Factors Associated with Positive SARS-CoV-2 Test Results in Outpatient Health Facilities and Emergency Departments Among Children and Adolescents Aged <18 Years — Mississippi, September–November 2020

As of December 14, 2020, children and adolescents aged <18 years have accounted for 10.2% of coronavirus disease 2019 (COVID-19) cases reported in the United States.* Mitigation strategies to prevent infection with SARS-CoV-2, the virus that causes COVID-19, among persons of all ages, are important for pandemic control. Characterization of risk factors for SARS-CoV-2 infection among children and adolescents can inform efforts by parents, school and program administrators, and public health officials to reduce SARS-CoV-2 transmission. To assess school, community, and close contact exposures associated with pediatric COVID-19, a case-control study was conducted to compare exposures reported by parents or guardians of children and adolescents aged <18 years with SARS-CoV-2 infection confirmed by reverse transcription-polymerase chain reaction (RT-PCR) testing (case-patients) with exposures reported among those who received negative SARS-CoV-2 RT-PCR test results (control participants). Among 397 children and adolescents investigated, in-person school or child care attendance ≤14 days before the SARS-CoV-2 test was reported for 62% of case-patients and 68% of control participants and was not associated with a positive SARS-CoV-2 test result (adjusted odds ratio [aOR] = 0.8, 95% confidence interval [CI] = 0.5-1.3). Among 236 children aged ≥2 years who attended child care or school during the 2 weeks before SARS-CoV-2 testing, parents of 64% of case-patients and 76% of control participants reported that their child and all staff members wore masks inside the facility (aOR = 0.4, 95% CI = 0.2-0.8). In the 2 weeks preceding SARS-CoV-2 testing, case-patients were more likely to have had close contact with a person with known COVID-19 (aOR = 3.2, 95% CI = 2.0-5.0), have attended gatherings† with persons outside their household, including social functions (aOR = 2.4, 95% CI = 1.1-5.5) or activities with other children (aOR = 3.3, 95% CI = 1.3-8.4), or have had visitors in the home (aOR = 1.9, 95% CI = 1.2-2.9) than were control participants. Close contacts with persons with COVID-19 and gatherings contribute to SARS-CoV-2 infections in children and adolescents. Consistent use of masks, social distancing, isolation of infected persons, and quarantine of those who are exposed to the virus continue to be important to prevent COVID-19 spread.

• Factors that were not statistically significant included: • Any in-person school or child care attendance (when not all participants and staff masked) were identified and telephoned an average of 32 days after testing; 494 parents or guardians could not be contacted or refused, and five were excluded because the child had been hospitalized with COVID-19; 397 participants were included (154 case-patients and 243 control participants). • Close contact was defined as contact within 6 feet for ≥15 minutes with a person with known COVID-19. • A higher proportion of masking and social distancing was reported for children who attended gatherings, compared to having visitors in the home. • The authors describe four limitations: • The sample included 397 children and adolescents tested during September-November 2020 at health care facilities associated with one large academic medical center in Mississippi and might not be representative of children and adolescents in other geographic areas of the United States. Further, parents of eligible children who could not be contacted or refused to participate could be systematically different from those who were interviewed for this investigation. • Unmeasured confounding is possible, such that reported behaviours might represent factors, including concurrently participating in activities in which possible exposures could have taken place that were not included in the analysis or measured in the study. Most respondents were aware of their child's SARS-CoV-2 test results and interviews were conducted several weeks after testing, factors which could have influenced parent responses. • Parent report of frequency of mask or cloth face covering use at schools and child care programs was not verified. • Case or control status might be subject to misclassification because of imperfect sensitivity or specificity of PCR-based testing.
Review of "Factors associated with positive SARS-CoV-2 test results in outpatient health facilities and emergency departments among children and adolescents aged <18 years-Mississippi, September-November 2020" 2 PHO reviewer's comments • The generalizability of the finding should be viewed with caution as not all practices (e.g., masking in schools) will apply to all jurisdictions. • Compared with the setting for this study, other countries likely had different public health measures implemented over different time periods, as well as different levels of adherence by the public. • This study included those who sought testing, and may not be representative of all individuals who do not seek testing. • The small sample size may have limited the ability to detect significance for certain factors.

Citation
Ontario Agency for Health Protection and Promotion (Public Health Ontario). Review of "Factors associated with positive SARS-CoV-2 test results in outpatient health facilities and emergency departments among children and adolescents aged <18 years-Mississippi, September-November 2020". Toronto, ON: Queen's Printer for Ontario; 2020.

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Review of "Factors associated with positive SARS-CoV-2 test results in outpatient health facilities and emergency departments among children and adolescents aged <18 years-Mississippi, September-November 2020" 3