• Rebecca L Laws, Rebecca J Chancey, Elizabeth M Rabold, Victoria T Chu, Nathaniel M Lewis, Mark Fajans, Hannah E Reses, Lindsey M Duca, Patrick Dawson, Erin E Conners, Radhika Gharpure, Sherry Yin, Sean Buono, Mary Pomeroy, Anna R Yousaf, Daniel Owusu, Ashutosh Wadhwa, Eric Pevzner, Katherine A Battey, Henry Njuguna, Victoria L Fields, Phillip Salvatore, Michelle O'Hegarty, Jeni Vuong, Christopher J Gregory, Michelle Banks, Jared Rispens, Elizabeth Dietrich, Perrine Marcenac, Almea Matanock, Ian Pray, Ryan Westergaard, Trivikram Dasu, Sanjib Bhattacharyya, Ann Christiansen, Lindsey Page, Angela Dunn, Robyn Atkinson-Dunn, Kim Christensen, Tair Kiphibane, Sarah Willardson, Garrett Fox, Dongni Ye, Scott A Nabity, Alison Binder, Brandi D Freeman, Sandra Lester, Lisa Mills, Natalie Thornburg, Aron J Hall, Alicia M Fry, Jacqueline E Tate, Cuc H Tran, and Hannah L Kirking.
• COVID-19 Response Team, lxq2@cdc.gov.
• Pediatrics. 2021 Jan 1; 147 (1).

Background And ObjectivesLimited data exist on severe acute respiratory syndrome coronavirus 2 in children. We described infection rates and symptom profiles among pediatric household contacts of individuals with coronavirus disease 2019.MethodsWe enrolled individuals with coronavirus disease 2019 and their household contacts, assessed daily symptoms prospectively for 14 days, and obtained specimens for severe acute respiratory syndrome coronavirus 2 real-time reverse transcription polymerase chain reaction and serology testing. Among pediatric contacts (<18 years), we described transmission, assessed the risk factors for infection, and calculated symptom positive and negative predictive values. We compared secondary infection rates and symptoms between pediatric and adult contacts using generalized estimating equations.ResultsAmong 58 households, 188 contacts were enrolled (120 adults; 68 children). Secondary infection rates for adults (30%) and children (28%) were similar. Among households with potential for transmission from children, child-to-adult transmission may have occurred in 2 of 10 (20%), and child-to-child transmission may have occurred in 1 of 6 (17%). Pediatric case patients most commonly reported headache (79%), sore throat (68%), and rhinorrhea (68%); symptoms had low positive predictive values, except measured fever (100%; 95% confidence interval [CI]: 44% to 100%). Compared with symptomatic adults, children were less likely to report cough (odds ratio [OR]: 0.15; 95% CI: 0.04 to 0.57), loss of taste (OR: 0.21; 95% CI: 0.06 to 0.74), and loss of smell (OR: 0.29; 95% CI: 0.09 to 0.96) and more likely to report sore throat (OR: 3.4; 95% CI: 1.04 to 11.18).ConclusionsChildren and adults had similar secondary infection rates, but children generally had less frequent and severe symptoms. In two states early in the pandemic, we observed possible transmission from children in approximately one-fifth of households with potential to observe such transmission patterns.Copyright © 2021 by the American Academy of Pediatrics.

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