key: cord-0955167-m9hh4ubg
authors: Lu, Liangjian; Koh, Chee Teck; Lim, Yi Herng; Sng, Andrew; Poon, Kok Siong; Tan, Shaun S Y; Kao, Pao Tang; Tee, Nancy; Yap, Hui Kim; Lee, Bee Wah; Tambyah, Paul A
title: Role of asymptomatic children in community SARS-CoV-2 transmission
date: 2021-03-17
journal: J Infect Dis
DOI: 10.1093/infdis/jiab138
sha: 561f740dfe5239f8aeb7dcdf7495f2a3dffbf6a0
doc_id: 955167
cord_uid: m9hh4ubg

nan

M a n u s c r i p t TO THE EDITOR-Goldstein and colleagues [1] recently reviewed the limited evidence suggesting that children are less susceptible to SARS-CoV-2, and have reduced infectivity upon being infected. As they point out, given that many infected children are asymptomatic or pauci-symptomatic, these data are sensitive to errors in index case ascertainment. This adds to the concern about the potential role of children in mediating undetected SARS-CoV-2 transmission [2] . We have utilized the comprehensive contact tracing system and low rates of community transmission outside worker dormitories in Singapore to investigate this further.

We hypothesized that there would be an excess of children with COVID-19 in households with no epidemiological links to other cases after comprehensive contact tracing, i.e., "unlinked households", compared to households with definite epidemiological links to other cases, i.e., "linked households". The prevalence of children with COVID-19 in linked households will reflect the household secondary attack rate [3] , while the prevalence of SARS-CoV-2 positive children in unlinked households will reflect the secondary attack rate plus cases in which children are an undetected index case, i.e., acting as a community reservoir of infection.

SARS-CoV-2 positive households with asymptomatic children aged between 28 days and 18 years were included, with asymptomatic children defined as those who had no symptoms within 2 weeks of index case diagnosis or had symptoms but were SARS-CoV-2 pharyngeal swab negative. They were recruited from the National University Hospital Infectious Diseases clinic, or from the Emergency Department which was a designated centre for the mandatory screening of household contacts of diagnosed COVID-19 cases. In Singapore, household contacts of diagnosed COVID- Mother, brother 

On the effect of age on the transmission of SARS-CoV-2 in households, schools and the community

COVID-19 in children: current evidence and key questions

Role of children in household transmission of COVID-19

Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore

Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections

Shorter incubation period is associated with severe disease progression in patients with COVID-19

Immune responses during COVID-19 infection

Profiling early humoral response to diagnose novel coronavirus disease (COVID-19)

Frequency of serological non-responders and false-negative RT-PCR results in SARS-CoV-2 testing: A populationbased study

COVID-19 and schools. Guidelines of the French Pediatric Society

The authors acknowledge Dr Si Min Chan for her help in patient recruitment, Dr Amanda Zain for her help in data collection, and Dr Yee Leong Teoh for his help in case classification.

A c c e p t e d M a n u s c r i p t