Association of Age and Pediatric Household Transmission of SARS-CoV-2 Infection
Open accessPublished version of a preprint
Abstract
Importance: As a result of low numbers of pediatric cases early in the COVID-19 pandemic, pediatric household transmission of SARS-CoV-2 remains an understudied topic. Objective: To determine whether there are differences in the odds of household transmission by younger children compared with older children. Design, Setting, and Participants: This population-based cohort study took place between June 1 and December 31, 2020, in Ontario, Canada. Private households in which the index case individual of laboratory-confirmed SARS-CoV-2 infection was younger than 18 years were included. Individuals were excluded if they resided in apartments missing suite information, in households with multiple index cases, or in households where the age of the index case individual was missing. Exposures: Age group of pediatric index cases categorized as 0 to 3, 4 to 8, 9 to 13, and 14 to 17 years. Main Outcomes and Measures: Household transmission, defined as households where at least 1 secondary case occurred 1 to 14 days after the pediatric index case. Results: A total of 6280 households had pediatric index cases, and 1717 households (27.3%) experienced secondary transmission. The mean (SD) age of pediatric index case individuals was 10.7 (5.1) years and 2863 (45.6%) were female individuals. Children aged 0 to 3 years had the highest odds of transmitting SARS-CoV-2 to household contacts compared with children aged 14 to 17 years (odds ratio, 1.43; 95% CI, 1.17-1.75). This association was similarly observed in sensitivity analyses defining secondary cases as 2 to 14 days or 4 to 14 days after the index case and stratified analyses by presence of symptoms, association with a school/childcare outbreak, or school/childcare reopening. Children aged 4 to 8 years and 9 to 13 years also had increased odds of transmission (aged 4-8 years: odds ratio, 1.40; 95% CI, 1.18-1.67; aged 9-13 years: odds ratio, 1.13; 95% CI, 0.97-1.32). Conclusions and Relevance: This study suggests that younger children may be more likely to transmit SARS-CoV-2 infection compared with older children, and the highest odds of transmission was observed for children aged 0 to 3 years. Differential infectivity of pediatric age groups has implications for infection prevention within households, as well as schools/childcare, to minimize risk of household secondary transmission. Additional population-based studies are required to establish the risk of transmission by younger pediatric index cases.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Indirect benefits of vaccination include the likelihood of reduced transmission in the home and school settings, including transmission affecting vulnerable persons, and safer in-person learning.
“Indirect benefits include the likelihood of reduced transmission in the home and in school settings, including transmission affecting vulnerable persons, and safer in-person learning.26-29”
From Evaluation of the BNT162b2 Covid-19 Vaccine in Children 5 to 11 Years of Age (2022) · cites this paper as [29]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Bi, Q., Wu, Y., Mei, S., Ye, C., Zou, X., Zhang, Z., Liu, X., Wei, L., Truelove, S., Zhang, T., et al. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30287-5 · Cited by 1,960 · see citing works
Transmission of SARS-COV-2 Infections in Households — Tennessee and Wisconsin, April–September 2020
Grijalva, C. G., Rolfes, M. A. R., Zhu, Y., McLean, H. Q., Hanson, K. E., Belongia, E. A., Halasa, N., Kim, A., Reed, C., Fry, A. M., et al. (2020) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6944e1 · Cited by 1,609 · see citing works
Changes in contact patterns shape the dynamics of the COVID-19 outbreak in China
Zhang, J., Litvinova, M., Liang, Y., Wang, Y., Wang, W., Zhao, S., Wu, Q., Merler, S., Viboud, C., Vespignani, A., et al. (2020) · Science · doi:10.1126/science.abb8001 · Cited by 1,107 · see citing works
Estimating infectiousness throughout SARS-CoV-2 infection course
Jones, T. C., Biele, G., Mühlemann, B., Veith, T., Schneider, J. A., Beheim-Schwarzbach, J., Bleicker, T., Tesch, J., Schmidt, M. L., Sander, L. E., et al. (2021) · Science · doi:10.1126/science.abi5273 · Cited by 716 · see citing works
Contact Tracing during Coronavirus Disease Outbreak, South Korea, 2020
Park, Y.-J., Choe, Y. J., Park, O., Park, S. Y., Kim, Y., Kim, J., Kweon, S., Woo, Y., Gwack, J., Kim, S. S., et al. (2020) · Emerging infectious diseases · doi:10.3201/eid2610.201315 · Cited by 499 · see citing works
Jing, Q.-L., Liu, M.-J., Zhang, Z.-B., Fang, L.-Q., Yuan, J., Zhang, A.-R., Dean, N. E., Luo, L., Ma, M.-M., Longini, I. M., et al. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30471-0 · Cited by 492 · see citing works
Wang, Y., Tian, H., Zhang, L., Zhang, M., Guo, D., Wu, W., Zhang, X., Kan, G. L., Jia, L., Huo, D., et al. (2020) · BMJ Global Health · doi:10.1136/bmjgh-2020-002794 · Cited by 487 · see citing works
Transmission heterogeneities, kinetics, and controllability of SARS-CoV-2
Sun, K., Wang, W., Gao, L., Wang, Y., Luo, K., Ren, L., Zhan, Z., Chen, X., Zhao, S., Huang, Y., et al. (2020) · Science · doi:10.1126/science.abe2424 · Cited by 404 · see citing works
On the Effect of Age on the Transmission of SARS-CoV-2 in Households, Schools, and the Community
Goldstein, E., Lipsitch, M., & Çevik, M. (2020) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiaa691 · Cited by 355 · see citing works
Yonker, L. M., Neilan, A. M., Bartsch, Y. C., Patel, A. B., Regan, J., Arya, P., Gootkind, E., Park, G. S. H., Hardcastle, M., John, A. S., et al. (2020) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2020.08.037 · Cited by 352 · see citing works
Transmission of COVID-19 in 282 clusters in Catalonia, Spain: a cohort study
Marks, M., Millat-Martínez, P., Ouchi, D., Roberts, C. H., Alemany, A., Corbacho‐Monné, M., Ubals, M., Tobı́as, A., Tebé, C., Ballana, E., et al. (2021) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30985-3 · Cited by 342 · see citing works
An analysis of SARS-CoV-2 viral load by patient agePreprint
Jones, T. C., Mühlemann, B., Veith, T., et al. (2020) · medRxiv · doi:10.1101/2020.06.08.20125484 · Cited by 330 · see citing works
Heald-Sargent, T. A., Muller, W. J., Zheng, X., et al. (2020) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2020.3651 · Cited by 330 · see citing works
COVID-19 in Children and the Dynamics of Infection in Families
Posfay-Barbe, K. M., Wagner, N., Gauthey, M., et al. (2020) · PEDIATRICS · doi:10.1542/peds.2020-1576 · Cited by 259 · see citing works
Children are unlikely to be the main drivers of the COVID‐19 pandemic – A systematic review
Ludvigsson, J. F. (2020) · Acta Paediatrica · doi:10.1111/apa.15371 · Cited by 244 · see citing works
Chang, T., Wu, J.-L., & Chang, L. (2020) · Journal of the Formosan Medical Association · doi:10.1016/j.jfma.2020.04.007 · Cited by 242 · see citing works
Li, F., Li, Y.-Y., Liu, M.-J., Fang, L.-Q., Dean, N. E., Wong, G., Yang, X.-B., Longini, I. M., Halloran, M. E., Wang, H.-J., et al. (2021) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30981-6 · Cited by 242 · see citing works
Zhu, Y., Bloxham, C. J., Hulme, K. D., Sinclair, J. E., Tong, Z. W. M., Steele, L. E., Noye, E. C., Lu, J., Xia, Y., Chew, K. Y., et al. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa1825 · Cited by 225 · see citing works
Thompson, H. A., Mousa, A., Dighe, A., Fu, H. J., Arnedo-Pena, A., Barrett, P., Bellido-Blasco, J. B., Bi, Q., Caputi, A., Chaw, L., et al. (2021) · Clinical Infectious Diseases · doi:10.1093/cid/ciab100 · Cited by 209 · see citing works
Koh, W. C., Naing, L., Chaw, L., Rosledzana, M. A., Alikhan, M. F., Jamaludin, S. A., Amin, F., Omar, A., Shazli, A., Griffith, M., et al. (2020) · PLoS ONE · doi:10.1371/journal.pone.0240205 · Cited by 207 · see citing works
Dattner, I., Goldberg, Y., Katriel, G., Yaari, R., Gal, N., Miron, Y., Ziv, A., Sheffer, R., Hamo, Y., & Huppert, A. (2021) · PLoS Computational Biology · doi:10.1371/journal.pcbi.1008559 · Cited by 182 · see citing works
Hu, S., Wang, W., Wang, Y., Litvinova, M., Luo, K., Ren, L., Sun, Q., Chen, X., Ge, Z., Li, J., et al. (2021) · Nature Communications · doi:10.1038/s41467-021-21710-6 · Cited by 166 · see citing works
Lee, L. Y. W., Rozmanowski, S., Pang, M., Charlett, A., Anderson, C. S., Hughes, G. J., Barnard, M., Peto, L., Vipond, R., Sienkiewicz, A., et al. (2021) · Clinical Infectious Diseases · doi:10.1093/cid/ciab421 · Cited by 141 · see citing works
Household Transmission of SARS-CoV-2, Zhuhai, China, 2020
Wu, J., Huang, Y., Tu, C., Bi, C., Chen, Z., Luo, L., Huang, M., Chen, M., Tan, C., Wang, Z., et al. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa557 · Cited by 129 · see citing works
Culture-Competent SARS-CoV-2 in Nasopharynx of Symptomatic Neonates, Children, and Adolescents
L’Huillier, A. G., Torriani, G., Pigny, F., Kaiser, L., & Eckerle, I. (2020) · Emerging infectious diseases · doi:10.3201/eid2610.202403 · Cited by 124 · see citing works
Soriano‐Arandes, A., Gatell, A., Marchuet, P. S., Biosca, M., Campillo, F., Capdevila, R., Fàbrega, A., Lobato, Z., Segura, N. L., Moreno, A. M., et al. (2021) · Clinical Infectious Diseases · doi:10.1093/cid/ciab228 · Cited by 99 · see citing works
On the effect of age on the transmission of SARS-CoV-2 in households, schools and the communityPreprint
Goldstein, E., Lipsitch, M., & Çevik, M. (2020) · medRxiv · doi:10.1101/2020.07.19.20157362 · Cited by 91 · see citing works
Transmission dynamics of SARS‐CoV‐2 within families with children in Greece: A study of 23 clusters
Maltezou, H. C., Vorou, R., Papadima, K., et al. (2020) · Journal of Medical Virology · doi:10.1002/jmv.26394 · Cited by 80 · see citing works
Association between SARS-CoV-2 Transmissibility, Viral Load, and Age in HouseholdsPreprint
Lyngse, F. P., Mølbak, K., Franck, K. T., et al. (2021) · medRxiv · doi:10.1101/2021.02.28.21252608 · Cited by 48 · see citing works
Infectivity of severe acute respiratory syndrome coronavirus 2 in children compared with adults
Bullard, J., Funk, D. J., Dust, K., Garnett, L., Tran, K. N., Bello, A., Strong, J. E., Lee, S. J., Waruk, J. L. M., Hedley, A., et al. (2021) · Canadian Medical Association Journal · doi:10.1503/cmaj.210263 · Cited by 44 · see citing works
Lyngse, F. P., Kirkeby, C. T., Halasa, T., et al. (2022) · Eurosurveillance · doi:10.2807/1560-7917.es.2022.27.6.2001800 · Cited by 39 · see citing works
Paul, L. A., Daneman, N., Brown, K. A., et al. (2021) · Clinical Infectious Diseases · doi:10.1093/cid/ciab186 · Cited by 35 · see citing works
Self-citationXin, H., Jiang, F., Xue, A., et al. (2020) · Transboundary and Emerging Diseases · doi:10.1111/tbed.13743 · Cited by 28 · see citing works
Hyde, Z. (2021) · Clinical Infectious Diseases · doi:10.1093/cid/ciab183 · Cited by 25 · see citing works
[The role of children in the transmission of SARS-CoV-2].
van der Hoek, W., Backer, J. A., Bodewes, R., et al. (2020) · PubMed · Cited by 23 · see citing works
Lewis, N. M., Duca, L. M., Marcenac, P., Dietrich, E. A., Gregory, C. J., Fields, V. L., Banks, M., Rispens, J. R., Hall, A. J., Harcourt, J. L., et al. (2020) · Emerging infectious diseases · doi:10.3201/eid2702.203517 · Cited by 22 · see citing works
De rol van kinderen in de transmissie van SARS-CoV-2.
van der Hoek, W., Backer, J., Bodewes, R., et al. (2020) · Rivm Repository (Netherlands National Institute for Public Health and the Environment) · Cited by 13 · see citing works
Hu, S., Wang, W., Wang, Y., et al. (2021) · Nature Communications · doi:10.1038/s41467-021-23108-w · Cited by 10 · see citing works
Report 38: SARS-CoV-2 setting-specific transmission rates: a systematic review and meta-analysis
Thompson, H., Mousa, A., Dighe, A., et al. (2020) · Spiral (Imperial College London) · doi:10.25561/84270 · Cited by 9 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Arnedo-Pena A, Sabater-Vidal S, Meseguer-Ferrer N, et al COVID-19 secondary attack rate and risk factors in household contacts in Castellon (Spain): preliminary report. Rev Enf Emerg. 2020;19(2):64-70.
- Lyngse FP, Kirkeby CT, Halasa T, et al COVID-19 transmission within Danish households: A nationwide study from lockdown to reopening. medRxiv. 2020. doi:10.1101/2020.09.09.20191239 · DOI
Cited by
Sorted by citations
Evaluation of the BNT162b2 Covid-19 Vaccine in Children 5 to 11 Years of Age
Walter, E. B., Talaat, K. R., Sabharwal, C., Gurtman, A., Lockhart, S., Paulsen, G. C., Barnett, E. D., Muñoz, F. M., Maldonado, Y., Pahud, B. A., et al. (2022) · New England Journal of Medicine · doi:10.1056/nejmoa2116298 · Cited by 593 · see citing works
- Authors
- Paul, L. A., Daneman, N., Schwartz, K. L., Science, M., Brown, K. A., Whelan, M., Chan, E., & Buchan, S. A.
- Affiliations
- Public Health Ontario (CA)
- Sunnybrook Health Science Centre (CA)
- University of Toronto (CA)
- Corresponding author
- Buchan, Sarah A.
- ORCID
- Venue
- JAMA Pediatrics
- Publisher
- American Medical Association (AMA)
- Published
- 2021-11-01
- Volume
- 175
- Issue
- 11
- Pages
- 1151
- ISSN
- 1072-4710 (ISSN-L)
- 2168-6203
- PMC
- PMC8369380
- OpenAlex
- W3194784134
- Cited by
- 140
- References
- 39
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 17 · 2023: 27 · 2022: 61 · 2021: 19
- FWCI
- 11.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- SARS-CoV-2, COVID-19 pandemic, household transmission, pediatric infection, child age, secondary transmission, household contacts, Ontario
- MeSH terms
- COVID-19, Adolescent, Age Factors, Child, Child, Preschool, Family Characteristics, Female, Humans, Infant, Male, Ontario, Age Distribution
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
