Age-dependency of the Propagation Rate of Coronavirus Disease 2019 Inside School Bubble Groups in Catalonia, Spain.

BACKGROUND: We analyzed contagions of coronavirus disease 2019 inside school bubble groups in Catalonia, Spain, in the presence of strong nonpharmaceutical interventions from September to December 2020. More than 1 million students were organized in bubble groups and monitored and analyzed by the Health and the Educational departments. METHODS: We had access to 2 data sources, and both were employed for the analysis, one is the Catalan school surveillance system and the other of the educational department. As soon as a positive index case is detected by the health system, isolation is required for all members of the bubble group, in addition to a mandatory proactive systematic screening of each individual. All infected cases are reported. It permits the calculation of the average reproductive number (R*), corresponding to the average number of infected individuals per index case. RESULTS: We found that propagation inside of the bubble group was small. Among 75% index cases, there was no transmission to other members in the classroom, with an average R* across all ages inside the bubble of R* = 0.4. We found a significant age trend in the secondary attack rates, with the R* going from 0.2 in preschool to 0.6 in high school youth. CONCLUSIONS: The secondary attack rate depends on the school level and therefore on the age. Super-spreading events (outbreaks of 5 cases or more) in childhood were rare, only occurring in 2.5% of all infections triggered from a pediatric index case.

Household Severe Acute Respiratory Syndrome Coronavirus 2 Transmission and Children: A Network Prospective Study.

BACKGROUND: The role of children in household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unclear. We describe the epidemiological and clinical characteristics of children with coronavirus disease 2019 (COVID-19) in Catalonia, Spain, and investigate the household transmission dynamics. METHODS: A prospective, observational, multicenter study was performed during summer and school periods (1 July 2020-31 October 2020) to analyze epidemiological and clinical features and viral household transmission dynamics in COVID-19 patients aged <16 years. A pediatric index case was established when a child was the first individual infected. Secondary cases were defined when another household member tested positive for SARS-CoV-2 before the child. The secondary attack rate (SAR) was calculated, and logistic regression was used to assess associations between transmission risk factors and SARS-CoV-2 infection. RESULTS: The study included 1040 COVID-19 patients. Almost half (47.2%) were asymptomatic, 10.8% had comorbidities, and 2.6% required hospitalization. No deaths were reported. Viral transmission was common among household members (62.3%). More than 70% (756/1040) of pediatric cases were secondary to an adult, whereas 7.7% (80/1040) were index cases. The SAR was significantly lower in households with COVID-19 pediatric index cases during the school period relative to summer (P = .02) and compared to adults (P = .006). No individual or environmental risk factors associated with the SAR. CONCLUSIONS: Children are unlikely to cause household COVID-19 clusters or be major drivers of the pandemic, even if attending school. Interventions aimed at children are expected to have a small impact on reducing SARS-CoV-2 transmission.

Symptom-Based Predictive Model of COVID-19 Disease in Children.

BACKGROUND: Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is neither always accessible nor easy to perform in children. We aimed to propose a machine learning model to assess the need for a SARS-CoV-2 test in children (<16 years old), depending on their clinical symptoms. METHODS: Epidemiological and clinical data were obtained from the REDCap® registry. Overall, 4434 SARS-CoV-2 tests were performed in symptomatic children between 1 November 2020 and 31 March 2021, 784 were positive (17.68%). We pre-processed the data to be suitable for a machine learning (ML) algorithm, balancing the positive-negative rate and preparing subsets of data by age. We trained several models and chose those with the best performance for each subset. RESULTS: The use of ML demonstrated an AUROC of 0.65 to predict a COVID-19 diagnosis in children. The absence of high-grade fever was the major predictor of COVID-19 in younger children, whereas loss of taste or smell was the most determinant symptom in older children. CONCLUSIONS: Although the accuracy of the models was lower than expected, they can be used to provide a diagnosis when epidemiological data on the risk of exposure to COVID-19 is unknown.

Factores asociados a la hiperfrecuentación en pediatría de atención primaria / Factors associated with over-attendance in pediatric primary care

Fundamento. La hiperfrecuentación de una parte de lapoblación pediátrica es una realidad diaria en nuestrasconsultas. Existen trabajos que relacionan este “abuso” delos servicios sanitarios con diferentes factores y entre ellos,los posibles trastornos psicológicos maternos.Objetivo. Analizar los factores asociados a la hiperfrecuentaciónpediátrica en atención primaria (AP), y la relacióncon trastornos psicológicos maternos.Método. Estudio observacional retrospectivo de niñosque acudieron a consultas de AP, seleccionados por muestreoaleatorio sistemático. Se registró el número de consultasrealizadas el año previo, definiéndose 2 grupos: hiperfrecuentadores(≥ 7 visitas/año), normofrecuentadores(< 7 visitas/año). En un cuestionario cumplimentado por lospadres se recogen las variables individuales, socioeconómicasy geográficas y el cuestionario PRIME MD de Pfizer SApara la detección de trastornos del estado del ánimo ytrastornos de ansiedad. Análisis estadístico SPSS 8.0.Resultados. Se incluyeron 124 pacientes, 57 niños(46%), 67 niñas (54%), rango de edad de 1 a 14 años.Resultaron 60 hiperfrecuentadores (48.4%), 64 normofrecuentadores(51.6%). Un 15,8% de las madres presentabantrastorno del estado del ánimo, el 8.3% trastorno por ansiedady un 8.3% ambos; frente un 67.5% sin ningún trastorno.No se observa relación estadísticamente significativaentre hiperfrecuentación y las variables: sexo, ingresoshospitalarios, enfermedad crónica, lactancia materna, nivelde estudios de los padres, cuidador habitual, nº de hijos,distancia al Centro de AP, edad de los padres y psicopatologíamaterna. Se observa relación entre hiperfrecuentacióny nº de orden del hijo (hiperfrecuenta más elsegundo), edad menor del niño y en menores de 3 años,aquéllos que van a guardería (RR=6).Conclusiones. La psicopatología materna no parece serun factor que influya en la hiperfrecuentación. La edad inferiora los tres años, que coincide con la asistencia a guarderíay una mayor prevalencia de la patología respiratoria,justifican la hiperfecuentación. El segundo hijo, expuesto aun mayor contagio por parte del hermano, también se relacionacon sobreutilización de los servicios sanitarios

Background. Over-attendance to pediatric primary careby a small group of patients is a consistent feature amongdifferent primary care centers. Studies indicate that thisover-use of the health care system is related to several factors,including maternal psychological disturbances.Objective. To analyze the factors associated with overattendanceto pediatric primary care and its relationshipwith maternal psychological disturbances.Methods. Retrospective study of children who attendeda primary care center, selected by a systematic aleatorysampling. The number of consults made during theprevious year was recorded, and two groups were defined:over-attendants (≥ 7 visits/year) and average-attendants(< 7 visits/year). The parents filled a questionnaire that includedpersonal characteristics, and socio-economic andgeographic data, and the PRIME MD questionnaire (Pfizer)for the detection of emotional and anxiety disorders. Statisticalanalysis was performed using SPSS 8.0.Results. One-hundred twenty-four patients (54% girls)with ages ranging between 1 and 14 years were included.Sixty patients (48.4%) were considered over-attendants.Emotional disturbances were found in 15.8% of the mothers,anxiety disorders in 8.3%, and both in 8.3%. No statisticalrelationship was found between over-attendanceand the following variables: gender, hospital admissions,chronic illness, breast feeding, parental educational level,usual caretaker, number of children, distance to the primarycare center, parental age, and maternal behavioraldisturbances. We found a relationship between over-attendanceand the numerical order of the child (secondchildren tend to over-attend more), younger child ageand, for those children in day care, age younger than 3years (RR = 6).Conclusions. Maternal psychopathology does not influenceover-attendance in pediatric primary care. Over-attendanceis associated with children younger than 3 yearswho are in day care, with a higher prevalence of respiratoryillnesses, and with the second child