The evolving picture of SARS-CoV- 2 and COVID-19 in children

Overview

► The initial impression that paediatric infection is uncommon and generally mild has been replaced by a more nuanced understanding of infectious manifestations in children across countries and by income group, with recognition of a widening disease spectrum.

► Critical knowledge gaps remain that have significant public policy and programme implications.

► Insufficient age and race/ethnicity disaggregated data are hindering efforts to assess fully the prevalence of SARS-CoV-2 infection and COVID-19 in children and the role of children in transmission.

► Potential biologic differences in susceptibility to infection and transmissibility between children and adults need to be explored.

► Determination of mother-to-child SARS-CoV-2 transmission requires appropriate samples obtained with proper timing, lacking in most studies.

► Predictors of disease progression and morbidity and mortality in children need to be determined, particularly as the pandemic moves to low-income and middle-income countries.

► The full spectrum of SARS-CoV-2 infection in children remains to be defined, and surveillance for and investigation of the pathogenesis of postinfectious sequelae, such as multisystem inflammatory syndrome, are vital.