Incidence Rates, Household Infection Risk, and Clinical Characteristics of SARS-CoV-2 Infection Among Children and Adults in Utah and New York City, New York
Incidence Rates, Household Infection Risk, and Clinical Characteristics of SARS-CoV-2 Infection Among Children and Adults in Utah and New York City, New York
复制标题
DOI：
10.1001/jamapediatrics.2021.4217
复制
发表时间：
2021-10-08
期刊：
影响因子：
26.1
通讯作者：
Stockwell, Melissa S.
中科院分区：
文献类型：
--
作者：
Dawood, Fatimah S.;Porucznik, Christina A.;Stockwell, Melissa S.
问题：在社区SARS-CoV-2传播增加期间，与成人相比，儿童感染SARS-CoV-2的风险是多少？在这项队列研究中，从2020年9月到2021年4月在纽约市、纽约和犹他州的选定县对310个家庭的1236名参与者进行了研究，按年龄组划分的每1000人周的现场调整发病率相似：0至4岁儿童6.3，5至11岁儿童4.4，12至17岁儿童6.0，成人5.1（年龄>= 18岁）。意义在这项研究中，儿童与成人相比有相似的SARS-CoV-2感染风险。这项对犹他州县和纽约市，纽约，比较成人和儿童SARS-CoV-2感染的发病率和临床特征，并前瞻性地评估感染风险。重要信息需要有关儿童与成人相比SARS-CoV-2感染风险的数据，以告知COVID-19 - 19 - 2019 19项风险沟通和预防策略，包括儿童COVID-19疫苗接种政策。目的比较成人和儿童SARS-CoV-2感染的发病率和临床特征，并在前瞻性家庭队列中估计家庭感染风险。设计，环境，和参与者在犹他州和纽约市，纽约的选定县至少有一个0至17岁的孩子的家庭有资格参加。从2020年9月至2021年4月，参与者每周自行采集中鼻甲鼻拭子进行SARS-CoV-2逆转录-聚合酶链反应检测，并回答症状问卷。参与者还自行采集了其他COVID-19样疾病发作的呼吸道标本。对于无法自行采集呼吸道标本的儿童，由一名成年护理人员采集标本。主要结果和测量主要结果是任何SARS-CoV-2感染的事件病例，包括无症状和有症状的感染。其他指标是无症状感染比例，计算方法是无症状感染发生率除以任何感染率、感染的临床特征和家庭感染风险。主要结果进行了比较，由参与者年龄group.RESULTS在310户共1236参与者参加了监测，其中包括176名参与者（14%）年龄为0至4岁，313（25%）年龄为5至11岁，163（13%）年龄为12至17岁，584（47%）18岁或以上。在犹他州和纽约市队列中，SARS-CoV-2感染的总体发病率分别为3.8（95%CI，2.4-5.9）和7.7（95%CI，4.1-14.5）/1000人周。各年龄组的研究中心校正的每1000人-周发生率相似：6.3（95% CI，3.6-11.0）0 - 4岁儿童，4.4（95% CI，2.5-7.5），12 - 17岁儿童为6.0（95% CI，3.0-11.7），成人（≥ 18岁）为5.1（95% CI，3.3-7.8）。在0至4岁、5至11岁、12至17岁和18岁或以上的人群中，按年龄组划分的无症状感染比例分别为52%、50%、45%和12%。在40个有1个或多个SARS-CoV-2感染的家庭中，所有登记的家庭成员中SARS-CoV-2感染的平均风险为52%（范围，11%-100%），与犹他州相比，纽约市的风险更高（80% [95%CI，64%-91%] vs 44% [95%CI，36%-53%]; P <0.001）。结论和相关性在这项研究中，儿童与成人相比，SARS-CoV-2感染的发病率相似，但儿童中更大比例的感染是无症状的。
Question What is the risk of SARS-CoV-2 infection among children compared with adults during periods of increased SARS-CoV-2 circulation in the community?Findings In this cohort study of 1236 participants in 310 households conducted from September 2020 through April 2021 in New York City, New York, and selected counties in Utah, site-adjusted incidence rates per 1000 person-weeks were similar by age group: 6.3 for children aged 0 to 4 years, 4.4 for children aged 5 to 11 years, 6.0 for children aged 12 to 17 years, and 5.1 for adults (aged >= 18 years).Meaning In this study, children had similar risks of SARS-CoV-2 infection compared with adults.This cohort study of households in selected Utah counties and New York City, New York, compares incidence rates and clinical characteristics of SARS-CoV-2 infection among adults and children and prospectively assesses infection risks.IMPORTANCE Data about the risk of SARS-CoV-2 infection among children compared with adults are needed to inform COVID-19 risk communication and prevention strategies, including COVID-19 vaccination policies for children.OBJECTIVE To compare incidence rates and clinical characteristics of SARS-CoV-2 infection among adults and children and estimated household infection risks within a prospective household cohort.DESIGN, SETTING, AND PARTICIPANTS Households with at least 1 child aged 0 to 17 years in selected counties in Utah and New York City, New York, were eligible for enrollment. From September 2020 through April 2021, participants self-collected midturbinate nasal swabs for reverse transcription-polymerase chain reaction testing for SARS-CoV-2 and responded to symptom questionnaires each week. Participants also self-collected additional respiratory specimens with onset of COVID-19-like illness. For children unable to self-collect respiratory specimens, an adult caregiver collected the specimens.MAIN OUTCOMES AND MEASURES The primary outcome was incident cases of any SARS-CoV-2 infection, including asymptomatic and symptomatic infections. Additional measures were the asymptomatic fraction of infection calculated by dividing incidence rates of asymptomatic infection by rates of any infection, clinical characteristics of infection, and household infection risks. Primary outcomes were compared by participant age group.RESULTS A total of 1236 participants in 310 households participated in surveillance, including 176 participants (14%) who were aged 0 to 4 years, 313 (25%) aged 5 to 11 years, 163 (13%) aged 12 to 17 years, and 584 (47%) 18 years or older. Overall incidence rates of SARS-CoV-2 infection were 3.8 (95% CI, 2.4-5.9) and 7.7 (95% CI, 4.1-14.5) per 1000 person-weeks among the Utah and New York City cohorts, respectively. Site-adjusted incidence rates per 1000 person-weeks were similar by age group: 6.3 (95% CI, 3.6-11.0) for children 0 to 4 years, 4.4 (95% CI, 2.5-7.5) for children 5 to 11 years, 6.0 (95% CI, 3.0-11.7) for children 12 to 17 years, and 5.1 (95% CI, 3.3-7.8) for adults (>= 18 years). The asymptomatic fractions of infection by age group were 52%, 50%, 45%, and 12% among individuals aged 0 to 4 years, 5 to 11 years, 12 to 17 years, and 18 years or older, respectively. Among 40 households with 1 or more SARS-CoV-2 infections, the mean risk of SARS-CoV-2 infection among all enrolled household members was 52% (range, 11%-100%), with higher risks in New York City compared with Utah (80% [95% CI, 64%-91%] vs 44% [95% CI, 36%-53%]; P < .001).CONCLUSIONS AND RELEVANCE In this study, children had similar incidence rates of SARS-CoV-2 infection compared with adults, but a larger proportion of infections among children were asymptomatic.