• Antoni Soriano-Arandes, Anna Gatell, Pepe Serrano, Mireia Biosca, Ferran Campillo, Ramon Capdevila, Anna Fàbrega, Zulema Lobato, Núria López, Ana Mª Moreno, Miriam Poblet, Maria Teresa Riera-Bosch, Neus Rius, Montserrat Ruiz, Almudena Sánchez, Cinta Valldepérez, Mònica Vilà, Valentí Pineda, Uxue Lazcano, Yesika Díaz, Juliana Reyes-Urueña, Pere Soler-Palacín, and COVID-19 Pediatric Disease in Catalonia Research Group.
• Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Valld'Hebron, Barcelona, Spain.
• Clin. Infect. Dis. 2021 Sep 15; 73 (6): e1261-e1269.

BackgroundThe role of children in household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unclear. We describe the epidemiological and clinical characteristics of children with coronavirus disease 2019 (COVID-19) in Catalonia, Spain, and investigate the household transmission dynamics.MethodsA prospective, observational, multicenter study was performed during summer and school periods (1 July 2020-31 October 2020) to analyze epidemiological and clinical features and viral household transmission dynamics in COVID-19 patients aged <16 years. A pediatric index case was established when a child was the first individual infected. Secondary cases were defined when another household member tested positive for SARS-CoV-2 before the child. The secondary attack rate (SAR) was calculated, and logistic regression was used to assess associations between transmission risk factors and SARS-CoV-2 infection.ResultsThe study included 1040 COVID-19 patients. Almost half (47.2%) were asymptomatic, 10.8% had comorbidities, and 2.6% required hospitalization. No deaths were reported. Viral transmission was common among household members (62.3%). More than 70% (756/1040) of pediatric cases were secondary to an adult, whereas 7.7% (80/1040) were index cases. The SAR was significantly lower in households with COVID-19 pediatric index cases during the school period relative to summer (P = .02) and compared to adults (P = .006). No individual or environmental risk factors associated with the SAR.ConclusionsChildren are unlikely to cause household COVID-19 clusters or be major drivers of the pandemic, even if attending school. Interventions aimed at children are expected to have a small impact on reducing SARS-CoV-2 transmission.© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

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