Background: The symptoms of SARS-CoV‑2 infections in children are mostly mild; however, the symptoms are highly variable. There are only a few studies on non-hospitalized children. The clinical picture described in hospitalized children cannot be transferred to non-hospitalized children and the frequency of certain symptoms in children may thus be overestimated. Furthermore, most studies include a broad age group (up to 18 years). The symptoms of younger children have so far been described in less detail.
Objective: The paper aims to describe the frequency of COVID-19 symptoms in younger children (1-6 years old). Data of the two modules COALA (Corona: Anlassbezogene Untersuchungen in Kitas) and CATS (Corona-KiTa surveillance) of the Corona-KiTa study are evaluated and the results of the two studies are compared and discussed against the background of the different methodologies. In the COALA study, the type and frequency of symptoms of children infected with SARS-CoV‑2 are evaluated and compared to symptoms of children who tested negative for SARS-CoV‑2. Symptom frequencies of SARS-CoV‑2 infected children of the COALA study are compared with data collected from surveillance data (CATS).
Material and methods: The COALA study investigated 30 SARS-CoV‑2 outbreaks in day care centers where at least 1 SARS-CoV‑2 case was reported between October 2020 and June 2021. Using a prospective study design, day care children who were infected with SARS-CoV‑2 and their contact persons were studied over a period of 12 days (including regular SARS-CoV‑2 testing, retrospective interviews and daily symptom reporting). The results from the COALA study were compared with data from COVID-19 surveillance cases (CATS) for the same age group and time period. In Germany, SARS-CoV‑2 cases are reported to the local health authorities by physicians and laboratories. When reporting cases symptoms can be reported as well.
Results: From the COALA study, interview and reported symptom data were available for 289 children from the participating day care centers. Of 39 children with a SARS-CoV‑2 infection (wild-type, α‑variant), 64% had at least 1 symptom; of the children who tested negative for SARS-CoV‑2, 40% had at least 1 symptom. In both groups, rhinitis was the most common symptom (36% vs. 25%, n. s.). From the surveillance data (CATS), clinical information was available for 84,371 SARS-CoV‑2 positive children; fever was most common (27%) along with rhinitis (26%). Severe symptoms such as dyspnea were rarely reported in the outbreak investigations and in the surveillance data (3% and 1%, respectively).
Conclusion: Day care-aged children infected with SARS-CoV‑2 usually have mild or asymptomatic courses. Their symptoms are similar to those of children who tested negative for SARS-CoV‑2 from the same day care centers; thus, the observed COVID-19 symptoms are nonspecific. Combining data from the two modules is useful: findings from a very large database, as provided by the surveillance data, are complemented by findings from day care center outbreaks, where detailed prospective data on infected children can be compared with those of children who tested negative for SARS-CoV‑2.
Hintergrund: Die Symptomatik einer pädiatrischen SARS-CoV-2-Infektion ist sehr variabel. Es gibt nur wenige Studien zu nichthospitalisierten Kindern bzw. Kindern im Kita-Alter.
Ziel der Arbeit: Die Arbeit soll die Häufigkeit verschiedener COVID-19-Symptome bei ein- bis 6‑jährigen Kindern beschreiben. Sie führt dazu Daten aus 2 Modulen der Corona-KiTa-Studie zusammen: 1) das Modul „COALA“ – Corona: Anlassbezogene Untersuchungen in Kitas und 2) das Modul „CATS“ – Corona KiTa Surveillance (Meldedaten).
Material und Methoden: In COALA wurden die Infektionsgeschehen in 30 Kitas, in denen ein SARS-CoV-2-Fall gemeldet wurde, untersucht (Oktober 2020 bis Juni 2021). Kita-Kinder wurden prospektiv über 12 Tage beobachtet (SARS-CoV-2-Tests, Symptomtagebuch). Die Ergebnisse wurden mit den Symptomangaben der deutschlandweit gemeldeten SARS-CoV-2-Fälle (Meldedaten) verglichen.
Ergebnisse: Aus den teilnehmenden Kitas liegen für 289 Kinder Angaben vor. Von 39 Kindern mit SARS-CoV‑2 (Wildtyp, α‑Variante) hatten 64 % mindestens ein Symptom, von den nicht mit SARS-CoV‑2 infizierten Kindern 40 %. In beiden Gruppen war Schnupfen das häufigste Symptom (36 % vs. 25 %, n. s.). Aus den Meldedaten liegen für 84.371 Kinder klinische Informationen vor, Fieber war am häufigsten (27 %), neben Schnupfen (26 %). Schwere Beschwerden wie z. B. Atemnot wurden in den Ausbruchsuntersuchungen und in den Meldedaten nur selten angegeben (3 % bzw. 1 %).
Schlussfolgerung: Kinder im Kita-Alter haben meist milde bzw. asymptomatische Verläufe einer SARS-CoV-2-Infektion. Ihre Symptome ähneln denjenigen von nicht mit SARS-CoV‑2 infizierten Kindern aus denselben Kitas. Es erscheint sinnvoll, Erkenntnisse aus den Meldedaten durch Ausbruchsuntersuchungen zu ergänzen, um methodische Limitationen der einzelnen Vorgehensweisen auszugleichen.
Zusatzmaterial online: Die Online-Version dieses Beitrags (10.1007/s00112-022-01640-3) enthält eine weitere Tabelle, die Symptome bei symptomatischen SARS-CoV-2-Fällen von Kindern im Alter von einem bis 6 Jahren in der COALA-Stichprobe und in den Meldedaten gegenüberstellt.
Keywords: COVID-19; Corona-KiTa study; Outbreak invesitgations; Rhinitis; Surveillance data.
© The Author(s) 2022.