At the beginning of the coronavirus-2019 (COVID-19) pandemic, Italy was one of the most affected countries in Europe. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is less frequent and less severe in children than in adults. This study analyzed the frequency of SARS-CoV-2 infection among all children aged <18 years in the Apulia region of southern Italy and the characteristics of the infected children. Clinical and demographic data were collected through the national platform for COVID-19 surveillance. Of the 166 infected children in the Apulia region, 104 (62.6%) were asymptomatic, 37 (22.3%) had mild infections, 22 (13.3%) had moderate infections, and 3 (1.8%) had severe infections. Only ten children (6.0%) were hospitalized, but none required intensive care support and none died. SARS-CoV-2 infection was transmitted mainly from parents or relatives to children. Because of school closure during the lockdown, infection was unlikely to have been transmitted among children. It is unclear whether school reopening would enhance virus spread, leading the Italian government to develop guidelines for safe school reopening. The actual role of children in virus transmission remains unclear. A sensitive surveillance system, prompt identification of cases, testing, and contact tracing will be key to reducing the further spread of infection.
Keywords: COVID-19; SARS-CoV-2; children; epidemiology; health policy; household transmission; lockdown; school closure; southern Italy; surveillance.