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Open accessJournal ArticleDOI: 10.1007/S00112-021-01134-8

Children and COVID-19—Data from mandatory reporting and results of contact person testing in daycare centers and schools in Frankfurt am Main, Germany, August–December 2020

02 Mar 2021-Monatsschrift Kinderheilkunde (Springer Medizin)-Vol. 169, Iss: 4, pp 1-11
Abstract: Angesichts der COVID-19-Pandemie wird haufig unterstellt, dass Kinder Treiber dieser Pandemie sind, und dass beim Auftreten von SARS-CoV-2 in Schulen und Kindertagesstatten ganze Gruppen, Klassen oder die gesamte Einrichtung geschlossen werden musse. Diesen Fragen wird anhand der Meldedaten in Frankfurt am Main sowie der umfangreichen Testungen der Kontaktpersonen (KP) in Schulen und Kitas nach dem Auftreten eines Indexfalles nachgegangen. Die Meldedaten wurden aus SurvStat entnommen. Die Indexfalle aus Kitas und Schulen wurden isoliert, den KP auf freiwilliger Basis eine PCR-Testung auf SARS-CoV‑2 angeboten – unabhangig davon, ob auf SARS-CoV‑2 hindeutende Symptome aufgetreten waren oder nicht. Die tiefen Nasen‑/Rachenabstriche wurden im Auftrag des Gesundheitsamtes der Stadt Frankfurt am Main durch Rettungsdienste vor Ort entnommen und nach etablierten Standards in 2 akkreditierten Instituten untersucht. Vom Marz bis zum 31.12.2020 wurden in Frankfurt am Main 22.715 COVID-19-Falle gemeldet, darunter 1588 (7,6 %) SARS-CoV-2-Nachweise bei Kindern bis 14 Jahren. Somit wurden bei Kindern bis 14 Jahren etwa halb so viele SARS-CoV-2-Nachweise gemeldet, als es ihrem Anteil an der Bevolkerung entsprochen hatte. Der Anstieg der Inzidenz bei Kindern uber die Wochen folgte zeitlich dem Anstieg der Inzidenz in der Allgemeinbevolkerung; die altersbezogene Inzidenz blieb unter der Inzidenz in der Allgemeinbevolkerung. Von der 35. bis zur 52. Kalenderwoche wurden 274 Indexfalle aus 143 Kitas und 75 Schulen gemeldet. Daraufhin wurden 7915 KP getestet. In Kitas wurde bei 4,5 % der erwachsenen KP und 2,5 % der Kinder-KP, in Schulen bei 0,9 % der Erwachsen-KP und 2,5 % der getesteten Schuler-KP SARS-CoV‑2 nachgewiesen. Pro Indexfall wurde im Mittel deutlich weniger als ein KP positiv getestet. Die Rate positiver Befunde nahm mit steigender Inzidenz in der Gesamtbevolkerung zu. Ein groserer Ausbruch trat nicht auf. Aus der Hohe und dem zeitlichen Ablauf der altersbezogenen Inzidenzen bei den Kindern in Frankfurt am Main ergaben sich keine Hinweise darauf, dass Kinder die „Treiber“ der Pandemie sind. Die untersuchten KP in Schulen und Kitas wurden nur in einem geringen Prozentsatz positiv auf SARS-CoV‑2 getestet. Bei fehlenden Hinweisen auf ein intensives Transmissionsgeschehen in den Einrichtungen kann/sollte der Besuch der KP unter Hygieneauflagen fortgesetzt werden, und es ergibt sich keine Notwendigkeit, ganze Gruppen, Klassen oder gar Einrichtungen zu schliesen.

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Open accessJournal ArticleDOI: 10.7189/JOGH.11.05013
Omar Irfan, Jiang Li, Kun Tang1, Zhicheng Wang1  +1 moreInstitutions (2)
Abstract: Background: There is uncertainty with respect to SARS-CoV-2 transmission in children (0-19 years) with controversy on effectiveness of school-closures in controlling the pandemic. It is of equal importance to evaluate the risk of transmission in children who are often asymptomatic or mildly symptomatic carriers that may incidentally transmit SARS-CoV-2 in different settings. We conducted this review to assess transmission and risks for SARS-CoV-2 in children (by age-groups or grades) in community and educational-settings compared to adults. Methods: Data for the review were retrieved from PubMed, EMBASE, Cochrane Library, WHO COVID-19 Database, China National Knowledge Infrastructure (CNKI) Database, WanFang Database, Latin American and Caribbean Health Sciences Literature (LILACS), Google Scholar, and preprints from medRixv and bioRixv) covering a timeline from December 1, 2019 to April 1, 2021. Population-screening, contact-tracing and cohort studies reporting prevalence and transmission of SARS-CoV-2 in children were included. Data were extracted according to PRISMA guidelines. Meta-analyses were performed using Review Manager 5.3. Results: Ninety studies were included. Compared to adults, children showed comparable national (risk ratio (RR) = 0.87, 95% confidence interval (CI) = 0.71-1.060 and subnational (RR = 0.81, 95% CI = 0.66-1.01) prevalence in population-screening studies, and lower odds of infection in community/household contact-tracing studies (odds ratio (OR) = 0.62, 95% CI = 0.46-0.84). On disaggregation, adolescents observed comparable risk (OR = 1.22, 95% CI = 0.74-2.04) with adults. In educational-settings, children attending daycare/preschools (OR = 0.53, 95% CI = 0.38-0.72) were observed to be at lower-risk when compared to adults, with odds of infection among primary (OR = 0.85, 95% CI = 0.55-1.31) and high-schoolers (OR = 1.30, 95% CI = 0.71-2.38) comparable to adults. Overall, children and adolescents had lower odds of infection in educational-settings compared to community and household clusters. Conclusions: Children (<10 years) showed lower susceptibility to COVID-19 compared to adults, whereas adolescents in communities and high-schoolers had comparable risk. Risks of infection among children in educational-settings was lower than in communities. Evidence from school-based studies demonstrate it is largely safe for children (<10 years) to be at schools, however older children (10-19 years) might facilitate transmission. Despite this evidence, studies focusing on the effectiveness of mitigation measures in educational settings are urgently needed to support both public health and educational policy-making for school reopening.

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Topics: Odds ratio (53%), Relative risk (53%), Cohort study (52%)

7 Citations


Open accessPosted ContentDOI: 10.1101/2021.08.06.21261728
Nora Bruns1, Lea Yvonne Willemsen1, Katharina Holtkamp1, Oliver Kamp1  +41 moreInstitutions (16)
07 Aug 2021-medRxiv
Abstract: ObjectiveTo compare the number of accident- and injury-related admissions to pediatric intensive care units (PICU) during the first German COVID-19 lockdown with previous years. To investigate if shifts in types of accidents or injuries occurred, especially regarding non-accidental injuries. DesignRetrospective observational multicenter study. Setting37 German PICUs. Patients1444 children and adolescents < 18 years admitted to German PICUs due to trauma or injuries during the first German lockdown period (16.3.-31.5.2020) and during the same periods of the years 2017-2019. InterventionsNone. Measurements and main resultsStandardized morbidity ratios (SMR) and 95% confidence intervals (CI) were calculated for the severity of disease, admission reasons, types of accidents, injury patterns, surgeries and procedures, and outcomes. Disease severity did not differ from previous years. We found an increase in ingestions (SMR 1.41 (CI 0.88 - 2.16)) and a decrease in aspirations (0.77 (0.41 - 1.32)) and burns (0.82 (0.59 - 1.12)). The total number of admissions for trauma remained constant, but traffic accidents (0.76 (0.56 - 1.01) and school/kindergarten accidents (0.25 (0.05 - 0.74) decreased. Household (1.32 (1.05 - 1.64)) and leisure accidents (1.32 (1.05 - 1.65)) increased. Injured structures did not change, but less neurosurgeries (0.69 (0.42 - 1.07)) and more visceral surgeries (2.00 (1.14 - 3.24)) were performed. Non-accidental non-suicidal injuries declined (0.85 (0.50 - 1.37)). Suicide attempts increased in adolescent boys (1.57 (0.58 - 3.42)), while there was a decrease in adolescent girls (0.86 (0.53 - 1.31)). ConclusionsOur study showed shifts in trauma types and associated surgeries during the lockdown period that are generally in line with current literature. The decreased number of non-accidental non-suicidal injuries we observed does not suggest a fundamental increase in severe child abuse during the lockdown period. The decrease in suicide attempts among adolescent girls confirms previous findings, while the increase among boys has not been described yet and deserves further investigation.

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Topics: Intensive care (54%), Child abuse (52%)

Open accessJournal ArticleDOI: 10.1007/S00103-021-03445-3
Abstract: Background The measures taken to combat the COVID-19 pandemic have severely restricted the opportunities for the development of children. This paper will discuss the reporting data of children and the public health department's activities against the background of the restrictions of school and leisure time offers as well as sports and club activities. Materials and methods Reporting data from Frankfurt am Main, Hesse, were obtained using a SURVStat query for the calendar weeks 10/2020-28/2021 and from SURVNet (until 30 June 2021). Contact persons (CP) of SARS-CoV‑2 positive persons from schools and daycare centers were screened for SARS-CoV‑2 by PCR test. These results and those of rapid antigen testing, which has been mandatory for schoolchildren since April 2021, are presented. Results Until Easter break, the age-related seven-day incidence values per 100,000 for children 14 years of age and younger were lower than the overall incidence; it was only higher after rapid antigen-testing was mandatory for schoolchildren. Most children with SARS-CoV‑2 had no or mild symptoms; hospitalization was rarely required and no deaths occurred. Contact tracing in schools and daycare centers found no positive contacts in most cases and rarely more than two. Larger outbreaks did not occur. Conclusion SARS-CoV‑2 infections in children appear to be less frequent and much less severe than in adults. Hygiene rules and contact management have proven themselves effective during times with high incidences in the local population without mandatory rapid antigen testing - and even with a high proportion of variants of concern (alpha and delta variants) in Germany. Against this background, further restriction of school and daycare operations appears neither necessary nor appropriate.

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Open accessJournal ArticleDOI: 10.1055/A-1594-2818
Anna-Lisa Sorg1, Veronika Kaiser1, Selina Becht1, Arne Simon2  +1 moreInstitutions (2)
Abstract: Background In addition to widely used basic hygiene measures in school, school closures are applied to contain SARS-CoV-2 spread, although the effect on the pandemic is unclear. We proposed a simple approach to disentangle the effect of school closures from other lockdown measures on the pandemic course based on publicly available data in Germany. Methods We used data on the number of SARS-CoV-2 cases from the onset of the pandemic to 14th April 2021. We compared the proportion of children (5–14 years old) in all cases prior to the lockdown measures, including school closure, to that during a ten-week lockdown in Germany. The total number of paediatric cases occurring during lockdown was compared to the number expected in absence of school closures. The latter was calculated based on the actual weekly number of all cases and the pre-lockdown proportion of paediatric cases. Results The proportion of children in all cases was 2.3 percentage points lower at the nadir than the proportion before the lockdown. The estimated total number of paediatric cases prevented by school closures was estimated at 13,246 amounting to 24% of the expected cases in absence of school closures. Conclusion School closure during the winter lockdown reduced the number of expected SARS-CoV-2 cases in children in absence of school closures. The contribution of these prevented cases to the total population incidence is small. These data might provide the basis to model the effect of school closures in addition to basic hygiene measures on the course of the COVID-19 pandemic. Hintergrund Schulschliesungen werden neben den herkommlichen Hygienemasnahmen (AHA-Regeln) eingesetzt, um die Verbreitung des Virus SARS-CoV-2 einzudammen. Der Effekt von Schulschliesungen auf das Pandemiegeschehen ist derzeit noch nicht ausreichend untersucht. Wir stellen eine einfache Herangehensweise vor, um den Effekt der Schulschliesungen, unabhangig von anderen Lockdown-Masnahmen, auf den Pandemieverlauf abzubilden. Die verwendeten Daten sind in Deutschland offentlich zuganglich. Methoden Fur die Untersuchungen verwenden wir die SARS-CoV-2-Fallzahlen ab Pandemiebeginn bis zum 14. April 2021. Wir verglichen die Falle unter Kindern (5–14 Jahre) im Verhaltnis zu der Gesamtfallzahl vor den Lockdown-Masnahmen, einschlieslich der Schulschliesungen, mit dem Verhaltnis wahrend des zehnwochigen Lockdowns in Deutschland. Die absolute Anzahl der padiatrischen Falle wahrend des Lockdowns stellten wir der Anzahl der erwarteten Falle ohne Schulschliesungen gegenuber. Letzteres berechneten wir auf Basis der tatsachlichen wochentlichen Fallzahlen und dem Anteil der padiatrischen Falle vor dem Lockdown. Ergebnisse Im Vergleich zum Anteil der padiatrischen Falle vor dem Lockdown, verringerte sich dieser wahrend des Lockdowns am Nadir um 2,3 Prozentpunkte. Die geschatzte Anzahl der padiatrischen Falle, die durch Schulschliesungen verhindert wurden, lag bei 13 246. Dies entspricht 24% der erwarteten Falle bei einem Verzicht auf Schulschliesungen. Schlussfolgerung Schulschliesungen wahrend des Winterlockdowns reduzierten die Anzahl der SARS-CoV-2 Falle unter den Kindern. Im Vergleich mit der Gesamtinzidenz konnte nur eine kleine Anzahl der Falle verhindert werden. Die Daten konnen eine Grundlage fur ein Modell zur Ermittlung der Auswirkungen von Schulschliesungen, neben den herkommlichen Hygienemasnahmen (AHA-Regeln), auf den Verlauf der Pandemie darstellen.

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Open accessJournal ArticleDOI: 10.1007/S00103-021-03445-3
Abstract: Die Masnahmen zur Bekampfung der COVID-19-Pandemie haben die Entwicklungsmoglichkeiten von Kindern stark eingeschrankt. In dem Beitrag werden die Meldedaten von Kindern und die Aktivitaten des Gesundheitsamtes vor dem Hintergrund der Einschrankungen der Schul- und Freizeitangebote sowie der Sport- und Vereinssportangebote diskutiert. Meldedaten aus Frankfurt am Main wurden mittels einer SURVStat-Abfrage (KW 10/2020–KW 28/2021) und aus SURVNet (bis 30.06.2021) ermittelt. Kontaktpersonen (KP) von SARS-CoV-2- positiv gemeldeten Personen aus Schulen und Kitas wurden mittels PCR-Test auf SARS-CoV‑2 untersucht. Die Ergebnisse sowie die der seit April 2021 fur Schuler verpflichtenden Antigenschnelltests werden vorgestellt. Die altersbezogenen 7‑Tage-Inzidenzen der Kinder bis 14 Jahre lagen vor der Einfuhrung der Testpflicht fur Schuler stets unter der Gesamtinzidenz, danach daruber. Die meisten Kinder mit SARS-CoV‑2 hatten keine oder nur milde Symptome; eine Hospitalisierung war selten erforderlich, Todesfalle traten nicht auf. Bei den Untersuchungen der KP in Schulen und Kitas wurden meist keine und nur selten mehr als 2 positive KP gefunden. Grosere Ausbruche traten nicht auf. SARS-CoV-2-Infektionen bei Kindern sind offenbar seltener und deutlich weniger schwer als bei Erwachsenen. Grosere Ausbruche konnten im Setting Schule und Kita zuverlassig verhindert werden. Die AHA + L-Regeln und das Kontaktmanagement haben sich bewahrt – auch bei hohen Inzidenzen in der lokalen Bevolkerung ohne Schnelltestpflicht und selbst bei einem hohen Anteil von besorgniserregenden Virusvarianten (Alpha und Delta) in Deutschland. Eine weitere Einschrankung des Schul- und Kitabetriebs scheint deshalb weder erforderlich noch angemessen zu sein.

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49 results found


Open accessJournal ArticleDOI: 10.1542/PEDS.2020-0702
Yuanyuan Dong1, Xi Mo1, Yabin Hu1, Xin Qi  +5 moreInstitutions (3)
01 Mar 2020-Pediatrics
Abstract: OBJECTIVE: To identify the epidemiological characteristics and transmission patterns of pediatric patients with the 2019 novel coronavirus disease (COVID-19) in China. METHODS: Nationwide case series of 2135 pediatric patients with COVID-19 reported to the Chinese Center for Disease Control and Prevention from January 16, 2020, to February 8, 2020, were included. The epidemic curves were constructed by key dates of disease onset and case diagnosis. Onset-to-diagnosis curves were constructed by fitting a log-normal distribution to data on both onset and diagnosis dates. RESULTS: There were 728 (34.1%) laboratory-confirmed cases and 1407 (65.9%) suspected cases. The median age of all patients was 7 years (interquartile range: 2–13 years), and 1208 case patients (56.6%) were boys. More than 90% of all patients had asymptomatic, mild, or moderate cases. The median time from illness onset to diagnoses was 2 days (range: 0–42 days). There was a rapid increase of disease at the early stage of the epidemic, and then there was a gradual and steady decrease. The disease rapidly spread from Hubei province to surrounding provinces over time. More children were infected in Hubei province than any other province. CONCLUSIONS: Children of all ages appeared susceptible to COVID-19, and there was no significant sex difference. Although clinical manifestations of children’s COVID-19 cases were generally less severe than those of adult patients, young children, particularly infants, were vulnerable to infection. The distribution of children’s COVID-19 cases varied with time and space, and most of the cases were concentrated in Hubei province and surrounding areas. Furthermore, this study provides strong evidence of human-to-human transmission.

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2,284 Citations


Open accessJournal ArticleDOI: 10.1111/APA.15270
23 Mar 2020-Acta Paediatrica
Abstract: Aim: The coronavirus disease 2019 (COVID-19) pandemic has affected hundreds of thousands of people. Data on symptoms and prognosis in children are rare.Methods: A systematic literature review was c ...

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Topics: Systematic review (54%)

1,219 Citations


Open accessJournal ArticleDOI: 10.1056/NEJMOA2006100
Abstract: Background During the current worldwide pandemic, coronavirus disease 2019 (Covid-19) was first diagnosed in Iceland at the end of February. However, data are limited on how SARS-CoV-2, th...

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Topics: Population (53%), Mass screening (50%)

1,033 Citations


Open accessJournal ArticleDOI: 10.1016/S2352-4642(20)30095-X
Russell M Viner1, Simon Russell1, Helen Croker1, Jessica Packer1  +5 moreInstitutions (5)
Abstract: In response to the coronavirus disease 2019 (COVID-19) pandemic, 107 countries had implemented national school closures by March 18, 2020. It is unknown whether school measures are effective in coronavirus outbreaks (eg, due to severe acute respiratory syndrome [SARS], Middle East respiratory syndrome, or COVID-19). We undertook a systematic review by searching three electronic databases to identify what is known about the effectiveness of school closures and other school social distancing practices during coronavirus outbreaks. We included 16 of 616 identified articles. School closures were deployed rapidly across mainland China and Hong Kong for COVID-19. However, there are no data on the relative contribution of school closures to transmission control. Data from the SARS outbreak in mainland China, Hong Kong, and Singapore suggest that school closures did not contribute to the control of the epidemic. Modelling studies of SARS produced conflicting results. Recent modelling studies of COVID-19 predict that school closures alone would prevent only 2-4% of deaths, much less than other social distancing interventions. Policy makers need to be aware of the equivocal evidence when considering school closures for COVID-19, and that combinations of social distancing measures should be considered. Other less disruptive social distancing interventions in schools require further consideration if restrictive social distancing policies are implemented for long periods.

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1,011 Citations


Open accessJournal ArticleDOI: 10.15585/MMWR.MM6914E4
Abstract: As of April 2, 2020, the coronavirus disease 2019 (COVID-19) pandemic has resulted in >890,000 cases and >45,000 deaths worldwide, including 239,279 cases and 5,443 deaths in the United States (1,2). In the United States, 22% of the population is made up of infants, children, and adolescents aged <18 years (children) (3). Data from China suggest that pediatric COVID-19 cases might be less severe than cases in adults and that children might experience different symptoms than do adults (4,5); however, disease characteristics among pediatric patients in the United States have not been described. Data from 149,760 laboratory-confirmed COVID-19 cases in the United States occurring during February 12-April 2, 2020 were analyzed. Among 149,082 (99.6%) reported cases for which age was known, 2,572 (1.7%) were among children aged <18 years. Data were available for a small proportion of patients on many important variables, including symptoms (9.4%), underlying conditions (13%), and hospitalization status (33%). Among those with available information, 73% of pediatric patients had symptoms of fever, cough, or shortness of breath compared with 93% of adults aged 18-64 years during the same period; 5.7% of all pediatric patients, or 20% of those for whom hospitalization status was known, were hospitalized, lower than the percentages hospitalized among all adults aged 18-64 years (10%) or those with known hospitalization status (33%). Three deaths were reported among the pediatric cases included in this analysis. These data support previous findings that children with COVID-19 might not have reported fever or cough as often as do adults (4). Whereas most COVID-19 cases in children are not severe, serious COVID-19 illness resulting in hospitalization still occurs in this age group. Social distancing and everyday preventive behaviors remain important for all age groups as patients with less serious illness and those without symptoms likely play an important role in disease transmission (6,7).

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Topics: Population (54%)

943 Citations


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