SARS-CoV-2 in children: spectrum of disease, transmission and immunopathological underpinnings

Pathology. 2020 Dec;52(7):801-808. doi: 10.1016/j.pathol.2020.08.001. Epub 2020 Aug 19.

Abstract

As the SARS-CoV-2 pandemic unfolds across the globe, consistent themes are emerging with regard to aspects of SARS-CoV-2 infection and its associated disease entities in children. Overall, children appear to be less frequently infected by, and affected by, SARS-CoV-2 virus and the clinical disease COVID-19. Large epidemiological studies have revealed children represent less than 2% of the total confirmed COVID-19 cases, of whom the majority experience minimal or mild disease that do not require hospitalisation. Children do not appear to be major drivers of SARS-CoV-2 transmission, with minimal secondary virus transmission demonstrated within families, schools and community settings. There are several postulated theories regarding the relatively low SARS-CoV-2 morbidity and mortality seen in children, which largely relate to differences in immune responses compared to adults, as well as differences in angiotensin converting enzyme 2 distribution that potentially limits viral entry and subsequent inflammation, hypoxia and tissue injury. The recent emergence of a multisystem inflammatory syndrome bearing temporal and serological plausibility for an immune-mediated SARS-CoV-2-related disease entity is currently under investigation. This article summarises the current available data regarding SARS-CoV-2 and the paediatric population, including the spectrum of disease in children, the role of children in virus transmission, and host-virus factors that underpin the unique aspects of SARS-CoV-2 pathogenicity in children.

Keywords: ACE2; COVID-19; SARS-CoV-2; multisystem inflammatory syndrome; paediatrics; transmission.

Publication types

  • Review

MeSH terms

  • COVID-19 / immunology
  • COVID-19 / transmission*
  • COVID-19 / virology
  • Child
  • Child, Preschool
  • Female
  • Host-Pathogen Interactions / physiology*
  • Humans
  • Infant
  • Male
  • SARS-CoV-2 / immunology
  • SARS-CoV-2 / pathogenicity*