Epidemiology and clinical features of SARS-CoV-2 infection in children and adolescents in the pre-Omicron era: A global systematic review and meta-analysis.

Publication date: Mar 01, 2024

We searched MEDLINE, Embase, Global Health, CINAHL, China National Knowledge Infrastructure, Wanfang, CQvip, and the World Health Organization (WHO) COVID-19 global literature databases for primary studies recruiting children aged ≤18 years with a diagnosis of SARS-CoV-2 infection confirmed either by molecular or antigen tests. We used the Joanna Briggs Institute critical appraisal tools to appraise the study quality and conducted meta-analyses using the random effects model for all outcomes except for race/ethnicity as risk factors of SARS-CoV-2 infection. We included 237 studies, each reporting at least one of the study outcomes. Based on data from 117 studies, the pooled SARS-CoV-2 positivity rate was 9. 30% (95% confidence interval (CI) = 7. 15-11. 73). Having a comorbidity was identified as a risk factor for SARS-CoV-2 infection (risk ratio (RR) = 1. 33; 95% CI = 1. 04-1. 71) based on data from 49 studies. Most cases in this review presented with mild disease (n = 50; 52. 47% (95% CI = 44. 03-60. 84)). However, 20. 70% of paediatric SARS-CoV-2 infections were hospitalised (67 studies), 7. 19% required oxygen support (57 studies), 4. 26% required intensive care (93 studies), and 2. 92% required assisted ventilation (63 studies). The case fatality ratio (n = 119) was 0. 87% (95% CI = 0. 54-1. 28), which included in-hospital and out-of-hospital deaths. Our data showed that children were at risk for SARS-CoV-2 infections and severe outcomes in the pre-Omicron era. These findings underscore the need for effective vaccination strategies for the paediatric population to protect against the acute and long-term sequelae of COVID-19. PROSPERO: CRD42022327680.

Concepts Keywords
China Based
Crd42022327680 Cov
Epidemiology Covid
Molecular Era
Race Global


Type Source Name
disease MESH SARS-CoV-2 infection
pathway REACTOME SARS-CoV-2 Infection
disease VO organization
disease IDO quality
disease MESH comorbidity
drug DRUGBANK Oxygen
disease VO effective
disease VO vaccination
disease VO population
disease MESH sequelae

Original Article

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