COVID-19 in Cuban children and adolescents. Third report. Epidemiological weeks 31-40, October 2020. Luisa Iñiguez Rojas. FLACSO-Cuba. University of Havana. Edgar Figueroa Fernández. CEPDE-ONEI. Laura Almora Andarcio. CIPS. CITMA. Angel Miguel Germán Almeida. IPK.Minsap. Antonio Herrada Hidalgo. FLACSO-Cuba. University of Havana. Lorenzo Somarriba López. Director. Centre for Health Surveillance. Ministerial Management Centre. Ministry of Health. CONTENTS 1.1. Evolution of the general characteristics of COVID-19 in children and adolescents from week 12 to 40 | 04 1.2. Provincial distribution of children and adolescents (aged 0-18 years) confirmed with COVID-19 | 06 1.3. Municipal distribution of children and adolescents (aged 0-18 years) confirmed with COVID-19 | 08 1.4. Distribution of children and adolescents (aged 0-18 years) confirmed with COVID-19 by human settlements | 12 1.5. Sources of transmission in children and adolescents | 15 Final considerations | 18 References | 19 After the epidemic reached a peak between weeks on the situation between weeks 31 and 40, and the 15 and 18, there was a decrease in the number of CO- comparison between both epidemic waves, while the VID-19 cases in the country, as they concentrated in a second one is still in progress. few municipalities, mostly from Havana and two from As seen in the two previous reports (June and July the neighboring province of Artemisa. This behavior 2020), this is a descriptive cross-cutting study that ex- is also reflected in the number of children and adoles- poses the characteristics of the spread of the epidemic cents infected with the coronavirus. according to individual specifications of sex and age of From week 301 onwards, the number of cases in- children and adolescents infected, and analyzes the creased, and up until week 40, the last week analyzed spatial spread according to political-administrative di- in this report, the country faced what could be con- vision levels of the country, variables of the Human sidered a second epidemic wave. Regardless of diffe- Settlement System, and especially the location of cases rent opinions about the actual occurrence of a second by residence or most likely place of infection. In the wave, which had been announced since April, the study period, no deaths have been reported in chil- event has been described in several countries, given dren and adolescents and up to week 40, about 90% the increase in the number of cases following their of confirmed patients have already been clinically dis- sustained decline. The second wave is usually associa- charged with strict follow-up by their health areas2. ted to the restart of daily activities, the reduction or The fundamental sources of the study come from elimination of containment measures and the conse- the database of the Ministry of Health’s Surveillance quent decrease in perception of risk or danger of con- Center, other databases on population and settlements tagion (Lockerd Maragakis, 2020) (Shunqing & Yuan- of the National Office of Statistics and Information yuan, 2020) (Horton, 2020). (ONEI), as well as mapping resources from GeoCuba This report provides an update on the behavior of Business Group. It is possible that some of the infor- COVID-19 in Cuban children and adolescents in 40 mation used may have been updated after the date of weeks of its evolution in the country, with emphasis this report, which could cause variations in some of the absolute numbers exposed. The relative frequen- 1 Hereafter, this report will use the term week and the corres- cies are unlikely to vary. ponding numbers to refer to the epidemiological weeks; time period which groups epidemiological events for surveillance actions and the analysis of the behaviour of diseases, especia- 2 The health area consists of a polyclinic and a number of family lly communicable ones. The epidemiological calendar is the in- doctor and nurse’s offices, according to the amount of the po- ternational standardization instrument for the time variable. pulation who receive attention. -3- LA COVID-19 EN NIÑOS Y ADOLESCENTES DE CUBA. TERCER REPORTE. SEMANAS EPIDEMIOLÓGICAS 31 A LA 40... Percentage of cases 1.1 Evolution of the general 0-18 years old characteristics of COVID-19 in 50 children and adolescents from 40 week 12 to 40 30 From week 30 onwards, there has been an increase in confirmed cases of COVID-19 in children and adoles- 20 cents, which has been regarded as a second epidemic 10 wave and officially described as a fresh outbreak of the 0 11 13 15 17 19 21 23 25 27 29 31 33 35 37 40 disease in the country (Figure 1). Epidemiological weeks Cases Figure 2. Cases detected in children and adolescents from 70 the total number of confirmed cases in the country per epidemiological week. 60 Source: Ministry of Health’s daily briefings. Department of Health Surveillance’s Database. 50 40 nance of one of them, with more noticeable differences 30 in favor of females in weeks 31 and 36. Thus, female 20 cases have increased from 50.74% to 53.5% between 10 the first and second epidemic wave, and its increase is 0 11 14 16 18 20 22 24 26 28 30 32 34 36 38 40 especially observed in weeks 33 and 36. The inciden- Epidemiological weeks ce rate between weeks 12 and 40 reached 29.05 per Figure 1. Cuba. COVID-19 in children and adolescents, 100,000 girls and female adolescents and 26.54 in boys weeks 12 to 40. and male adolescents, according to the rising waves in Source: Ministry of Health’s daily briefings. Department of Health Surveillance’s Database. both sexes, with more noticeable differences among females (Figures 3 and 4). Compared to the first epidemic wave, which lasted Cases 18 weeks, the second wave, with 10 weeks of evolu- 35 tion, accumulates 56% of the total number of cases, 30 showing greater intensity. The incidence rate be- 25 20 tween weeks 12 and 30 was 12.11 and rises from 31 15 to 40 to 15.64 per 100,000 children and adolescents. 10 The cumulative rate reaches 27.75 per 100,000 people 5 0 aged 0 to 18 years old. 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 The detection of cases in children and adoles- Epidemiological weeks cents registered in 40 weeks of evolution represents Female Male approximately 11%3 of the total. The figure drops to less Figure 3. Cases of COVID-19 in children and adolescents than 5% of the total in some weeks, while in week 27, by sex and epidemiological weeks. Source: Ministry of Health’s daily briefings. Department of it exceeds 40%. More than half of the 17 detected cases Health Surveillance’s Database. occurred in only one municipality of the province of Sex Havana (Figure 2). The differences by sex are not significant in the pe- Female riod under study, with 50.7% of females and 49.7% of Male males. In terms of epidemiological weeks, the number of cases by sex approaches or shows a slight pre-domi- 0 5 10 15 20 Tasa por 100 000 First Wave Second Wave 3 This is calculated by using a total of cases, without the impor- ted cases from the moment when all people arriving in the Figure 4. Incidence rates by sex and epidemic waves. country were isolated in centres created for that purpose or Source: Ministry of Health’s daily briefings. Department of health centres. Health Surveillance’s Database. -4- LA COVID-19 EN NIÑOS Y ADOLESCENTES DE CUBA. TERCER REPORTE. SEMANAS EPIDEMIOLÓGICAS 31 A LA 40... Cases By age group, the highest number of cases detected 30 in the 12 - 18 age group in the first wave remains with 42.86% of the total cases. In the second wave, there is 25 a slight decrease in those confirmed in the 6 - 11 and 20 12 – 18 age groups, and an increase in those aged 0 to 5 15 years (Figure 5). 10 Percentage of the total 5 50 0 40 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 30 Epidemiological weeks 20 10 0-5 years old 6-11 years old 12-18 years old 0 Figure 7. Distribution of cases by age groups and First wave Second wave epidemiological weeks. 0-5 years old 6-11 years old 12-18 years old Source: Ministry of Health’s daily briefings. Department of Health Surveillance’s Database. Figure 5. Cases by age groups in percentage of the total. Source: Ministry of Health’s daily briefings. Department of Health Surveillance’s Database. By age group, 61% of cases in the 12-18 age group are female and 55% of cases in the 6-11 age group are In accordance with the increase in transmission male. In the 0 to 5 age group the figures are similar among children and adolescents in the last weeks, for both sexes. Incidence rates by sex remain similar and considering a steady age structure, the incidence throughout the period, although it is observed that rate in all age groups rises and their values come clo- from close values in the first epidemic wave, there is ser, with the exception of the 0-5 age group that goes an increase in female cases in the 12-18 age group du- from approximately 9 to 15 per 100,000 people be- ring the second wave, without significant changes in tween those ages. The highest rate of the entire study the other groups. (Figures 8 and 9). period corresponds to the 12-18 age group with 31.87 Rate per 100,000 adolescents in this group.