2020. www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30137-5/fulltext
- 175Tullie L, Ford K, Bisharat M, et al. Gastrointestinal features in children with COVID-19: an observation of varied presentation in eight children. The Lancet Child & Adolescent Health. 2020. www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30165-6/fulltext
- 176Verdoni L, Mazza A, Gervasoni A, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. The Lancet. 2020. www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31103-X/fulltext
- 177 a b Riphagen S, Gomez X, Gonzalez-Martinez C, et al. Hyperinflammatory shock in children during COVID-19 pandemic. The Lancet. 2020. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31094-1/fulltext
- 178Toubiana J, Poirault C, Corsia A, et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. The British Medical Journal. 2020. www.bmj.com/content/369/bmj.m2094
- 179Chiotos K, Bassiri H, Behrens EM, et al. Multisystem Inflammatory Syndrome in Children during the COVID-19 pandemic: a case series. Journal of the Pediatric Infectious Diseases Society. 2020. academic.oup.com/jpids/advance-article/doi/10.1093/jpids/piaa069/5848127
- 180Deza Leon MP, Redzepi A, McGrath E, et al. COVID-19–Associated Pediatric Multisystem Inflammatory Syndrome. Journal of the Pediatric Infectious Diseases Society. 2020. academic.oup.com/jpids/advance-article/doi/10.1093/jpids/piaa061/5842067
- 181 a b c d e Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. New England Journal of Medicine. 2020. https://www.nejm.org/doi/full/10.1056/NEJMoa2021680
- 182 a b Dufort EM, Koumans EH, Chow EJ, et al. Multisystem Inflammatory Syndrome in Children in New York State. New England Journal of Medicine. 2020. https://www.nejm.org/doi/full/10.1056/NEJMoa2021756
- 183Riollano-Cruz M, Akkoyun E, Briceno-Brito E, et al. Multisystem Inflammatory Syndrome in Children (MIS-C) Related to COVID-19: A New York City Experience. Journal of Medical Virology. 2020. onlinelibrary.wiley.com/doi/abs/10.1002/jmv.26224
- 184Oberweis ML, Codreanu A, Boehm W, et al. Pediatric Life-Threatening Coronavirus Disease 2019 With Myocarditis. The Pediatric Infectious Disease Journal. 2020. journals.lww.com/pidj/Abstract/9000/Pediatric_Life_Threatening_Coronavirus_Disease.96160.aspx
- 185Belhadjer Z, Méot M, Bajolle F, et al. Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic. Circulation. 2020. www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.048360
- 186Grimaud M, Starck J, Levy M, et al. Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children. Annals of Intensive Care. 2020. annalsofintensivecare.springeropen.com/articles/10.1186/s13613-020-00690-8
- 187Miller J, Cantor A, Zachariah P, et al. Gastrointestinal symptoms as a major presentation component of a novel multisystem inflammatory syndrome in children (MIS-C) that is related to COVID-19: a single center experience of 44 cases. Gastroenterology. 2020. www.ncbi.nlm.nih.gov/pmc/articles/PMC7270806/
- 188 a b c d Moraleda C, Serna-Pascual M, Soriano-Arandes A, et al. Multi-Inflammatory Syndrome in Children related to SARS-CoV-2 in Spain. Clinical Infectious Diseases. 2020. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1042/5876334
- 189 a b García-Salido A, de Carlos Vicente JC, Belda Hofheinz S, et al. Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain. Critical Care. 2020. https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03332-4
- 190Niño-Taravilla C, Otaola-Arca H, Lara-Aguilera N, et al. Multisystem Inflammatory Syndrome in Children, Chile, May–August 2020. Emerging Infectious Disease journal. 2021. wwwnc.cdc.gov/eid/article/27/5/20-4591_article
- 191Pouletty M, Borocco C, Ouldali N, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Annals of the Rheumatic Diseases. 2020. ard.bmj.com/content/early/2020/06/25/annrheumdis-2020-217960
- 192Blondiaux E, Parisot P, Redheuil A, et al. Cardiac MRI of Children with Multisystem Inflammatory Syndrome (MIS-C) Associated with COVID-19: Case Series. Radiology. 2020. www.ncbi.nlm.nih.gov/pmc/articles/PMC7294821/
- 193Cheung EW, Zachariah P, Gorelik M, et al. Multisystem Inflammatory Syndrome Related to COVID-19 in Previously Healthy Children and Adolescents in New York City. JAMA. 2020. jamanetwork.com/journals/jama/fullarticle/2767207
- 194Abdel-Mannan O, Eyre M, Löbel U, et al. Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children. JAMA Neurology. 2020. jamanetwork.com/journals/jamaneurology/fullarticle/2767979
- 195European Centre for Disease Prevention and Control. Paediatric inflammatory multisystem syndrome and SARS-CoV-2 infection in children – 15 May 2020. ECDC: Stockholm. 2020. www.ecdc.europa.eu/en/publications-data/paediatric-inflammatory-multisystem-syndrome-and-sars-cov-2-rapid-risk-assessment
- 196 a b c Davies P, Evans C, Kanthimathinathan HK, et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. The Lancet Child & Adolescent Health. 2020. https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30215-7/fulltext
- 197To KK, Chua GT, Kwok KL, et al. False-positive SARS-CoV-2 serology in 3 children with Kawasaki disease. Diagnostic Microbiology and Infectious Disease. 2020. www.sciencedirect.com/science/article/pii/S0732889320305186
- 198Belot A, Antona D, Renolleau S, et al. SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020. Eurosurveillance. 2020. www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.22.2001010
- 199Ouldali N, Pouletty M, Mariani P, et al. Emergence of Kawasaki disease related to SARS-CoV-2 infection in an epicentre of the French COVID-19 epidemic: a time-series analysis. The Lancet Child & Adolescent Health. 2020. linkinghub.elsevier.com/retrieve/pii/S2352464220301759
- 200 a b Belay ED, Abrams J, Oster ME, et al. Trends in Geographic and Temporal Distribution of US Children With Multisystem Inflammatory Syndrome During the COVID-19 Pandemic. JAMA pediatrics. 2021. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2778429
- 201Carter MJ, Fish M, Jennings A, et al. Peripheral immunophenotypes in children with multisystem inflammatory syndrome associated with SARS-CoV-2 infection. Nature Medicine. 2020. www.nature.com/articles/s41591-020-1054-6
- 202Godfred-Cato S, Bryant B, Leung J, et al. COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020. Morbidity and Mortality Weekly Report. 2020. www.cdc.gov/mmwr/volumes/69/wr/mm6932e2.htm?s_cid=mm6932e2_w
- 203Prieto LM, Toral B, Llorente A, et al. Cardiovascular magnetic resonance imaging in children with pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 and heart dysfunction. Clinical Microbiology and Infection. 2020. www.clinicalmicrobiologyandinfection.com/article/S1198-743X(20)30616-9/fulltext
- 204Clouser KN, Gadhavi J, Bhavsar SM, et al. Short-Term Outcomes After Multisystem Inflammatory Syndrome in Children Treatment. Journal of the Pediatric Infectious Diseases Society. 2020. academic.oup.com/jpids/article/10/1/52/5992300
- 205Harman K, Verma A, Cook J, et al. Ethnicity and COVID-19 in children with comorbidities. The Lancet Child & Adolescent Health. 2020. www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30167-X/fulltext
- 206Lee EH, Kepler KL, Geevarughese A, et al. Race/Ethnicity Among Children With COVID-19–Associated Multisystem Inflammatory Syndrome. JAMA Network Open. 2020. jamanetwork.com/journals/jamanetworkopen/fullarticle/2773289
- 207Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. The Lancet. 2020. www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/fulltext
- 208 a b Dong Y, Mo X, Hu Y, et al. Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China. Pediatrics. 2020. https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0702.full.pdf
- 209Sola AM, David AP, Rosbe KW, et al. Prevalence of SARS-CoV-2 Infection in Children Without Symptoms of Coronavirus Disease 2019. JAMA Pediatrics. 2020. jamanetwork.com/journals/jamapediatrics/fullarticle/2769878
- 210Liu X, Tang J, Xie R, et al. Clinical and Epidemiological Features of 46 Children <1 Year Old With Coronavirus Disease 2019 in Wuhan, China: A Descriptive Study. The Journal of Infectious Diseases. 2020. academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiaa472/5881823
- 211 a b Chen J, Zhang ZZ, Chen YK, et al. The clinical and immunological features of pediatric COVID-19 patients in China. Genes & Diseases. 2020. https://www.sciencedirect.com/science/article/pii/S2352304220300507
- 212 a b Liu H, Liu F, Li J, et al. Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children. Journal of Infection. 2020. https://www.journalofinfection.com/article/S0163-4453(20)30118-3/fulltext
- 213Xing Y, Ni W, Wu Q, et al. Prolonged viral shedding in feces of pediatric patients with coronavirus disease 2019. Journal of Microbiology, immunology and Infection. 2020. www.sciencedirect.com/science/article/pii/S1684118220300815?via%3Dihub
- 214Chen D, Li Y, Deng X, et al. Four cases from a family cluster were diagnosed as COVID-19 after 14-day of quarantine period. Journal of Medical Virology. 2020. onlinelibrary.wiley.com/doi/abs/10.1002/jmv.25849
- 215Feng K, Yun YX et al. Analysis of CT features of 15 children with 2019 novel coronavirus. Chinese Journal of Paediatrics. 2020. rs.yiigle.com/yufabiao/1181979.htm
- 216Li W, Cui H, Li K, Fang Y, Li S. Chest computed tomography in children with COVID-19 respiratory infection. Pediatric Radiology. 2020. link.springer.com/article/10.1007/s00247-020-04656-7
- 217de Ceano-Vivas M, Martín-Espín I, del Rosal T, et al. SARS-CoV-2 infection in ambulatory and hospitalised Spanish children. Archives of Disease in Childhood. 2020. adc.bmj.com/content/early/2020/05/22/archdischild-2020-319366
- 218 a b Caro-Dominguez P, Shelmerdine SC, Toso S, et al. Thoracic imaging of coronavirus disease 2019 (COVID-19) in children: a series of 91 cases. Pediatric Radiology. 2020. https://link.springer.com/article/10.1007/s00247-020-04747-5
- 219Oterino Serrano C, Alonso E, Andrés M, et al. Pediatric chest x-ray in covid-19 infection. European Journal of Radiology. 2020. www.sciencedirect.com/science/article/pii/S0720048X20304253
- 220Oved K, Olmer L, Shemer-Avni Y, et al. Multi-center nationwide comparison of seven serology assays reveals a SARS-CoV-2 non-responding seronegative subpopulation. EClinicalMedicine. 2020. linkinghub.elsevier.com/retrieve/pii/S2589537020303953
- 221Wikramaratna P, Paton RS, Ghafari M, Lourenco J. Estimating the false-negative test probability of SARS-CoV-2 by RT-PCR. Eurosurveillance. 2020. www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.50.2000568
- 222Issitt R, Booth J, Bryant W, et al. Children with COVID-19 at a specialist centre: initial experience and outcome. The Lancet Child & Adolescent Health. 2020. www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30204-2/fulltext
- 223Tsankov BK, Allaire JM, Irvine MA, et al. Severe COVID-19 Infection and Pediatric Comorbidities: A Systematic Review and Meta-Analysis. International Journal of Infectious Diseases. 2020. www.ijidonline.com/article/S1201-9712(20)32475-9/fulltext
- 224Brisca G, Mariani M, Andrea Rotulo G, et al. Clinical course of COVID-19 in children with pre-existing medical conditions. Acta Paediatrica. 2020. onlinelibrary.wiley.com/doi/abs/10.1111/apa.15730
- 225Havers F, Whitaker M, Self J, et al. Hospitalization of Adolescents Aged 12–17 Years with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1, 2020–April 24, 2021. Morbidity and Mortality Weekly Report. 2021. www.cdc.gov/mmwr/volumes/70/wr/mm7023e1.htm
- 226Kompaniyets L, Agathis NT, Nelson JM, et al. Underlying Medical Conditions Associated With Severe COVID-19 Illness Among Children. JAMA Network Open. 2021. jamanetwork.com/journals/jamanetworkopen/fullarticle/2780706
- 227D'Antiga L. Coronaviruses and immunosuppressed patients. The facts during the third epidemic. Liver Transplantation. 2020. aasldpubs.onlinelibrary.wiley.com/doi/10.1002/lt.25756
- 228 a b Balduzzi A, Brivio E, Rovelli A, et al. Lessons After the Early Management of the COVID-19 Outbreak in a Pediatric Transplant and Hemato-Oncology Center Embedded within a COVID-19 Dedicated Hospital in Lombardia, Italy. Estote Parati. 2020. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3559560
- 229 a b c Turner D, Huang Y, Martín-de-Carpi J, et al. COVID-19 and Paediatric Inflammatory Bowel Diseases: Global Experience and Provisional Guidance (March 2020) from the Paediatric IBD Porto group of ESPGHAN. Journal of Pediatric Gastroenterology and Nutrition. 2020. https://www.ncbi.nlm.nih.gov/pubmed/32235161
- 230Hrusak O, Kalina T, Wolf J, et al. Flash survey on severe acute respiratory syndrome coronavirus-2 infections in paediatric patients on anticancer treatment. European Journal of Cancer. 2020. www.ejcancer.com/article/S0959-8049(20)30162-3/fulltext
- 231Sieni E, Pegoraro F, Casini T, et al. Favourable outcome of Coronavirus‐19 in a 1‐year‐old girl with acute myeloid leukaemia and severe treatment‐induced immunosuppression. British Journal of Haematology. 2020. onlinelibrary.wiley.com/doi/abs/10.1111/bjh.16781
- 232Morand A, Roquelaure B, Colson P, et al. Child with liver transplant recovers from COVID-19 infection. A case report. Archives de Pédiatrie. 2020. www.sciencedirect.com/science/article/pii/S0929693X2030110X
- 233Ferrari A, Zecca M, Rizzari C, et al. Children with cancer in the time of COVID-19: An 8-week report from the six pediatric onco-hematology centers in Lombardia, Italy. Pediatric Blood & Cancer. 2020. onlinelibrary.wiley.com/doi/full/10.1002/pbc.28410
- 234Gampel B, Troullioud Lucas AG, Broglie L, et al. COVID-19 disease in New York City pediatric hematology and oncology patients. Pediatric Blood & Cancer. 2020. onlinelibrary.wiley.com/doi/abs/10.1002/pbc.28420
- 235Freeman MC, Rapsinski GJ, Zilla ML, et al. Immunocompromised Seroprevalence and Course of Illness of SARS-CoV-2 in One Pediatric Quaternary Care Center. Journal of the Pediatric Infectious Diseases Society. 2020. academic.oup.com/jpids/advance-article/doi/10.1093/jpids/piaa123/5922694
- 236Goss MB, Galván NTN, Ruan W, et al. The pediatric solid organ transplant experience with COVID-19: An initial multi-center, multi-organ case series. Pediatric Transplantation. 2020. onlinelibrary.wiley.com/doi/abs/10.1111/petr.13868
- 237Marlais M, Wlodkowski T, Al-Akash S, et al. COVID-19 in children treated with immunosuppressive medication for kidney diseases. Archives of Disease in Childhood. 2020. adc.bmj.com/content/archdischild/early/2020/12/20/archdischild-2020-320616
- 238Millen GC, Arnold R, Cazier J-B, et al. Severity of COVID-19 in children with cancer: Report from the United Kingdom Paediatric Coronavirus Cancer Monitoring Project. British Journal of Cancer. 2020. www.nature.com/articles/s41416-020-01181-0
- 239Schwierzeck V, Konig JC, Kuhn J, et al. First reported nosocomial outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a pediatric dialysis unit. Clinical Infectious Diseases. 2020. academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa491/5825509
- 240Poli P, Timpano S, Goffredo M, et al. Asymptomatic case of Covid-19 in an infant with cystic fibrosis. Journal of Cystic Fibrosis. 2020. www.cysticfibrosisjournal.com/article/S1569-1993(20)30096-5/fulltext
- 241Odièvre MH, de Marcellus C, Ducou Le Pointe H, et al. Dramatic improvement after Tocilizumab of a severe COVID‐19 in a child with sickle cell disease and acute chest syndrome. American Journal of Hematology. 2020. onlinelibrary.wiley.com/doi/abs/10.1002/ajh.25855?af=R
- 242Kabesch M. Shielding against SARS-CoV-2 infection is not justified in children with severe asthma. Pediatric Allergy and Immunology. 2020. onlinelibrary.wiley.com/doi/abs/10.1111/pai.13327
- 243Bain R, Cosgriff R, Zampoli M, et al. Clinical characteristics of SARS-CoV-2 infection in children with cystic fibrosis: An international observational study. Journal of Cystic Fibrosis. 2020. www.cysticfibrosisjournal.com/article/S1569-1993(20)30931-0/fulltext
- 244Kainth MK, Goenka PK, Williamson KA, et al. Early Experience of COVID-19 in a US Children' Hospital. Pediatrics. 2020. pediatrics.aappublications.org/content/pediatrics/early/2020/07/15/peds.2020-003186
- 245Gaborieau L, Delestrain C, Bensaid P, et al. Epidemiology and Clinical Presentation of Children Hospitalized with SARS-CoV-2 Infection in Suburbs of Paris. Journal of Clinical Medicine. 2020. www.mdpi.com/2077-0383/9/7/2227
- 246Kim L, Whitaker M, O’Halloran A, et al. Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1–July 25, 2020. Morbidity and Mortality Weekly Report. 2020. www.cdc.gov/mmwr/volumes/69/wr/mm6932e3.htm
- 247Bixler D, Miller A, Mattison C, et al. SARS-CoV-2–Associated Deaths Among Persons Aged <21 Years — United States, February 12–July 31, 2020. MMWR Morbidity and Mortality Weekly Report. 2020. www.cdc.gov/mmwr/volumes/69/wr/mm6937e4.htm?s_cid=mm6937e4_w
- 248Williamson EJ, McDonald HI, Bhaskaran K, et al. Risks of covid-19 hospital admission and death for people with learning disability: population based cohort study using the OpenSAFELY platform. British Medical Journal. 2021. www.bmj.com/content/374/bmj.n1592
- 249Preston LE, Chevinsky JR, Kompaniyets L, et al. Characteristics and Disease Severity of US Children and Adolescents Diagnosed With COVID-19. JAMA Network Open. 2021. jamanetwork.com/journals/jamanetworkopen/fullarticle/2778347
- 250Oualha M, Bendavid M, Berteloot L, et al. Severe and fatal forms of COVID-19 in children. Archives de Pédiatrie. 2020. www.sciencedirect.com/science/article/pii/S0929693X20301172
- 251 a b Shekerdemian LS, Mahmood NR, Wolfe KK, et al. Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units. Jama Pediatrics. 2020. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2766037
- 252Prata-Barbosa A, Lima-Setta F, Santos GR, et al. Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study. Jornal de Pediatria. 2020. www.sciencedirect.com/science/article/pii/S0021755720301923
- 253Lanyon N, du Pré P, Thiruchelvam T, et al. Critical paediatric COVID-19: varied presentations but good outcomes. Archives of Disease in Childhood. 2020. adc.bmj.com/content/early/2020/06/28/archdischild-2020-319602
- 254Derespina KR, Kaushik S, Plichta A, et al. Clinical Manifestations and Outcomes of Critically Ill Children and Adolescents with COVID-19 in New York City. The Journal of Pediatrics. 2020. www.jpeds.com/article/S0022-3476(20)30888-X/fulltext
- 255Xiong X, Chua GT, Chi S, et al. A Comparison Between Chinese Children Infected with Coronavirus Disease-2019 and with Severe Acute Respiratory Syndrome 2003. The Journal of Pediatrics. 2020. www.jpeds.com/article/S0022-3476(20)30743-5/fulltext
- 256Lorenz N, Treptow A, Schmidt S, et al. Neonatal Early-Onset Infection With SARS-CoV-2 in a Newborn Presenting With Encephalitic Symptoms. The Pediatric Infectious Disease Journal. 2020. journals.lww.com/pidj/Citation/9000/Neonatal_Early_Onset_Infection_With_SARS_CoV_2_in.96175.aspx
- 257White A, Mukherjee P, Stremming J, et al. Neonates Hospitalized with Community-Acquired SARS-CoV-2 in a Colorado Neonatal Intensive Care Unit. Neonatology. 2020. www.karger.com/Article/Abstract/508962
- 258Fan C, Lei D, Fang C, et al. Perinatal Transmission of COVID-19 Associated SARS-CoV-2: Should We Worry? Clinical Infectious Diseases. 2020. academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa226/5809260
- 259 a b Zhang ZJ, Yu XJ, Fu T, et al. Novel Coronavirus Infection in Newborn Babies Under 28 Days in China. European Respiratory Journal. 2020. https://erj.ersjournals.com/content/early/2020/04/01/13993003.00697-2020
- 260 a b Wang S, Guo L, Chen L, et al. A case report of neonatal COVID-19 infection in China. Clinical Infectious Diseases. 2020. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa225/5803274
- 261Wardell H, Campbell JI, VanderPluym C, et al. Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Febrile Neonates. Journal of the Pediatric Infectious Diseases Society. 2020. academic.oup.com/jpids/advance-article/doi/10.1093/jpids/piaa084/5869489
- 262Flaherman V, Afshar Y, Boscardin J, et al. Infant Outcomes Following Maternal Infection with SARS-CoV-2: First Report from the PRIORITY Study. Clinical Infectious Diseases. 2020. academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1411/5908705
- 263 a b Knight M, Bunch K, Vousden N, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. British Medical Journal. 2020. https://www.bmj.com/content/369/bmj.m2107
- 264Yan J, Guo J, Fan C, et al. Coronavirus disease 2019 in pregnant women: a report based on 116 cases. American Journal of Obstetrics & Gynecology. 2020. www.ajog.org/article/S0002-9378(20)30462-2/fulltext
- 265 a b Diriba K, Awulachew E, Getu E. The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and the possibility of vertical maternal–fetal transmission: a systematic review and meta-analysis. European Journal of Medical Research. 2020. https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-020-00439-w
- 266Ferrazzi E, Frigerio L, Savasi V, et al. Vaginal delivery in SARS‐CoV‐2 infected pregnant women in Northern Italy: a retrospective analysis. BJOG: An International Journal of Obstetrics & Gynaecology. 2020. obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.16278
- 267Woodworth KR, Olsen EO, Neelam V, et al. Birth and Infant Outcomes Following Laboratory-Confirmed SARS-CoV-2 Infection in Pregnancy — SET-NET, 16 Jurisdictions, March 29–October 14, 2020. Morbidity and Mortality Weekly Report. 2020. www.cdc.gov/mmwr/volumes/69/wr/mm6944e2.htm?s_cid=mm6944e2_w
- 268Cribiù FM, Erra R, Pugni L, et al. Severe SARS-CoV-2 placenta infection can impact neonatal outcome in the absence of vertical transmission. The Journal of Clinical Investigation. 2021. www.jci.org/articles/view/145427
- 269Chmielewska B, Barratt I, Townsend R, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. The Lancet Global Health. 2021. www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00079-6/fulltext
- 270Breslin N, Baptiste C, Miller R, et al. COVID-19 in pregnancy: early lessons. American Journal of Obstetrics & Gynecology. 2020. www.sciencedirect.com/science/article/pii/S2589933320300410
- 271Li N, Han L, Peng M, et al. Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study. Clinical Infectious Diseases. 2020. www.ncbi.nlm.nih.gov/pmc/articles/PMC7184430/
- 272Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clinical Infectious Diseases. 2020. academic.oup.com/cid/article/doi/10.1093/cid/ciaa200/5771323
- 273Kalafat E, Yaprak E, Cinar G, et al. Lung ultrasound and computed tomographic findings in pregnant woman with COVID-19. Ultrasound in Obstetrics & Gynecology. 2020. obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/uog.22034
- 274Iqbal SN, Overcash R, Mokhtari N, et al. An Uncomplicated Delivery in a Patient with Covid-19 in the United States. The New England Journal of Medicine. 2020. www.nejm.org/doi/full/10.1056/NEJMc2007605
- 275Lee DH, Lee J, Kim E, Woo K, Park HY, An J. Emergency cesarean section on severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) confirmed patient. Korean Journal of Anesthesiology. 2020. ekja.org/journal/view.php?doi=10.4097/kja.20116
- 276Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. Journal of Infection. 2020. www.journalofinfection.com/article/S0163-4453(20)30109-2/fulltext
- 277Li Y, Zhao R, Zheng S, et al. Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China. Emerging Infectious Diseases. 2020. wwwnc.cdc.gov/eid/article/26/6/20-0287_article
- 278Liu D, Li L, Wu X, et al. Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID-19) Pneumonia: A Preliminary Analysis. American Journal of Roentgenology. 2020. www.ajronline.org/doi/full/10.2214/AJR.20.23072
- 279Chen S, Liao E, Shao Y. Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia. Journal of Medical Virology. 2020. onlinelibrary.wiley.com/doi/full/10.1002/jmv.25789
- 280Zambrano LI, Fuentes-Barahona IC, Bejarano-Torres DA, et al. A pregnant woman with COVID-19 in Central America. Travel Medicine and Infectious Disease. 2020. www.sciencedirect.com/science/article/pii/S1477893920301071?via%3Dihub
- 281Chen Y, Peng H, Wang L, et al. Infants Born to Mothers With a New Coronavirus (COVID-19). Frontiers in Pediatrics. 2020. www.frontiersin.org/articles/10.3389/fped.2020.00104/full
- 282 a b Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet. 2020. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30360-3/fulltext
- 283Liu W, Wang J, Li W, et al. Clinical characteristics of 19 neonates born to mothers with COVID-19. Frontiers of Medicine. 2020. www.ncbi.nlm.nih.gov/pmc/articles/PMC7152620/
- 284Buonsenso D, Costa S, Sanguinetti M, et al. Neonatal Late Onset Infection with Severe Acute Respiratory Syndrome Coronavirus 2. American Journal of Perinatology. 2020. www.ncbi.nlm.nih.gov/pubmed/32359227
- 285Perlman J, Oxford C, Chang C, et al. Delivery Room Preparedness and Early Neonatal Outcomes During COVID19 Pandemic in New York City. Pediatrics. 2020. pediatrics.aappublications.org/content/early/2020/05/12/peds.2020-1567.long
- 286Rosen H, Bart Y, Zlatkin R, et al. Fetal and Perinatal Outcome Following First and Second Trimester COVID-19 Infection: Evidence from a Prospective Cohort Study. Journal of Clinical Medicine. 2021. www.mdpi.com/2077-0383/10/10/2152
- 287Kotlyar A, Grechukhina O, Chen A, et al. Vertical Transmission of COVID-19: A Systematic Review and Meta-analysis. American Journal of Obstetrics and Gynecology. 2020. www.ajog.org/article/S0002-9378(20)30823-1/fulltext
- 288Hecht JL, Quade B, Deshpande V, et al. SARS-CoV-2 can infect the placenta and is not associated with specific placental histopathology: a series of 19 placentas from COVID-19-positive mothers. Modern Pathology. 2020. www.nature.com/articles/s41379-020-0639-4
- 289Fenizia C, Biasin M, Cetin I, et al. Analysis of SARS-CoV-2 vertical transmission during pregnancy. Nature Communications. 2020. www.nature.com/articles/s41467-020-18933-4
- 290Dong L, Tian J, Songming H et al. Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn. JAMA. 2020. jamanetwork.com/journals/jama/fullarticle/2763853
- 291Zeng H, Xu C, Fan J, et al. Antibodies in Infants Born to Mothers With COVID-19 Pneumonia. JAMA. 2020. jamanetwork.com/journals/jama/fullarticle/2763854
- 292McDevitt KEM, Ganjoo N, Mlangeni D, et al. Outcome of universal screening of neonates for COVID-19 from asymptomatic mothers. The Journal of infection. 2020. www.ncbi.nlm.nih.gov/pmc/articles/PMC7303651/
- 293Marín Gabriel MA, Reyne Vergeli M, Caserío Carbonero S, et al. Maternal, Perinatal and Neonatal Outcomes With COVID-19: A Multicenter Study of 242 Pregnancies and Their 248 Infant Newborns During Their First Month of Life. Pediatric Infectious Disease. 2020. pubmed.ncbi.nlm.nih.gov/32947599/
- 294Alzamora MC, Paredes T, Caceres D, et al. Severe COVID-19 during Pregnancy and Possible Vertical Transmission. America Journal of Perinatology. 2020. www.ncbi.nlm.nih.gov/pubmed/32305046
- 295Gao J, Li W, Hu X, et al. Disappearance of SARS-CoV-2 Antibodies in Infants Born to Women with COVID-19, Wuhan, China. Emerging Infectious Disease Journal. 2020. wwwnc.cdc.gov/eid/article/26/10/20-2328_article
- 296Beharier O, Mayo RP, Raz T, et al. Efficient maternal to neonatal transfer of antibodies against SARS-CoV-2 and BNT162b2 mRNA COVID-19 vaccine. The Journal of Clinical Investigation. 2021. www.jci.org/articles/view/150319
- 297Mo H, Wang M, Wang M, et al. Detectable antibodies against SARS-CoV-2 in newborns from mothers infected with COVID-19 at different gestational ages. Pediatrics & Neonatology. 2021. www.pediatr-neonatol.com/article/S1875-9572(21)00052-8/fulltext
- 298Kalamdani P, Kalathingal T, Manerkar S, et al. Clinical Profile of SARS-CoV-2 Infected Neonates From a Tertiary Government Hospital in Mumbai, India. Indian Journal of Pediatrics. 2020. pubmed.ncbi.nlm.nih.gov/33043888/
- 299Gidlof S, Savchenko J, Brune T, Josefsson H. COVID-19 in pregnancy with comorbidities: More liberal testing strategy is needed. Acta Obstetricia et Gynecologica Scandinavica. 2020. obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.13862
- 300Salvatori G, De Rose DU, Concato C, et al. Managing COVID-19-Positive Maternal-Infant Dyads: An Italian Experience. Breastfeeding Medicine. 2020. www.ncbi.nlm.nih.gov/pubmed/32311273
- 301Pace RM, Williams JE, Järvinen KM, et al. Characterization of SARS-CoV-2 RNA, Antibodies, and Neutralizing Capacity in Milk Produced by Women with COVID-19. mBio. 2021. mbio.asm.org/content/mbio/12/1/e03192-20
- 302Costa S, Posteraro B, Marchetti S, et al. Excretion of SARS-CoV-2 in human breast milk. Clinical Microbiology and Infection. 2020. www.ncbi.nlm.nih.gov/pmc/articles/PMC7266588/
- 303Groß R, Conzelmann C, Müller JA, et al. Detection of SARS-CoV-2 in human breastmilk. The Lancet. 2020. www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31181-8/fulltext#articleInformation
- 304Chambers CD, Krogstad P, Bertrand K, et al. Evaluation of SARS-CoV-2 in Breastmilk from 18 Infected Women. JAMA. 2020. jamanetwork.com/journals/jama/fullarticle/2769825
- 305Demers-Mathieu V, Dung M, Mathijssen GB, et al. Difference in levels of SARS-CoV-2 S1 and S2 subunits- and nucleocapsid protein-reactive SIgM/IgM, IgG and SIgA/IgA antibodies in human milk. Journal of Perinatology. 2020. www.nature.com/articles/s41372-020-00805-w
- 306*Golan Y, Prahl M, Cassidy A, et al. COVID-19 mRNA vaccine is not detected in human milk. medRxiv. 2021. www.medrxiv.org/content/medrxiv/early/2021/03/08/2021.03.05.21252998
- 307Golan Y, Prahl M, Cassidy A, et al. COVID-19 mRNA Vaccination in Lactation: Assessment of Adverse Events and Vaccine Related Antibodies in Mother-Infant Dyads. frontiers in Immunology. 2021. www.frontiersin.org/articles/10.3389/fimmu.2021.777103/full
- 308Gray KJ, Bordt EA, Atyeo C, et al. COVID-19 vaccine response in pregnant and lactating women: a cohort study. American Journal of Obstetrics & Gynecology. 2021. www.ajog.org/article/S0002-9378(21)00187-3/fulltext
- 309Rottenstreich A, Zarbiv G, Oiknine-Djian E, et al. Efficient maternofetal transplacental transfer of anti- SARS-CoV-2 spike antibodies after antenatal SARS-CoV-2 BNT162b2 mRNA vaccination. Clinical Infectious Diseases. 2021. academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab266/6209876
- 310Snapiri O, Rosenberg Danziger C, Shirman N, et al. Transient Cardiac Injury in Adolescents Receiving the BNT162b2 mRNA COVID-19 Vaccine. The Pediatric Infectious Disease Journal. 2021. journals.lww.com/pidj/Fulltext/9000/Transient_Cardiac_Injury_in_Adolescents_Receiving.95800.aspx
- 311Nathan N, Prevost B, Corvol H. Atypical presentation of COVID-19 in young infants. The Lancet. 2020. www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30980-6/fulltext#articleInformation
- 312Wang D, Ju X, Xie F, et al. Clinical analysis of 31 cases of 2019 novel coronavirus infection in children from six provinces (autonomous region) of northern China. Chinese Journal of Pediatrics. 2020. rs.yiigle.com/yufabiao/1183296.htm
- 313Toh Z, Higgins R, Do L, et al. Persistence of SARS-CoV-2–Specific IgG in Children 6 Months After Infection, Australia. Emerging Infectious Diseases Journal. 2021. wwwnc.cdc.gov/eid/article/27/8/21-0965_article
- 314Ludvigsson JF. Case report and systematic review suggest that children may experience similar long-term effects to adults after clinical COVID-19. Acta Paediatrica. 2020. onlinelibrary.wiley.com/doi/abs/10.1111/apa.15673
- 315Osmanov IM, Spiridonova E, Bobkova P, et al. Risk factors for long covid in previously hospitalised children using the ISARIC Global follow-up protocol: A prospective cohort study. European Respiratory Journal. 2021. erj.ersjournals.com/content/early/2021/06/10/13993003.01341-2021
- 316*Miller F, Nguyen V, Navaratnam AM, et al. Prevalence of persistent symptoms in children during the COVID-19 pandemic: evidence from a household cohort study in England and Wales. medRxiv. 2021. www.medrxiv.org/content/medrxiv/early/2021/06/02/2021.05.28.21257602
- 317Lazzerini M, Barbi E, Apicella A, et al. Delayed access or provision of care in Italy resulting from fear of COVID-19. The Lancet Child & Adolescent Health. 2020. www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30108-5/fulltext
- 318Lynn RM, Avis JL, Lenton S, et al. Delayed access to care and late presentations in children during the COVID-19 pandemic: a snapshot survey of 4075 paediatricians in the UK and Ireland. Archives of Disease in Childhood. 2020. adc.bmj.com/content/early/2020/06/24/archdischild-2020-319848
- 319Roland D, Harwood R, Bishop N, et al. Children's emergency presentations during the COVID-19 pandemic. The Lancet Child & Adolescent Health. 2020. www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30206-6/fulltext