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The evolving picture of SARS-CoV-2 and COVID-19 in children: critical knowledge gaps
  1. Priscilla Idele1,
  2. David Anthony2,
  3. Danzhen You3,
  4. Chewe Luo4,
  5. Lynne Mofenson5
  1. 1Office of Research, UNICEF, New York, New York, USA
  2. 2Office of Research, UNICEF, Florence, Toscana, Italy
  3. 3Data & Analytics, UNICEF, New York, New York, USA
  4. 4HIV/AIDS Section, UNICEF, New York, New York, USA
  5. 5Research Programme, Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, District of Columbia, USA
  1. Correspondence to Dr Priscilla Idele; pidele{at}

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  • The initial impression that paediatric infection is uncommon and generally mild has been replaced by a more nuanced understanding of infectious manifestations in children across countries and by income group, with recognition of a widening disease spectrum.

  • Critical knowledge gaps remain that have significant public policy and programme implications.

  • Insufficient age and race/ethnicity disaggregated data are hindering efforts to assess fully the prevalence of SARS-CoV-2 infection and COVID-19 in children and the role of children in transmission.

  • Potential biologic differences in susceptibility to infection and transmissibility between children and adults need to be explored.

  • Determination of mother-to-child SARS-CoV-2 transmission requires appropriate samples obtained with proper timing, lacking in most studies.

  • Predictors of disease progression and morbidity and mortality in children need to be determined, particularly as the pandemic moves to low-income and middle-income countries.

  • The full spectrum of SARS-CoV-2 infection in children remains to be defined, and surveillance for and investigation of the pathogenesis of postinfectious sequelae, such as multisystem inflammatory syndrome, are vital.


In December 2019, a novel coronavirus, SARS-CoV-2, emerged in Wuhan City, China, causing a cluster of cases of severe pneumonia (COVID-19), and becoming a global pandemic. Individuals of all ages are susceptible to SARS-CoV-2, but older age and underlying comorbidities are known to be associated with increased risk of disease severity and mortality. However, despite the rapidly increasing amount of data on SARS-CoV-2 infection and COVID-19, data on how SARS-CoV-2 affects children and adolescents remain limited and conflicting, with an increased spectrum of disease manifestations emerging (eg, multisystem inflammatory syndrome). Critical research needs have emerged with important public policy implications.

Lack of data hinders a full epidemiologic assessment of COVID-19/SARS-CoV-2 infection in children

In initial data from China, children had significantly lower rates and severity of COVID-19 than adults; 2% of cases were aged 0–19 years, 0.9% <10 years, with no child deaths.1 Children continue to constitute a …

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