A Study of the Infection and Transmission of SARS-CoV-2 in Paediatric Patients

Covid-19 disease, originated by SARS-Cov-2 Coronavirus, officially appeared in Italy in February 2020. Children and adolescents, in most cases, have an asymptomatic or paucisymptomatic clinical picture and are very rarely hospitalized. Precisely because of the modest symptoms presented, information on the natural history of Covid19 disease and its symptomatology is still limited.

Because almost all children with Covid19 are treated by community medicine, family pediatricians are the most suitable figures to collect the clinical history of these patients.

Information regarding the mode of infection and spread at both the intrafamily and school levels is also poor, and the role that the opening of schools may have on the spread of infection is not yet well established. However, scientific evidence supports the adverse effect of school closures on the physical and mental health of children and adolescents.

Analysis of school spread in a specific area can therefore contribute to increased knowledge about the role of schools, and such information may be useful in guiding health policy choices.

Study Overview

• Status: Recruiting
• Conditions: Covid19
• Intervention / Treatment: Other: Questionnaire

Detailed Description

Covid-19 disease, caused by the coronavirus Sars-Cov-2, officially appeared in Italy in February 2020. As of January 2020, the first pediatric cases had already been described, initially in China and then in other countries. Clinical studies suggest that children are susceptible at any age and can transmit the SARS-CoV-2 virus; for the most part pediatric studies analyzed hospitalized patients.

Mainly children and young people present asymptomatic or paucisymptomatic symptoms, and very rarely require hospitalization: the biological reasons for this different clinical picture compared to the adult population are not clear. Just because of the modest symptomatology presented in pediatric age, the natural history of Covid-19 disease and its clinical features in pediatric age are not well known and the disease may be underdiagnosed. Equally scarce is information about Covid-19 spread both within the family and in school communities. These data depend on the availability of tests for the identification of Sars-CoV-2 infection and on how population screenings are organized.

However, knowledge about clinical aspects and diffusion of Covid-19 within the family and at school are fundamental to orient health policy choices such as the opening of schools and of social, educational and sports spaces for children and young people. It is known that transmission of SARS-CoV-2 can occur in school settings, but there are still no definitive data on the impact that this transmission may have on the spread of the infection within the population, because school closures always coincide with closures of other activities and often with general restrictions on the movement of people. Several studies suggest that transmission of SARS-CoV-2 at school is not frequent. School contributes a modest number to the total number of cases and in many cases the infection is attributable to the school staff. Also, the presence of multiple cases in the same school may depend on a greater spread of the virus in the community.

Scientific evidence confirms adverse effect of school closures on the physical and mental health of children and young people, with a very high cost considering impact on learning and reduction of skills in the long term: any reduction in school hours has negative effects on students' cognitive abilities, on the probability of dropping out of school, on college enrollment, and on employment outcomes. In addition, distance learning has exacerbated inequality, because access to computers and the internet is much more complicated for lower class families. Moreover, in some contexts, school closure has generated increases in domestic violence and situations of toxic prolonged stress for children.

The network of community medicine, formed by family pediatricians, represents a unique resource to study Covid-19 natural history in children and spread of disease in their family and at school within a specific territory.

• Study Type: Observational
• Enrollment (Anticipated): 100

Contacts and Locations

• Study Contact: Name: Alessandra R. Brazzale, PhD; Phone Number: +39 049 827 4136; Email: alessandra.brazzale@unipd.it
• Study Contact Backup: Name: Emanuela Frascella, MD, PhD; Phone Number: +39 347 4194941; Email: ela.frascella@gmail.com

Study Locations

• Italy
  • RO
    • Rovigo, RO, Italy
      • Recruiting
      • AULSS 5 Polesana
      • Contact: Emanuela Frascella, PhD; Email: ela.frascella@gmail.com
      • Contact: Alessandra R Brazzale, PhD; Email: alessandra.brazzale@unipd.it

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 day to 16 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Pediatric patients enrolled by the family pediatricians participating in this study, affected by Covid-19 disease whose diagnosis was confirmed by SARS-Cov-2 molecular test

Description

Pediatric patients affected by Covid-19 disease whose diagnosis was confirmed by SARS-Cov-2 molecular test enrolled by the family pediatricians participating in this study from February 1 2020 to December 31 2021

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Children diagnosed with Covid-19; Pediatric patients enrolled by the family pediatricians participating in this study, affected by Covid-19 disease whose diagnosis was confirmed by SARS-Cov-2 molecular test	Other: Questionnaire; Family-based questionnaire

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Natural history	Description of the natural history of Covid19 in paediatric patients in terms of length, severity and symptoms	Feb. 1, 2020 - Dec. 31, 2021
Infection and spread	Description of the mode of infection and spread at both the intrafamily and school levels using suitable statistical models	Feb. 1, 2020 - Dec. 31, 2021

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
School opening	Study of the impact of school opening on the infection spread using suitable statistical models	Feb. 1, 2020 - Dec. 31, 2021
Monitoring	Development of a monitoring tool of the spread of infection at school level using GIS technology	Feb. 1, 2020 - Dec. 31, 2021

Collaborators and Investigators

• Sponsor: University of Padova
• Collaborators: Imperial College London; Azienda ULSS 5 Polesana

Publications and helpful links

General Publications

• Mehta NS, Mytton OT, Mullins EWS, Fowler TA, Falconer CL, Murphy OB, Langenberg C, Jayatunga WJP, Eddy DH, Nguyen-Van-Tam JS. SARS-CoV-2 (COVID-19): What Do We Know About Children? A Systematic Review. Clin Infect Dis. 2020 Dec 3;71(9):2469-2479. doi: 10.1093/cid/ciaa556.
• Posfay-Barbe KM, Wagner N, Gauthey M, Moussaoui D, Loevy N, Diana A, L'Huillier AG. COVID-19 in Children and the Dynamics of Infection in Families. Pediatrics. 2020 Aug;146(2):e20201576. doi: 10.1542/peds.2020-1576. Epub 2020 May 26. No abstract available.
• Dorigatti I, Lavezzo E, Manuto L, Ciavarella C, Pacenti M, Boldrin C, Cattai M, Saluzzo F, Franchin E, Del Vecchio C, Caldart F, Castelli G, Nicoletti M, Nieddu E, Salvadoretti E, Labella B, Fava L, Guglielmo S, Fascina M, Grazioli M, Alvisi G, Vanuzzo MC, Zupo T, Calandrin R, Lisi V, Rossi L, Castagliuolo I, Merigliano S, Unwin HJT, Plebani M, Padoan A, Brazzale AR, Toppo S, Ferguson NM, Donnelly CA, Crisanti A. SARS-CoV-2 antibody dynamics and transmission from community-wide serological testing in the Italian municipality of Vo'. Nat Commun. 2021 Jul 19;12(1):4383. doi: 10.1038/s41467-021-24622-7. Erratum In: Nat Commun. 2021 Aug 12;12(1):5020.
• European Centre for Disease Prevention and Control. TECHNICAL REPORT COVID-19 in children and the role of school settings in transmission - update 23 December 2020.

Study record dates

Study Major Dates

• Study Start (Actual): November 3, 2021
• Primary Completion (Anticipated): December 31, 2021
• Study Completion (Anticipated): June 30, 2022

Study Registration Dates

• First Submitted: November 24, 2021
• First Submitted That Met QC Criteria: November 24, 2021
• First Posted (Actual): November 30, 2021

Study Record Updates

• Last Update Posted (Actual): November 30, 2021
• Last Update Submitted That Met QC Criteria: November 24, 2021
• Last Verified: November 1, 2021

More Information

Terms related to this study

• Keywords: SARS-CoV-2; pediatric; Covid-19; children; clinical features; transmission
• Additional Relevant MeSH Terms: Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Pneumonia, Viral; Pneumonia; Lung Diseases; COVID-19
• Other Study ID Numbers: PLS COVID 19 - Prog. 3401CESC

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No