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Epidemiology of COVID-19 Among Children in China

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Epidemiology of COVID-19 Among Children in China Epidemiology of COVID-19 Among Children in China Yuanyuan Dong, MD,a,b,p Xi Mo, PhD,a,p Yabin Hu, MD,a Xin Qi, PhD,c Fan Jiang, MD, PhD,a Zhongyi Jiang, MD,a,b Shilu Tong, MD, PhDa,d,e OBJECTIVE: To identify the epidemiological characteristics and transmission patterns of pediatric abstract 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. aShanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; bChild WHAT’S KNOWN ON THIS SUBJECT: A growing number Health Advocacy Institute, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China; of studies have focused on the 2019 novel coronavirus cSchools of Public Health and Medicine, Xian Jiaotong University, Xian, China; dInstitute of Environment and disease (COVID-19) since its outbreak, but few data are e Population Health, School of Public Health, Anhui Medical University, Hefei, China; and School of Public Health, available on epidemiological features and Nanjing Medical University, Nanjing, China transmission patterns in children with COVID-19. pContributed equally as co-first authors WHAT THIS STUDY ADDS: Children of all ages were Prof Tong conceptualized and designed the study, collected data, drafted the initial manuscript, susceptible to COVID-19, but no significant sex obtained the funding, and reviewed and revised the manuscript; Ms Dong and Dr Mo conducted the difference was found. Clinical manifestations of initial analyses, drafted the initial manuscript, and reviewed and revised the manuscript; Dr Qi, pediatric patients were generally less severe than Mr Hu, and Profs Jiang and Jiang critically reviewed the manuscript for important intellectual those of adult patients. However, young children, content; and all authors approved the final manuscript as submitted and agree to be particularly infants, were vulnerable to 2019 novel accountable for all aspects of the work. coronavirus infection. DOI: https://doi.org/10.1542/peds.2020-0702 Accepted for publication Mar 13, 2020 To cite: Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID-19 ’ Address correspondence to Shilu Tong, Shanghai Childrens Medical Center, Shanghai Jiao Tong Among Children in China. Pediatrics. 2020;145(6):e20200702 University School of Medicine, Shanghai 200127, China. E-mail: [email protected] Downloaded from www.aappublications.org/news by guest on April 11, 2020 PEDIATRICS Volume 145, number 6, June 2020:e20200702 ARTICLE In early December 2019, a number of epidemiological characteristics and of the possibility of contracting the pneumonia cases of unknown origin transmission patterns of 2135 disease. Suspected cases were emerged in Wuhan, Hubei province, pediatric patients with COVID-19 in identified if a child at high risk had China.1,2 Most of these patients mainland China. 2 of the following conditions: (1) fever, reported exposure to the Huanan respiratory, digestive symptoms (eg, Seafood Wholesale Market selling METHODS vomiting, nausea, and diarrhea), or many species of live animals. The fatigue; (2) laboratory test white blood disease rapidly spread, domestically, Data Sources cell count was normal, decreased, or to other parts of China, and globally We conducted a retrospective study had a lymphocyte count or increased to many countries across 6 on the epidemiological characteristics level of C-reactive protein; or (3) continents. On January 3, 2020, of 2135 pediatric patients with abnormal chest radiograph imaging a novel member of enveloped RNA fi result. For a child at medium or low fi COVID-19. Children were de ned as coronavirus was identi ed in samples , risk, similar diagnostic criteria were fl being 18 years old. of bronchoalveolar lavage uid from applied after excluding influenza The cases were initially diagnosed on a patient in Wuhan and subsequently and other common respiratory confirmed as the cause of this disease the basis of clinical manifestations infections. Suspected cases by the Chinese Center for Disease and exposure history.8,9 Within the that met any one of the following Control and Prevention (CDC).3–5 On last 2 weeks, if a child was exposed to criteria were defined as confirmed January 7, 2020, the World Health a COVID-19 case patient or lived in an cases: Organization (WHO) named it the epidemic area (ie, Hubei province), 2019 novel coronavirus (2019-nCoV). a community where a COVID-19 case 1. Nasal and pharyngeal swab On February 11, 2020, the WHO (or cases) was reported, or specimens or blood samples tested named the illness associated a nonepidemic area where no COVID- positive for 2019-nCoV nucleic with 2019-nCoV the 2019 19 case(s) was reported, she or he acid by using real-time reverse- novel coronavirus disease was defined as having high, medium, transcriptase polymerase chain (COVID-19). or low risk, respectively, on the basis reaction assay. Emergence of 2019-nCoV has attracted global attention, and the TABLE 1 Characteristics of Children’s COVID-19 Cases in China WHO has declared the COVID-19 Characteristics All Cases Category P a public health emergency of Confirmed Suspected international concern (PHEIC).6 Since Age, median (interquartile range) 7 (2–13) 10 (4–15) 6 (2–12) ,.001 the outbreak of severe acute Age group, n (%) respiratory syndrome in Guangdong, ,1 379 (17.6) 85 (11.7) 291 (20.7) ,.001 China, in 2003, the WHO has declared 1–5 491 (23.0) 137 (18.8) 354 (25.2) 5 PHEICs: H1N1 (2009), polio (2014), 6–10 522 (24.5) 170 (23.4) 352 (25.0) 11–15 412 (19.3) 180 (24.7) 232 (16.5) Ebola in West Africa (2014), Zika .15 334 (15.6) 156 (21.4) 178 (12.6) (2016), and Ebola in the Democratic Sex, n (%) Republic of the Congo (2019). Male 1208 (56.6) 418 (57.4) 790 (56.1) .575 Declaring a PHEIC is an urgent call, at Female 927 (43.4) 310 (42.6) 617 (43.9) the highest level, for the international Severity of illness, n (%) Asymptomatic 94 (4.4) 94 (12.9) 0 (0.0) — community to launch a global Mild 1088 (51.0) 314 (43.1) 774 (55.0) ,.001 coordinated effort to stop the Moderate 826 (38.7) 298 (40.9) 528 (37.5) outbreak, which requires a strong Severe 112 (5.2) 18 (2.5) 94 (6.7) public health response, high-level Critical 13 (0.6) 3 (0.4) 10 (0.7) political commitment, and sufficient Missing 2 (0.1) 1 (0.2) 1 (0.1) Days from symptom onset to diagnosis funding. As of March 2, 2020, a total Median (interquartile range) 2 (1–5) 3 (1–5) 2 (0–4) ,.001 of 80 174 COVID-19 cases in China Range 0–42 0–42 0–36 — and 8774 cases in 64 countries (and Province, n (%) regions) have been confirmed.7 Hubei 981 (46.0) 229 (31.5) 752 (53.4) ,.001 a Despite the worldwide spread, the Surrounding areas 396 (18.5) 154 (21.1) 242 (17.2) Other 758 (35.5) 345 (47.4) 413 (29.4) epidemiological and clinical patterns Total 2135 728 (34.1) 1407 (65.9) — of COVID-19 remain largely unclear, —, not applicable. particularly among children. In this a Surrounding areas are the provinces and municipality bordering Hubei; they are Anhui, Henan, Hunan, Jiangxi, Shaanxi, study, we explored the and Chongqing. Downloaded from www.aappublications.org/news by guest on April 11, 2020 2 DONG et al TABLE 2 Different Severity of Illness by Age Group Age Group, ya Asymptomatic, Mild, n (%) Moderate, n (%) Severe, n (%) Critical, n (%) Total, n n (%) ,1 7 (1.9) 204 (54.2) 125 (33.2) 33 (8.8) 7 (1.9) 376 1–5 15 (3.1) 245 (49.9) 195 (39.7) 34 (6.9) 2 (0.4) 491 6–10 30 (5.8) 277 (53.3) 191 (36.7) 22 (4.2) 0 (0.0) 520 11–15 27 (6.5) 198 (48.1) 170 (41.3) 14 (3.4) 3 (0.7) 412 .15 15 (4.5) 164 (49.1) 145 (43.4) 9 (2.7) 1 (0.3) 334 Total 94 (4.4) 1088 (51.0) 826 (38.7) 112 (5.3) 13 (0.6) 2133 See also Supplemental Table 3.
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