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Systematic review of outbreaks of COVID-19 within households in the European region when the child is the index case

Vardavas, Constantine I.; Nikitara, Katerina; Aslanoglou, Katerina; Kamekis, Apostolos; Ramesh, Nithya; Symvoulakis, Emmanouil; Agaku, Israel; Phalkey, Revati; Leonardi-Bee, Jo; Fernandez, Esteve; Condell, Orla; Lamb, Favelle; Deogan, Charlotte; Suk, Jonathan E.

Systematic review of outbreaks of COVID-19 within households in the European region when the child is the index case Thumbnail


Constantine I. Vardavas

Katerina Nikitara

Katerina Aslanoglou

Apostolos Kamekis

Nithya Ramesh

Emmanouil Symvoulakis

Israel Agaku

Revati Phalkey

Professor of Medical Statistics and Epidemiology

Esteve Fernandez

Orla Condell

Favelle Lamb

Charlotte Deogan

Jonathan E. Suk


Objectives This systematic review aims to identify the secondary attack rates (SAR) to adults and other children when children are the index cases within household settings.

Methods This literature review assessed European-based studies published in Medline and Embase between January 2020 and January 2022 that assessed the secondary transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within household settings. The inclusion criteria were based on the PEO framework (P-Population, E-Exposure, O-Outcome) for systematic reviews. Thus, the study population was restricted to humans within the household setting in Europe (population), in contact with pediatric index cases 1–17 years old (exposure) that led to the transmission of SARS-CoV-2 reported as either a SAR or the probability of onward infection (outcome).

Results Of 1,819 studies originally identified, 25 met the inclusion criteria. Overall, the SAR ranged from 13% to 75% in 23 studies, while there was no evidence of secondary transmission from children to other household members in two studies. Evidence indicated that asymptomatic SARS-CoV-2 index cases also have a lower SAR than those with symptoms and that younger children may have a lower SAR than adolescents (>12 years old) within household settings.

Conclusions SARS-CoV-2 secondary transmission from paediatric index cases ranged from 0% to 75%, within household settings between January 2020 and January 2022, with differences noted by age and by symptomatic/asymptomatic status of the index case. Given the anticipated endemic circulation of SARS-CoV-2, continued monitoring and assessment of household transmission is necessary.

Journal Article Type Review
Acceptance Date Dec 7, 2022
Online Publication Date Jan 11, 2023
Publication Date Jan 11, 2023
Deposit Date Dec 9, 2022
Publicly Available Date Dec 9, 2022
Journal BMJ Paediatrics Open
Electronic ISSN 2399-9772
Peer Reviewed Peer Reviewed
Volume 7
Issue 1
Article Number e001718
Keywords COVID-19; Epidemiology; Virology
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