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Epidemiology of COVID-19 infection in young children under five years: A systematic review and meta-analysis

Bhuiyan, Mejbah Uddin; Stiboy, Eunice; Hassan, Md. Zakiul; Chan, Mei; Islam, Md. Saiful; Haider, Najmul; Jaffe, Adam; Homaira, Nusrat

Authors

Mejbah Uddin Bhuiyan

Eunice Stiboy

Md. Zakiul Hassan

Mei Chan

Md. Saiful Islam

Najmul Haider

Adam Jaffe

Nusrat Homaira



Abstract

Introduction
Emerging evidence suggests young children are at greater risk of COVID-19 infection than initially predicted. However, a comprehensive understanding of epidemiology of COVID-19 infection in young children under five years, the most at-risk age-group for respiratory infections, remain unclear. We conducted a systematic review and meta-analysis of epidemiological and clinical characteristics of COVID-19 infection in children under five years.

Method
Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses , we searched several electronic databases (Pubmed, EMBASE, Web of Science, and Scopus) with no language restriction for published epidemiological studies and case-reports reporting laboratory-confirmed COVID-19 infection in children under five years until June 4, 2020. We assessed pooled prevalence for key demographics and clinical characteristics using Freeman-Tukey double arcsine random-effects model for studies except case-reports. We evaluated risk of bias separately for case-reports and other studies.

Results
We identified 1,964 articles, of which, 65 articles were eligible for systematic review that represented 1,214 children younger than five years with laboratory-confirmed COVID-19 infection. The pooled estimates showed that 50% young COVID-19 cases were infants (95% CI: 36% − 63%, 27 studies); 53% were male (95% CI: 41% − 65%, 24 studies); 43% were asymptomatic (95% CI: 15% − 73%, 9 studies) and 7% (95% CI: 0% − 30%, 5 studies) had severe disease that required intensive-care-unit admission. Of 139 newborns from COVID-19 infected mothers, five (3.6%) were COVID-19 positive. There was only one death recorded.

Discussion
This systematic review reports the largest number of children younger than five years with COVID-19 infection till date. Our meta-analysis shows nearly half of young COVID-19 cases were asymptomatic and half were infants, highlighting the need for ongoing surveillance to better understand the epidemiology, clinical pattern, and transmission of COVID-19 to develop effective preventive strategies against COVID-19 disease in young paediatric population.

Citation

Bhuiyan, M. U., Stiboy, E., Hassan, M. Z., Chan, M., Islam, M. S., Haider, N., Jaffe, A., & Homaira, N. (2020). Epidemiology of COVID-19 infection in young children under five years: A systematic review and meta-analysis. Vaccine, https://doi.org/10.1016/j.vaccine.2020.11.078

Journal Article Type Article
Acceptance Date Nov 30, 2020
Online Publication Date Dec 5, 2020
Publication Date 2020-12
Deposit Date Feb 15, 2021
Publicly Available Date Jan 22, 2022
Journal Vaccine
Print ISSN 0264-410X
Publisher Elsevier
Peer Reviewed Peer Reviewed
DOI https://doi.org/10.1016/j.vaccine.2020.11.078
Keywords Public Health, Environmental and Occupational Health; General Immunology and Microbiology; Molecular Medicine; General Veterinary; Infectious Diseases
Public URL https://rvc-repository.worktribe.com/output/1442971