SARS-CoV-2 variants of concern in children and adolescents with COVID-19: a systematic review

Abstract

Objectives Infections by SARS-CoV-2 variants of concern (VOCs) might affect children and adolescents differently than earlier viral lineages. We aimed to address five questions about SARS-CoV-2 VOC infections in children and adolescents: (1) symptoms and severity, (2) risk factors for severe disease, (3) the risk of infection, (4) the risk of transmission and (5) long-term consequences following a VOC infection.

Design Systematic review. Data sources The COVID-19 Open Access Project database was searched up to 1 March 2022 and PubMed was searched up to 9 May 2022.

Eligibility criteria We included observational studies about Alpha, Beta, Gamma, Delta and Omicron VOCs among ≤18-year-olds. We included studies in English, German, French, Greek, Italian, Spanish and Turkish.

Data extraction and synthesis Two reviewers extracted and verified the data and assessed the risk of bias. We descriptively synthesised the data and assessed the risks of bias at the outcome level.

Results We included 53 articles. Most children with any VOC infection presented with mild disease, with more severe disease being described with the Delta or the Gamma VOC. Diabetes and obesity were reported as risk factors for severe disease during the whole pandemic period. The risk of becoming infected with a SARS-CoV-2 VOC seemed to increase with age, while in daycare settings the risk of onward transmission of VOCs was higher for younger than older children or partially vaccinated adults. Long-term symptoms following an infection with a VOC were described in <5% of children and adolescents.

Conclusion Overall patterns of SARS-CoV-2 VOC infections in children and adolescents are similar to those of earlier lineages. Comparisons between different pandemic periods, countries and age groups should be improved with complete reporting of relevant contextual factors, including VOCs, vaccination status of study participants and the risk of exposure of the population to SARS-CoV-2.

Metadata

Authors/Creators:	Wiedenmann, M. https://orcid.org/0000-0002-2357-4133 Ipekci, A.M. Araujo-Chaveron, L. https://orcid.org/0000-0002-2110-6088 Prajapati, N. Lam, Y.T. https://orcid.org/0000-0002-2380-834X Alam, M.I. https://orcid.org/0000-0002-8759-6585 L'Huillier, A.G. Zhelyazkov, I. Heron, L. Low, N. https://orcid.org/0000-0003-4817-8986 Goutaki, M. https://orcid.org/0000-0001-8036-2092
Copyright, Publisher and Additional Information:	© 2023 Author(s) (or their employer(s)). Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made.
Keywords:	Infectious Diseases; Prevention; Pediatric; Emerging Infectious Diseases; Vaccine Related; Aetiology; Factors relating to the physical environment; Infection; Good Health and Well Being
Dates:	Accepted: 4 September 2023 Published (online): 9 October 2023 Published: October 2023
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health
Depositing User:	Symplectic Sheffield
Date Deposited:	16 Oct 2023 13:51
Last Modified:	16 Oct 2023 13:53
Status:	Published
Publisher:	BMJ
Refereed:	Yes
Identification Number:	https://doi.org/10.1136/bmjopen-2023-072280

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SARS-CoV-2 variants of concern in children and adolescents with COVID-19: a systematic review

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