Meta-Analysis
Copyright ©The Author(s) 2021.
World J Methodol. Jan 20, 2021; 11(1): 1-14
Published online Jan 20, 2021. doi: 10.5662/wjm.v11.i1.1
Table 1 Salient features of the reviewed studies
Ref.
Country
Continent
Study design
Study period (2020)
Inclusion criteria
COVID-19 diagnosis confirmation in children
Age of COVID-19 infected children with index case
No. of COVID-19 infected children with index case
COVID-19 infected index case/s’
Parent
Not-parent1
Age
COVID-19 diagnosis Ascertainment
Symptoms around the time of contact with children
Death due to COVID-192
Götzinger et al[15], 202021 European nations except France3EuropeCase series1 Apr-24 Apr≤ 18 yr SARS-CoV-2 infected individualsRT-PCRMedian age 5·yr (IQR 5–12)32424 (sibling); 234 (immediate family member or unknown)UnclearHistoryUnclearUnclear
Kim et al[16], 2020South KoreaAsiaCross-sectional20 Jan- 6 Apr≤ 18 yr SARS-CoV-2 infected individualsRT-PCR15 yr01 (sibling)16 yrRT-PCRSymptomaticNo
01 [unknown (not parent or sibling)]UnclearUnclearUnclearUnclear
Luo et al[20], 2020ChinaAsiaCase reportNANART-PCRAverage 7 yr2039 yrRT-PCRSymptomatic No
Merza et al[21], 2020IraqAsiaCase series18 Mar-07 AprilHospitalized conformed COVID-19 casesRT-PCRAverage 11 yr3045 yrRT-PCRSymptomaticNo
Silva et al[22], 2020BrazilSouth AmericaDescriptive reportNANARapid testAverage 10.5 yr202 index cases: Male: 51 yr; female: 42 yrRT-PCRSymptomatic (both)No
Song et al[23], 2020ChinaAsiaDescriptive reportNANART-PCRAverage 3.94 yr50Parents (n = 3): Average age 40.33 yrRT-PCRSymptomaticNo
02 (grandparent)Grandparent (n = 1): 60 yrSymptomaticNo
Torres et al[24], 2020ChileSouth AmericaCross-sectionalNAAll school staff and randomly selected studentsRT-PCRUnclear07 (school staff)UnclearRT-PCRUnclearUnclear
Yang et al[25], 2020TaiwanAsiaDescriptive reportNANART-PCR11 yr01 (grandparent)85 yrRT-PCRSymptomaticYes
Yung et al[26], 2020SingaporeAsiaCase series5 Mar–30 AprPaediatric household contacts of confirmed COVID-19 casesRT-PCRUnclear742 (grandparent or another adult except parent)5UnclearRT-PCRUnclearUnclear
Zhang et al[27], 2020ChinaAsiaResearch letter28 Jan–15 MarSecondary COVID-19 casesRT-PCRAverage 3 yr20UnclearRT-PCROne case: Mild symptoms. Other case: Moderate symptomUnclear
Danis et al[17], 2020FranceAsiaDescriptive reportNANART-PCR9 yr01 (a visitor/tourist)UnclearRT-PCRYesNo
James et al[18], 2020United StatesNorth AmericaDescriptive reportNANART-PCR≤ 18 yr02 (a pastor and his wife)Two index cases aged 56 and 57 yrRT-PCRDuring contact: Initially asymptomatic, then symptomaticNo
Jung et al[19], 2020South KoreaAsiaResearch letterNANART-PCRAverage 5.5 yr10The mother: 40 yrRT-PCRDuring contact asymptomatic (symptomatic after RT-PCR diagnosis)No
01 (another patient who stayed in the same room)For 9 years old: UnclearUnclearUnclearUnclear
Table 2 Risk of bias assessment using National Heart, Lung, and Blood Institute's tool[12]
Study design: Case series
Ref.
1. Was the study question or objective clearly stated?
2. Was the study population clearly and fully described, including a case definition?
3. Were the cases consecutive?
4. Were the subjects comparable?
5. Was the intervention clearly described?
6. Were the outcome measures clearly defined, valid, reliable, and implemented consistently across all study participants?
7. Was the length of follow-up adequate?
8. Were the statistical methods well-described?
9. Were the results well-described?
Quality rating (Good, fair, or poor)
Götzinger et al[15], 2020YesYesCDYesNAYesNAYesYesFair
Merza et al[21], 2020YesYesCDYesNAYesNAYesYesFair
Yung et al[26], 2020YesYesYesYesNAYesNAYesYesFair
Study design: Cross-sectional study
Ref.1. Was the research question or objective in this paper clearly stated?2. Was the study population clearly specified and defined?3. Was the participation rate of eligible persons at least 50%?4. Were all the subjects selected or recruited from the same or similar populations (including the same time period)? Were inclusion and exclusion criteria for being in the study prespecified and applied uniformly to all participants?5. Was a sample size justification, power description, or variance and effect estimates provided?6. For the analyses in this paper, were the exposure(s) of interest measured prior to the outcome(s) being measured?7. Was the timeframe sufficient so that one could reasonably expect to see an association between exposure and outcome if it existed?8. For exposures that can vary in amount or level, did the study examine different levels of the exposure as related to the outcome (e.g., categories of exposure, or exposure measured as continuous variable)?9. Were the exposure measures (independent variables) clearly defined, valid, reliable, and implemented consistently across all study participants?10. Was the exposure(s) assessed more than once over time?11. Were the outcome measures (dependent variables) clearly defined, valid, reliable, and implemented consistently across all study participants?12. Were the outcome assessors blinded to the exposure status of participants?13. Was loss to follow-up after baseline 20% or less?14. Were key potential confounding variables measured and adjusted statistically for their impact on the relationship between exposure(s) and outcome(s)?Quality rating (Good, fair, or poor)
Kim et al[16], 2020YesYesNAYesNoNoNoNAYesNACDNANANoFair
Torres et al[24], 2020YesYesNAYesYesNoNoNAYesNACDNANANoFair
Table 3 Subgroup wise weighted prevalence of parent being the index case in coronavirus disease 2019 infected children
Prevalence of COVID-19 infected children with parents being the index case
SubgroupCategoryNumber of studiesNumber of COVID-19 positive childrenNumber of COVID-19 positive children with parent being the index caseWeighted prevalence of COVID-19 positive children with parent being the index case
95% prediction intervalHeterogeneity measures
%
95%CI
I2 (%)
Q (P value)
ContinentAsia8282075.00.45-0.970.1-1.031.80.17
Europe258332458.00.52-0.63Inestimable--
North America1200.00.00-0.84Inestimable--
South America29211.00.00- 0.47Inestimable--
Country21 European nations except France1158232456.00.52-0.60 Inestimable--
France1100.00.00-0.98 Inestimable--
Brazil122100.00.16-1.00Inestimable--
Chile1700.00.00-0.41Inestimable--
China311987.00.54-1.00Inestimable--
Iraq133100.00.29-1.00Inestimable--
Singapore19778.00.40-0.97Inestimable--
South Korea24118.00.00-0.77Inestimable--
Taiwan1100.00.00-0.98Inestimable--
United States1200.00.00-0.84 Inestimable--
COVID-19 diagnosis in childrenRT-PCR1262034450.00.24-0.76 0.0-1.063.40
Rapid Method122100.00.16-1.00 Inestimable--
COVID-19 diagnosis in the index caseRT-PCR10362160.00.20-0.940.0-1.069.00.00
History158232456.00.52-0.60Inestimable--
Unclear24118.00.00-0.77Inestimable--
COVID-19 index patient clinical presentationSymptomatic8201473.00.33-1.000.0-1.044.20.08
Unclear560233236.00.06-0.720.0-1.077.20.00
COVID-19 index patient mortalityDied1100.00.00-0.98Inestimable--
Not died6171274.00.29-1.000.0-1.048.50.08
Unclear660433444.00.13-0.780.0-1.074.10.00
OverallNA1362234654.00.29-0.790.0-1.062.30.00
Table 4 Subgroup wise weighted prevalence of parent not being the index case in coronavirus disease 2019 infected children
Prevalence of COVID-19 infected children with parents not being the index case
SubgroupCategoryNumber of studiesNumber of COVID-19 positive childrenNumber of COVID-19 positive children with parent not being the index caseWeighted prevalence of COVID-19 positive children with parent not being the index case
95% prediction intervalHeterogeneity measures
%
95% CI
I2 (%)
Q (P value)
ContinentAsia828825.00.03-0.550.0-0.931.80.17
Europe258325942.00.37-0.48Inestimable--
North America122100.00.16-1.00Inestimable--
South America29789.00.53-1.00Inestimable--
Country21 European nations except France1158225844.00.40-0.48 Inestimable--
France111100.00.03-1.00 Inestimable--
Brazil1200.00.00-0.84 Inestimable--
Chile177100.00.59-1.00 Inestimable--
China311213.00.00-0.46Inestimable--
Iraq1300.00.00-0.71Inestimable--
Singapore19222.00.03-0.60Inestimable--
South Korea24382.00.23-1.00 Inestimable--
Taiwan111100.00.03-1.00Inestimable--
United States122100.00.16-1.00Inestimable--
COVID-19 diagnosis in childrenRT-PCR1262027650.00.24-0.76 0..0-1.063.40.00
Rapid method1200.00.00-0.84Inestimable--
COVID-19 diagnosis in the index caseRT-PCR10361540.00.06-0.800.0-1.068.90.00
History158225844.00.40-0.48Inestimable--
Unclear24382.00.23-1.00Inestimable--
COVID-19 index patient clinical presentationSymptomatic820627.00.00-0.670.0-1.044.30.08
Unclear560227064.00.28-0.940.0-1.077.20.00
OverallNA1362227646.00.21-0.710.0-1.062.30.00