SARS-CoV-2 infection in children of healthcare workers

Secondary attack rate and family clustering of SARS-CoV-2 infection in children of healthcare workers with confirmed COVID-19

Authors: Mathuramat Seesen, Roberto G Lucchini, Somkiat Siriruttanapruk, Ratana Sapbamrer, Surat Hongsibsong, Susan Woskie, Pornpimol Kongtip

Abstract

We measured serum SARS-CoV-2 antibodies in 215 children of healthcare workers to estimate secondary attack rates (SAR). Twenty-one families had a parent with confirmed COVID-19. There was strong evidence of family clustering (P<0.001): 20/21 (95.2%) children were seropositive in 9 families and none of 23 children in 12 other families.

Introduction

Children are relatively protected against coronavirus disease 2019 (COVID-19) compared to adults. Exposure to SARS-CoV-2, the virus responsible for COVID-19, typically results in asymptomatic infection or a mild, transient illness that rarely requires hospitalisation and is rarely fatal in children. Systematic reviews of contact tracing studies estimate that children are 54% less likely to develop COVID-19 compared to adults, while household transmission studies suggest a 3-fold lower risk of COVID-19 in children than in adults. Such transmission studies, however, invariably utilised upper respiratory tract swabs to identify SARS-CoV-2 infection among contacts of confirmed cases, but this test relies on timing and technique of swabbing and is limited by the sensitivity of the RT-PCR assays for SARS-CoV-2, which at least in part explains the heterogeneity of estimated secondary attack rates (SAR) in contacts of index cases, which have ranged from 4.6-90%. Many studies also limited testing to symptomatic contacts only. In contrast, serological studies have reported higher rates of SARS-CoV-2 infection than estimated through swabing. and there is growing evidence that children are as likely as adults to be infected with SARS-CoV-2 and develop a robust antibody response.

In London, England, COVID-19 cases began to increase rapidly in early March and peaked in midApril before declining to low numbers by the end of May 2020. Healthcare workers were disproportionately affected, with high rates of COVID-19, especially among clinical staff with direct patient contact. We hypothesised that children of healthcare workers were more likely to be exposed to SARS-CoV-2 in a household setting, especially since most healthcare workers developed COVID-19 in March and England went into lockdown from 20 March until schools partially reopened on 01 June 2020, thus restricting opportunities for children to be exposed to SARS-CoV-2 outside the household.

The RAPID-19 study recruited children of healthcare workers in five UK cities from May 2020. The study had multiple objectives, including monitoring SARS-CoV-2 infection, symptoms, illness severity, hospitalisation and seroprevalence over 4-6 months. For this analysis, we used the London cohort to estimate SAR using SARS-CoV-2 seropositivity to confirm virus exposure in a subset of children of healthcare workers with laboratory-confirmed COVID-19.

This article is a trending article in the field of Occupational and Environmental Medicine. The abstract above was written by the author(s) below. This study was conducted by the author(s) below and published in the journal or book below.

Authors: Mathuramat Seesen, Roberto G Lucchini, Somkiat Siriruttanapruk, Ratana Sapbamrer, Surat Hongsibsong, Susan Woskie, Pornpimol Kongtip

Journal: Clinical Infectious Disease

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