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Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents
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  1. Russell M Viner1,
  2. Joseph Lloyd Ward1,
  3. Lee D Hudson1,
  4. Melissa Ashe2,
  5. Sanjay Valabh Patel3,
  6. Dougal Hargreaves4,
  7. Elizabeth Whittaker5
  1. 1 Population, Policy & Practice Research Programme, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
  2. 2 Research & Policy, Royal College of Paediatrics and Child Health, London, UK
  3. 3 Paediatric Infectious Diseases and Immunology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  4. 4 School of Primary Care and Public Health, Imperial College London, London, UK
  5. 5 Paediatrics, Imperial College London Faculty of Medicine, London, UK
  1. Correspondence to Professor Russell M Viner, Population, Policy & Practice Research Programme, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London WC1N 1EH, UK; r.viner{at}ucl.ac.uk

Abstract

Objective To undertake a systematic review of reviews of the prevalence of symptoms and signs of COVID-19 in those aged under 20 years.

Design Narrative systematic review of reviews. PubMed, medRxiv, Europe PMC and COVID-19 Living Evidence Database were searched on 9 October 2020.

Setting All settings, including hospitalised and community settings.

Patients Children and young people (CYP) under age 20 years with laboratory-proven COVID-19.

Study review, data extraction and quality Potentially eligible articles were reviewed on title and abstract by one reviewer. Quality was assessed using the modified AMSTARS criteria and data were extracted from included studies by two reviewers.

Main outcome measures Prevalence of symptoms and signs of COVID-19.

Results 1325 studies were identified and 18 reviews were included. Eight were high quality, 7 medium and 3 low quality. All reviews were dominated by studies of hospitalised children. The proportion of asymptomatic CYP ranged from 14.6% to 42%. Fever and cough were the the most common symptoms; proportions with fever ranged from 46% to 64.2% and with cough from 32% to 55.9%. All other symptoms or signs including rhinorrhoea, sore throat, headache, fatigue/myalgia and gastrointestinal symptoms including diarrhoea and vomiting were infrequent, occurring in less than 10%–20%.

Conclusions Fever and cough are the most common symptoms in CYP with COVID-19, with other symptoms infrequent. Further research on symptoms in community samples are needed to inform pragmatic identification and testing programmes for CYP.

  • virology
  • epidemiology

Data availability statement

No data are available. All data are from open-access published papers.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/archdischild-2020-320972

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    Data availability statement

    No data are available. All data are from open-access published papers.

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    Footnotes

    • Twitter @_joe_ward, @melissaashe

    • Contributors RMV, EW, SVP and MA conceptualised the paper. RMV undertook the searching of databases and identification of potentially eligible articles. JLW and RMV agreed the inclusion of the final articles, assessed quality and extracted data. All authors contributed to editing of the final paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.