Although children were the least affected by Covid-19, a study found that 70.4 percent of the approximately 850,000 US households with the SARS-CoV-2 virus were infected by a child. Research published in JAMA Network Open found that young children are more likely to spread the virus. A team led by researchers at Boston Children’s Hospital gave smartphone-connected thermometers to 848,591 households with 1,391,095 members, who took 23,153,925 temperature readings from October 2019 to October 2022.
Fever was a proxy for infection. Of the 166,170 households with both adult and child participants (51.9 percent of multiple participant households), there were 516,159 participants, of whom 51.4 percent were children.
In these families, 38,787 transmissions occurred, of which 40.8 percent were child-to-child, 29.6 percent child-to-adult, 20.3 percent adult-to-child, and 9.3 percent adult-to-adult. The serial interval between index and secondary cases was two days.
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Of all household infections, 70.4 percent started with a child, with the proportion fluctuating weekly from 36.9 percent to 87.5 percent.
Children 8 years and younger were more likely to be the source of infection than 9- to 17-year-olds (7.6 percent vs. 5.8 percent). During most epidemics, the proportion of infections from children was negatively associated with new community Covid-19 cases.
“More than 70 percent of infections in adults and households with children had a pediatric index case, but this percentage fluctuated weekly,” the researchers said. “Once US schools reopen in the fall of 2020, children contribute more to estimated transmission within households when they are in school, and less during summer and winter vacation, a pattern consistent for 2 consecutive school years.”
The researchers said that pediatric Covid-19 infections during most epidemics were negatively associated with new community cases, consistent with previous studies.
“When the prevalence of Covid-19 increases, adults in the community are at greater risk of infection; this may increase the likelihood of adults becoming index cases in household infections and explains the negative association we observed,” the researchers said.
“Furthermore, when the incidence of Covid-19 is low, the overall use of non-pharmaceutical interventions may decrease, thereby increasing the prevalence of non-SARS-CoV-2 pathogens that may be more common in children.”
The team concluded that children had an important role in the spread of SARS-CoV-2 and that private schooling also resulted in substantial spread.
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