An increasing public health burden arising from children infected with SARS-CoV2: A systematic review and meta-analysis

Pediatr Pulmonol. 2020 Dec;55(12):3487-3496. doi: 10.1002/ppul.25008. Epub 2020 Sep 25.


Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is spreading all over the world and poses a great threat to humans. This study aimed to systematically review the current situation and public health burden associated with children infected with SARS-CoV2.

Methods: We searched four electronic databases without language limitations. The pooled proportion or odds ratio (OR) and 95% CI confidence interval (CI) were calculated for each analysis to explore the prevalence of asymptomatic infection and coinfection, as well as to assess the sex of SARS-CoV-2-infected children.

Results: We obtained data from 14 eligible studies with 410 patients for the meta-analysis. The pooled proportion of asymptomatic infection was 40.45% (95% CI, 24.04-56.85), while coinfection was 10.14% (95% CI, 3.97-16.30), of which Mycoplasma pneumonia (50%; 95% CI, 28.24-71.76) and influenza virus or parainfluenza virus (22.76%; 95% CI, 4.76-40.77) were the most common pathogens. Both male and female children were susceptible to SARS-CoV2 infection. And the pooled proportion of family clustering infection was 83.63% (95% CI, 77.54-89.72).

Conclusion: A high proportion of asymptomatic infections occurs in children infected with SARS-CoV2, who are also susceptible to coinfection regardless of sex. These data affirm the increasing public health burden arising from infected children regarding the causation of asymptomatic infection or misdiagnosis and as a significant contributor to virus spread. The public should pay more attention to children during epidemics and conduct multimethod detection to further effectively identify infected children and control the source of infection.

Keywords: SARS-CoV2; asymptomatic infection; children; coinfection.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Asymptomatic Infections / epidemiology*
  • Betacoronavirus
  • COVID-19
  • Child
  • Child, Preschool
  • Coinfection / epidemiology*
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / transmission
  • Humans
  • Infant
  • Pandemics
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / transmission
  • Prevalence
  • Public Health*
  • SARS-CoV-2