{"id":16676,"date":"2020-08-24T16:58:17","date_gmt":"2020-08-24T16:58:17","guid":{"rendered":"http:\/\/evaggelatos.com\/?p=16676"},"modified":"2020-08-24T16:59:53","modified_gmt":"2020-08-24T16:59:53","slug":"%cf%83%cf%85%ce%bd%ce%bf%ce%bb%ce%b9%ce%ba%ce%ae-%ce%b1%ce%bd%ce%b1%cf%86%ce%bf%cf%81%ce%ac-%ce%b5%cf%81%ce%b3%ce%b1%cf%83%ce%b9%cf%8e%ce%bd-%ce%bc%ce%b5-%cf%84%ce%b1-%cf%87%ce%b1%cf%81%ce%b1%ce%ba","status":"publish","type":"post","link":"https:\/\/evaggelatos.com\/?p=16676","title":{"rendered":"\u03a3\u03c5\u03bd\u03bf\u03bb\u03b9\u03ba\u03ae \u03b1\u03bd\u03b1\u03c6\u03bf\u03c1\u03ac \u03b5\u03c1\u03b3\u03b1\u03c3\u03b9\u03ce\u03bd \u03bc\u03b5 \u03c4\u03b1 \u03c7\u03b1\u03c1\u03b1\u03ba\u03c4\u03b7\u03c1\u03b9\u03c3\u03c4\u03b9\u03ba\u03ac \u03c4\u03b7\u03c2 \u03b5\u03c0\u03b9\u03b4\u03b7\u03bc\u03af\u03b1\u03c2 COVID\u201019 \u03c3\u03c4\u03b1 \u03c0\u03b1\u03b9\u03b4\u03b9\u03ac. \u0391\u03c0\u03cc \u03c4\u03bf \u03a0\u03b5\u03c1\u03b9\u03bf\u03b4\u03b9\u03ba\u03cc \u0399\u03b1\u03c4\u03c1\u03b9\u03ba\u03ae \u0399\u03bf\u03bb\u03bf\u03b3\u03af\u03b1 \u03c4\u03bf\u03c5 \u0391\u03c0\u03c1\u03af\u03bb\u03b7 15 2020"},"content":{"rendered":"<div class=\"fm-sec half_rhythm no_top_margin\">\n<div class=\"fm-citation half_rhythm no_top_margin clearfix\">\n<div class=\"inline_block eight_col va_top\">\n<div>\n<div><span class=\"cit\"><span role=\"menubar\"><a role=\"menuitem\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">J Med Virol<\/a><\/span>. 2020 Apr 15 : 10.1002\/jmv.25807. <\/span><\/div>\n<div><span class=\"doi\">doi:\u00a0<a href=\"https:\/\/dx.doi.org\/10.1002%2Fjmv.25807\" target=\"pmc_ext\" rel=\"noopener noreferrer\">10.1002\/jmv.25807<\/a><\/span> [Epub ahead of print]<\/div>\n<\/div>\n<\/div>\n<div class=\"inline_block four_col va_top show-overflow align_right\">\n<div class=\"fm-citation-ids\">\n<div class=\"fm-citation-pmcid\"><span class=\"fm-citation-ids-label\">PMCID: <\/span>PMC7228385<\/div>\n<div class=\"fm-citation-pmid\">PMID: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/32232980\">32232980<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n<h1 class=\"content-title\">COVID\u201019 epidemic: Disease characteristics in children<\/h1>\n<div class=\"half_rhythm\">\n<div class=\"contrib-group fm-author\"><a id=\"jmv25807-cr-0001\" class=\"affpopup\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=She%20J%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=32232980\">Jiatong She<\/a>,<sup> 1 <\/sup> <a id=\"jmv25807-cr-0002\" class=\"affpopup\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Liu%20L%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=32232980\">Lanqin Liu<\/a>,<sup> 2 ,<\/sup><sup> 3 <\/sup> and <a id=\"jmv25807-cr-0003\" class=\"affpopup\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Liu%20W%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=32232980\">Wenjun Liu<\/a><sup><img decoding=\"async\" src=\"https:\/\/www.ncbi.nlm.nih.gov\/corehtml\/pmc\/pmcgifs\/corrauth.gif\" alt=\"corresponding author\" \/><\/sup><sup> 1 ,<\/sup><sup> 2 ,<\/sup><sup> 3 <\/sup><\/div>\n<\/div>\n<div class=\"fm-panel half_rhythm\">\n<div class=\"togglers\"><a class=\"pmctoggle\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#\">Author information<\/a> <a class=\"pmctoggle\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#\">Article notes<\/a> <a class=\"pmctoggle\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#\">Copyright and License information<\/a> <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/about\/disclaimer\/\">Disclaimer<\/a><\/div>\n<\/div>\n<div id=\"pmclinksbox\" class=\"links-box whole_rhythm\">\n<div class=\"fm-panel\">\n<div>This article has been <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/citedby\/\">cited by<\/a> other articles in PMC.<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sec\"><\/div>\n<div id=\"idm140406744195728\" class=\"tsec sec\" lang=\"en\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><span role=\"menubar\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"menuitem\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/span><\/div>\n<h2 id=\"idm140406744195728title\" class=\"head no_bottom_margin ui-helper-clearfix\">Abstract<\/h2>\n<div>\n<p id=\"__p1\" class=\"p p-first-last\">In mid\u2010December 2019, a disease caused by infection with severe acute respiratory syndrome coronavirus\u20102, which began in Wuhan, China, has spread throughout the country and many countries around the world. The number of children with coronavirus disease\u20102019 (COVID\u201019) has also increased significantly. Although information regarding the epidemiology of COVID\u201019 in children has accumulated, relevant comprehensive reports are lacking. The present article reviews the epidemiological characteristics of COVID\u201019 in children.<\/p>\n<\/div>\n<div class=\"sec\"><strong class=\"kwd-title\">Keywords: <\/strong><span class=\"kwd-text\">children, COVID\u201019, epidemiological characteristics, SARS\u2010CoV\u20102<\/span><\/div>\n<\/div>\n<div id=\"jmv25807-sec-0010\" class=\"tsec sec\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/div>\n<h2 id=\"jmv25807-sec-0010title\" class=\"head no_bottom_margin ui-helper-clearfix\">1.\u2003INTRODUCTION<\/h2>\n<p id=\"__p3\" class=\"p p-first\">Since the middle of December 2019, a new type of coronavirus infection has been prevalent in Wuhan, China, and has rapidly spread to a large area.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0001\"> 1 <\/a> To date, the disease epidemic caused by this virus has rapidly spread to all parts of China and 197 countries abroad. Genome sequencing of the virus isolated from a patient&#8217;s lower respiratory tract on 10 January 2020 confirmed that this is a new type of coronavirus. Two days later, the World Health Organization (WHO) termed this pathogen \u201c2019 novel coronavirus (2019\u2010nCoV).\u201d On 20 January 2020, the National Health Commission of the People&#8217;s Republic of China (PRC) formally incorporated the disease caused by the virus, known as COVID\u201019, into the Class B infectious diseases stipulated in \u201cthe Law of the People&#8217;s Republic of China on the Prevention and Control of Infectious Diseases,\u201d and adopted measures for the prevention and control of class A infectious diseases.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0002\"> 2 <\/a> On 7 February 2020, the National Health Commission named the latest type of coronavirus\u2010infected pneumonia as \u201cnovel coronavirus pneumonia.\u201d On 11 February 2020, the Coronavirus Study Group of the International Commission on Virus Classification named the new coronavirus \u201cSevere Acute Respiratory Syndrome Coronavirus 2 (SARS\u2010CoV\u20102).\u201d On the same day, the WHO named the disease caused by the new coronavirus as coronavirus disease\u20102019 (COVID\u201019). After evaluation, on 12 March 2020, the WHO announced that COVID\u201019 had reached pandemic status.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0003\"> 3 <\/a><\/p>\n<p id=\"__p4\">Current investigations have determined that SARS\u2010CoV\u20102 belongs to a new type of coronavirus family, namely, genus \u03b2. Its genetic characteristics are distinctly different from those of severe acute respiratory syndrome coronavirus (SARS\u2010CoV) and Middle East respiratory syndrome coronavirus (MERS\u2010CoV). SARS\u2010CoV\u20102 is more than 85% homologous to bat SARS\u2010like CoV (bat\u2010SL\u2010CoVZC45). The Wuhan Institute of Virology (Wuhan, Hebei Province, China) also obtained evidence that SARS\u2010CoV\u20102 originated from bats and confirmed that SARS\u2010CoV\u20102, similar to SARS\u2010CoV, enters cells by binding to the angiotensin\u2010converting enzyme 2 (ACE\u20102) cell receptor.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0001\"> 1 <\/a> Subsequently, the South China Agricultural University (Guangdong, China) targeted pangolins as a potential intermediate host for SARS\u2010CoV\u20102. A study by Wong et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0004\"> 4 <\/a> reported that SARS\u2010CoV\u20102 and Malay pangolin recombinant coronavirus share 98% amino acid homology and 89% nucleotide homology for the same receptor binding motif fragment. Zhou et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0005\"> 5 <\/a> used cryo\u2010electron microscopy to analyze the full\u2010length structure of the SARS\u2010CoV\u20102 receptor, namely, ACE\u20102, for the first time, which will be helpful in developing inhibitors to block entry of the virus into cells. On 21 February 2020, Thi et al proposed that active SARS\u2010CoV\u20102 can be produced and transformed based on viral genetic structure, which is important in understanding and predicting development trends of the virus and the disease.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0006\"> 6 <\/a> On 3 March 2020, Tang et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0007\"> 7 <\/a> described the genome evolution of 103 new coronaviruses and found that SARS\u2010CoV\u20102 has evolved into two subtypes, L and S, and the virus strain has 149 mutation points more common in the early stages of the Wuhan outbreak; as such, it is speculated that it is more infectious and capable of spreading.<\/p>\n<p id=\"__p5\" class=\"p p-last\">COVID\u201019 was predominantly more prevalent among adults more than or equal to 15 years of age in the early stages of the outbreak, and the proportion of confirmed cases among children was relatively small. Since then, however, more regions have launched pathogen detection campaigns and, because younger children cannot wear masks and have not taken other special preventive and control measures, the number of child infection cases has increased significantly, especially in younger age groups and, therefore, should be given high attention.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0008\"> 8 <\/a> On 2 February 2020, the PRC issued a notice on \u201cdoing a good job in the prevention and control of pneumonia outbreaks in children and pregnant women with new coronavirus infection,\u201d which clearly states that children are susceptible to SARS\u2010CoV\u20102 due to the immaturity of their immune systems.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0001\"> 1 <\/a> The latest guidelines also make it clear that all individuals, including children, are generally susceptible to SARS\u2010CoV\u20102.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0009\"> 9 <\/a> Furthermore, children exhibit certain particularities and cannot clearly describe their own health status or contact history, which has contributed to the severe challenge of protecting, diagnosing, and treating this population.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0010\"> 10 <\/a> Due to the increasing global spread of SARS\u2010CoV\u20102, China is now facing the risk of transmission of imported cases, which poses new challenges for the prevention and control of the COVID\u201019 epidemic among Chinese children. At the same time, children with other (ie, comorbid) diseases (such as congenital heart, lung and airway diseases, malnutrition, and tumors, etc) are vulnerable to infection with SARS\u2010CoV\u20102; more specifically, \u201cprone to severe illness.\u201d<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0011\"> 11 <\/a> The present article reviews the epidemiological characteristics of COVID\u201019 in children.<\/p>\n<\/div>\n<div id=\"jmv25807-sec-0020\" class=\"tsec sec\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/div>\n<h2 id=\"jmv25807-sec-0020title\" class=\"head no_bottom_margin ui-helper-clearfix\">2.\u2003EPIDEMIC STATUS<\/h2>\n<p id=\"__p6\" class=\"p p-first-last\">As of 24:00, 26 March 2020, China&#8217;s 31 provinces (autonomous regions and municipalities) and the Xinjiang Production and Construction Corps had reported a total of 81\u2009340 confirmed cases, 3292 deaths, 74\u2009588 discharged patients, and 189 suspected cases of COVID\u201019. A total of 738 confirmed cases were also reported in Hong Kong (n\u2009=\u2009453), Macao (n\u2009=\u200933), and Taiwan (n\u2009=\u2009252). The cumulative number of confirmed cases in America ranks first outside of China, reaching 83\u2009507.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0012\"> 12 <\/a> After the nation&#8217;s concerted efforts to fight the spread of the virus, the epidemic situation in China was gradually brought under control. On 26 March 2020, there were only 55 new confirmed cases across China, 54 of which were imported, and one of which was from Zhejiang, China. Current case data in China reveal that children less than 18 years of age accounted for only 2.4% of all reported cases.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0011\"> 11 <\/a> As of 15 February 2020, incomplete statistics from China (excluding Hubei region) cumulatively reported 300 confirmed cases involving children<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0013\"> 13 <\/a> and, as of 26 February 2020, the total number of confirmed cases in Wuhan, China was 490.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0014\"> 14 <\/a> Two children with COVID\u201019 were diagnosed in Germany on 4 February 2020<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0001\"> 1 <\/a> and a 5\u2010year\u2010old child in the Philippines was also diagnosed.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0015\"> 15 <\/a> Canada reported the first confirmed case of COVID\u201019, who still carries the virus after rehabilitation and discharge, and is a possible communicator.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0016\"> 16 <\/a> Zou et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0017\"> 17 <\/a> analyzed the relationship between viral load and symptoms of infection in 18 patients with COVID\u201019, and found that the pattern of viral nucleic acid excretion in those with SARS\u2010CoV\u20102 infection was similar to that of influenza and that the viral load determined in asymptomatic patients was similar to that of those with symptoms, which indirectly suggested potential transmission capacity in asymptomatic or mild cases with COVID\u201019. Current studies have shown that the incubation period of SARS\u2010CoV\u20102 is 1 to 14 days, and most commonly 3 to 7 days.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0009\"> 9 <\/a> However, Guan et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0018\"> 18 <\/a> described a patient with an incubation period of up to 24 days. Subsequently, Bai et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0019\"> 19 <\/a> reported a patient with an incubation period of up to 19 days, who was also the first asymptomatic infection in China. Children, generally, have low immunity and some exhibit a long incubation period after SARS\u2010CoV\u20102 infection. Therefore, children should try to avoid contact with complex populations to avoid being infected by potential spreaders. COVID\u201019 is an acute, self\u2010limiting disease; nevertheless, patients can die, with a mortality rate of 2%,<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0020\"> 20 <\/a> and have also been reported in critically ill children.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0021\"> 21 <\/a> Compared with the current COVID\u201019 epidemic, during the outbreak of SARS\u2010CoV, the number of confirmed in children cases (4 months to 17 years of age) worldwide was less than 0.02% of the total number of cases (no deaths were confirmed in children), and children with severe cases accounted for \u223c7.9%, and the vast majority of these had a history of family exposure or adult contacts, while a few had a history of travel in affected areas and a history of exposure in the hospital. Of the 1621 confirmed cases of MERS\u2010CoV reported globally, children less than 19 years of age accounted for \u223c2.2%. Of the 14 pediatric cases (8 months to 16 years of age), nine (64%) were children infected after home exposure, but all were asymptomatic: five (36%) were in the hospital and at home, with a history of internal exposure were symptomatic infections, of whom two (14.3%) exhibited mild respiratory symptoms, three (21.4%) had pneumonia; and two (14.3%) children with underlying diseases complicated by severe respiratory distress died from it.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0022\"> 22 <\/a> Due to its rapid spread and the insufficient clinical analysis of children with SARS\u2010CoV\u20102 infection, we reference the epidemic characteristics of children in the SARS\u2010CoV and MERS\u2010CoV period to provide clues for effective prevention.<\/p>\n<\/div>\n<div id=\"jmv25807-sec-0030\" class=\"tsec sec\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/div>\n<h2 id=\"jmv25807-sec-0030title\" class=\"head no_bottom_margin ui-helper-clearfix\">3.\u2003EPIDEMIOLOGICAL CHARACTERISTICS<\/h2>\n<div id=\"jmv25807-sec-0040\" class=\"sec sec-first\">\n<h3 id=\"jmv25807-sec-0040title\">3.1. Patients with COVID\u201019 exhibit clustered infection characteristics<\/h3>\n<div id=\"jmv25807-sec-0050\" class=\"sec sec-first\">\n<p>&nbsp;<\/p>\n<h4 id=\"jmv25807-sec-0050title\" class=\"inline\">3.1.1. Children with COVID\u201019 exhibit characteristics of family\u2010aggregated infections and a longer incubation period than adults<\/h4>\n<p id=\"__p7\" class=\"p p-first-last\">As the outbreak spread, it was gradually confirmed that SARS\u2010CoV\u20102 could be transmitted from person to person in places such as homes or hospitals, and even from city to city, and country to country. Children are a very special group, largely due to close family contacts, and may be susceptible to cross\u2010infection. According to existing epidemiological data, 56% (34\/61) of children with COVID\u201019 demonstrated clear evidence of transmission through family gatherings.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0023\"> 23 <\/a> China&#8217;s first newborn COVID\u201019 patient was diagnosed at 17 days of age, first confirmed in the family nursing staff, followed by the parents, who were also diagnosed with COVID\u201019.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0024\"> 24 <\/a> A 5\u2010day\u2010old neonatal COVID\u201019 patient, whose mother was also confirmed to be infected with SARS\u2010CoV\u20102, and a newborn with suspected disease from cesarean delivery was confirmed to be infected with SARS\u2010CoV\u20102 36\u2009hours after birth, followed by his mother who was diagnosed with COVID\u201019 shortly after giving birth.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0025\"> 25 <\/a> On 26 January 2020, a 3\u2010month\u2010old baby and its parents in Hubei Province, China, were both confirmed to be infected with SARS\u2010CoV\u20102.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0026\"> 26 <\/a> On 19 January 2020, a hospital in Shanghai, China, admitted a 7\u2010year\u2010old boy diagnosed with SARS\u2010CoV\u20102 infection, whose father was diagnosed with COVID\u201019 earlier than the child.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0027\"> 27 <\/a> On 11 January 2020, a case of asymptomatic infection was found in a 10\u2010year\u2010old boy in Shenzhen, Guangdong, China, whose parents, grandparents, and grandparents all developed fever, diarrhea, cough, and other symptoms, and were diagnosed with COVID\u201019 earlier than the boy.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0028\"> 28 <\/a> According to the epidemic situation described by Anhui Provincial Health Commission on 28 and 29 January 2020, a family of six in Huangshan city, Anhui, China, was confirmed to have COVID\u201019, including an 8\u2010month\u2010old baby and a 10\u2010year\u2010old child.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0001\"> 1 <\/a> These cases were found in family clusters. Wei et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0008\"> 8 <\/a> performed a study on nine infant COVID\u201019 patients, revealing that they all had at least one family member who had been infected with SARS\u2010CoV\u20102 earlier, among which seven infants lived in Wuhan, China or had family members who had traveled to Wuhan. The parents of a 6\u2010month\u2010old baby in Singapore were infected with SARS\u2010CoV\u20102. After the parents were diagnosed, the baby was initially asymptomatic but was admitted to the hospital due to close contact. The baby was diagnosed with SARS\u2010CoV\u20102 the day after admission.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0029\"> 29 <\/a> The average incubation period for COVID\u201019 in children is \u223c6.5 days, which is longer than the 5.4 days reported in adults. The average number of secondary infections transmitted within the family was 2.43. The duration of nasal and pharyngeal detoxification in children is 6 to 21 days (average 12 days).<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0030\"> 30 <\/a> An epidemiological analysis of 31 children with COVID\u201019 in six provinces (autonomous region) of northern China found that 21 (68%) had contact with an adult with confirmed disease. One (3%), who had contact with asymptomatic Wuhan return Township staff (without nucleic acid testing), became ill after 5 days, and 28 of these 31 children (90%) were clustered in families.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0031\"> 31 <\/a><\/p>\n<\/div>\n<div id=\"jmv25807-sec-0060\" class=\"sec sec-last\">\n<p>&nbsp;<\/p>\n<h4 id=\"jmv25807-sec-0060title\" class=\"inline\">3.1.2. Patients with COVID\u201019 exhibit characteristics of exposure to infection in the foci<\/h4>\n<p id=\"__p8\" class=\"p p-first-last\">According to available epidemiological data, 43% of children with COVID\u201019 (26\/61) exhibited characteristics of infection from epidemic exposure.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0023\"> 23 <\/a> Wang et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0031\"> 31 <\/a> conducted an epidemiological analysis of 31 children with COVID\u201019 in six northern provinces of China (autonomous regions) and found that nine (29%) lived in Hubei Province, China, for a long time. China&#8217;s foremost critically ill child with COVID\u201019 was seen in several medical institutions at an early stage and may have been exposed to infection in this process, with a history of endemic exposure.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0021\"> 21 <\/a> Wang et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0032\"> 32 <\/a> analyzed 138 cases in Wuhan, China, and found that if a group of inpatients or medical personnel in the same ward were infected, the suggested source of infection was through the hospital\u2010related transmission. Other studies have reported that the spread of SARS\u2010CoV\u20102 from the township level also demonstrates obvious geographical aggregation (especially in Hubei, Beijing, Yangtze River Delta, Pearl River Delta, Hong Kong, \u201cDiamond Princess\u201d cruise ship, \u201cGrand Princess\u201d cruise ship, and other areas are more obvious).<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0033\"> 33 <\/a> Therefore, as a susceptible population, children should try to avoid exposure to epidemic sources to reduce the risks of infection.<\/p>\n<\/div>\n<\/div>\n<div id=\"jmv25807-sec-0070\" class=\"sec\">\n<h3 id=\"jmv25807-sec-0070title\">3.2. Age and sex distribution characteristics of COVID\u201019 patients<\/h3>\n<p id=\"__p9\" class=\"p p-first-last\">Patients with COVID\u201019 are distributed among all age groups. A study investigating 8866 cases of COVID\u201019 reported that the majority of patients were 36 to 65 years of age, with only 14 children less than 10 years of age diagnosed with the disease.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0033\"> 33 <\/a> In an investigation of 72\u2009314 cases, Wu et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0034\"> 34 <\/a> reported that children less than or equal to 9 and 10 to 19 years of age accounted for 1% of the total number cases, respectively. The youngest of the confirmed child cases to date was merely 30\u2009hours of age, and the oldest was 18 years.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0001\"> 1 <\/a> Studies have reported a higher incidence in men than in women (0.31\/100\u2009000 vs 0.27\/100\u2009000, respectively).<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0033\"> 33 <\/a> In a study involving nine children with COVID\u201019 less than 1 year of age, seven were girls<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0008\"> 8 <\/a>; however, it was not possible to determine whether girls or boys were more susceptible to SARS\u2010CoV\u20102 infection due to the small sample size. Recently, the Chinese Center For Disease Control And Prevention published a case analysis of more than 70\u2009000 cases of COVID\u201019 in which individuals 30 to 79 years of age accounted 89.8% of the total number of confirmed cases in Wuhan, 88.6% in Hubei Province, and 86.6% of all cases in China. Among them, the ratio of men to women in confirmed cases was 0.99:1 in Wuhan, China, 1.04:1 in Hubei province, and 1.06:1 in all of China.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0035\"> 35 <\/a> Nevertheless, there is still no direct evidence supporting whether I or women are more susceptible to SARS\u2010CoV\u20102 infection.<\/p>\n<\/div>\n<div id=\"jmv25807-sec-0080\" class=\"sec\">\n<h3 id=\"jmv25807-sec-0080title\">3.3. SARS\u2010CoV\u20102 is highly infectious<\/h3>\n<p id=\"__p10\" class=\"p p-first\">According to statistics from the WHO, 4 months after the outbreak of SARS\u2010CoV in 2003, more than 1000 cases accumulated worldwide; the MERS\u2010CoV outbreak in June 2012, as of 30 May 2015, had accumulated 1180 cases. The total number of confirmed cases of SARS\u2010CoV\u20102 infection in China reached 1297 in less than 25 days since the first notification from the Wuhan Municipal Health Commission.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0036\"> 36 <\/a>, <a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0037\"> 37 <\/a> However, there is no clear evidence that adults are a source of infection in children.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0023\"> 23 <\/a><\/p>\n<p id=\"__p11\">The basic regeneration number (<em>R<\/em>0 value) represents the number of second\u2010generation individuals that a patient can infect after entering a susceptible population under ideal conditions. The <em>R<\/em>0 value not only indicates the rate of transmission of the virus but also reflects the potential and severity of the outbreak of infectious diseases.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0038\"> 38 <\/a> Many research institutions have analyzed the <em>R<\/em>0 value of SARS\u2010CoV\u20102, among which Li et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0039\"> 39 <\/a> calculated the <em>R<\/em>0 value of SARS\u2010CoV\u20102 to be 2.2. Mahase reported that <em>R<\/em>0 fluctuated between 1.4 and 2.5.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0040\"> 40 <\/a> Using a sample size of 8866, Yang et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0033\"> 33 <\/a> calculated a SARS\u2010CoV\u20102 R0 up to 3.77 (95% confidence interval, 3.51\u20104.05). That study demonstrated that the longer the infection period, the higher and longer the reported rate, the higher <em>R<\/em>0.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0033\"> 33 <\/a> Based on these studies, it is clear that the estimated <em>R<\/em>0 values were all greater than 1, indicating that SARS\u2010CoV\u20102 is in an epidemic phase and has a strong transmission capacity. Research data from Chen et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0041\"> 41 <\/a> showed that the <em>R<\/em>0 value for SARS\u2010CoV was \u223c2 to 5 and less than 1 for MERS\u2010CoV.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0041\"> 41 <\/a> As such, the <em>R<\/em>0 values of SARS\u2010CoV\u20102 (1.4\u20105.5) and SARS\u2010CoV (2\u20105) are similar and significantly higher than that of MERS\u2010CoV.<\/p>\n<p id=\"__p12\">To measure the spread of the disease following the adoption of prevention and control measures, Yang et al studied the effective reproductive number (<em>Rt<\/em> value), which represents the average number of follow\u2010on cases of infection per infected person at time <em>t<\/em>. The <em>Rt<\/em> value after the human intervention will decrease slightly with effective prevention and control measures. The results of the study revealed that from 25 December 2019, the <em>Rt<\/em> value of SARS\u2010CoV\u20102 increased to greater than 1 around 3 January 2020, and peaked at 8 to 15 January, but fell again to less than 1 after 16 January 2020. However, the researchers believe that this did not necessarily indicate a decline in the transmission capacity of the virus, but may have been related to a delay in reporting epidemiological data.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0033\"> 33 <\/a> According to a study involving 1099 patients, Bai et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0019\"> 19 <\/a> reported that there was asymptomatic transmission of infected patients without excluding the existence of \u201csuper\u2010disseminators.\u201d<\/p>\n<p id=\"__p13\" class=\"p p-last\">The Korean government confirmed a \u201csuper\u2010spread incident\u201d on 20 February 2020, in which a surge of 53 cases in a single\u2010day was reported, of which 43 individuals from a church in Daegu were diagnosed.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0042\"> 42 <\/a> In response to this epidemic, a new virus was found in the clinical front line before it spread, which is of great importance to early detection of pathogens and the implementation of effective prevention and control measures. Success in containing the SARS\u2010CoV\u20102\u2010triggered epidemic was largely due to the country&#8217;s immediate measures at the beginning of the first spread of COVID\u201019, a very important \u201cgolden window\u201d for disease control. A second\u2010generation epidemic will be exponentially larger. Therefore, the application of modern diagnostic technology can more effectively grasp the \u201cgolden window\u201d period for infectious disease prevention and control.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0043\"> 43 <\/a><\/p>\n<\/div>\n<div id=\"jmv25807-sec-0090\" class=\"sec\">\n<h3 id=\"jmv25807-sec-0090title\">3.4. SARS\u2010CoV\u20102 infection is widespread<\/h3>\n<div id=\"jmv25807-sec-0100\" class=\"sec sec-first\">\n<p>&nbsp;<\/p>\n<h4 id=\"jmv25807-sec-0100title\" class=\"inline\">3.4.1. SARS\u2010CoV\u20102 can be transmitted by respiratory droplets, close contact, aerosols, and through the conjunctiva<\/h4>\n<p id=\"__p14\" class=\"p p-first-last\">According to the latest release from the National Health Commission, PRC, SARS\u2010CoV\u20102 is transmitted mainly through respiratory droplets and close contact(s). Spread is also possible through the conjunctiva, and the presence of SARS\u2010CoV\u20102 in relatively closed environments with prolonged exposure to high concentrations of aerosols may also facilitate transmission. More specifically, the air\u2010tightness of the environment and the density of viruses per unit volume can affect the spread of SARS\u2010CoV\u20102.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0009\"> 9 <\/a> Because SARS\u2010CoV\u20102 binds to the ACE2 receptor, the virus must first come in contact with cells that express the receptor. Human mucosal cells express ACE2 receptors, and the lips, eyelids, and nasal cavities, which are exposed to the air, have a large number of mucosal cells. SARS\u2010CoV\u20102 binds to ACE2 receptors in close contact and conjunctival transmission without proper cleaning, disinfection and direct contact with eye, mouth, and nose. Teams headed by Lu and Xia both have shown that infectious droplets and body fluids can contaminate the human conjunctival epithelium. The respiratory virus can cause ocular complications in infected patients, which in turn lead to respiratory tract infection; thus, exposure to SARS\u2010CoV\u20102 may cause acute respiratory tract infection.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0044\"> 44 <\/a>, <a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0045\"> 45 <\/a> Similarly, ACE2 receptors are present in human lung AT2 cells<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0046\"> 46 <\/a>; as such, an infection can be caused by exposure to respiratory droplets as well as aerosol transmission. To reduce the probability of SARS\u2010CoV\u20102 infection in children and avoid potential hospital transmission through aerosol the route, digestive endoscopy centers, fever clinics, and others have issued relevant emergency plans and management measures during the epidemic period.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0047\"> 47 <\/a>, <a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0048\"> 48 <\/a><\/p>\n<\/div>\n<div id=\"jmv25807-sec-0110\" class=\"sec\">\n<p>&nbsp;<\/p>\n<h4 id=\"jmv25807-sec-0110title\" class=\"inline\">3.4.2. SARS\u2010CoV\u20102 may be transmitted through the digestive tract<\/h4>\n<p id=\"__p15\" class=\"p p-first-last\">SARS\u2010CoV\u20102 must bind to ACE2 receptors to cause infection. Accordingly, Zhang et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0046\"> 46 <\/a> explored the infection pathway of SARS\u2010CoV\u20102 and the role of ACE2 in the digestive system after identifying the cell composition and proportion of expression of ACE2 in normal human lung and the gastrointestinal system through single\u2010cell transcription. They found that ACE2 was not only expressed in lung AT2 cells, but also in upper esophageal and stratified epithelial cells, as well as intestinal epithelial cells in the ileum and colon. Therefore, intestinal symptoms of SARS\u2010CoV\u20102 may be associated with invasion of intestinal epithelial cells expressing ACE2.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0046\"> 46 <\/a> In an earlier report from Wuhan, China, 2% to 10% of patients with COVID\u201019 experienced gastrointestinal symptoms such as diarrhea, abdominal pain, and vomiting. Patients with SARS\u2010CoV\u20102 infection who were transferred to the intensive care unit exhibited a higher frequency of abdominal pain than those with SARS\u2010CoV\u20102 infection who did not require intensive care, and 10% of patients with COVID\u201019 experienced diarrhea and nausea symptoms in the 1 to 2 days before the onset of fever and respiratory symptoms.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0049\"> 49 <\/a> A study from the USA reported detected SARS\u2010CoV\u20102 RNA in the feces of a patient.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0050\"> 50 <\/a> Given that both SARS\u2010CoV and MERS\u2010CoV can be excreted through feces and remain viable under conditions conducive to transmission, it is speculated that SARS\u2010CoV\u20102 may also be transmitted through this route. Guan et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0018\"> 18 <\/a> isolated SARS\u2010CoV\u20102 from the urine of a COVID\u201019 patient. This suggests that viral nucleic acids may persist in bodily fluids, secretions, and excreta of patients with COVID\u201019, and that the digestive tract is a potential route of transmission. Viral nucleic acids may also be detected in the cerebrospinal fluid, pleural effusions, and additional specimens from patients with COVID\u201019 in the future. A study by Cai et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0030\"> 30 <\/a> revealed that viral RNA from feces of children with COVID\u201019 was detected at a high rate, and the detoxification period can be as long as 2 to 4 weeks. Xu et al performed nucleic acid testing on anal swabs from 10 children with COVID\u201019 and found that the duration of positivity in anal swabs and intestinal detoxification was longer. The longest time for the nucleic acid test to change from positive to negative in anal swabs from 10 children was 51 days; the time for a throat swab nucleic acid test in these 10 children to change from positive to negative was generally 1 week. At the same time, this study demonstrated that anal swab testing in children may be more useful than nasopharyngeal swab testing in determining the effectiveness of treatment and determining the timing of quarantine termination.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0051\"> 51 <\/a> However, there was no direct evidence of fecal\u2010oral transmission because the study did not capture live viruses.<\/p>\n<\/div>\n<div id=\"jmv25807-sec-0120\" class=\"sec sec-last\">\n<p>&nbsp;<\/p>\n<h4 id=\"jmv25807-sec-0120title\" class=\"inline\">3.4.3. There is no direct evidence that SARS\u2010CoV\u20102 can be transmitted vertically from mother to child<\/h4>\n<p id=\"__p16\" class=\"p p-first\">Since the Wuhan Children&#8217;s Hospital diagnosed COVID\u201019 in an infant at 30\u2009hours of age on 5 February 2020, it has been argued that SARS\u2010CoV\u20102 may be transmitted vertically from the mother to the child.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0001\"> 1 <\/a> Based on the potential mechanism of vertical transmission to the fetus, potential susceptible cell subsets of SARS\u2010CoV\u20102 may not exist at the maternal\u2010fetal interface, and the results show that there is no evidence of vertical transmission of SARS\u2010CoV\u20102 to the fetus.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0052\"> 52 <\/a> Chen et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0053\"> 53 <\/a> tested for the presence of SARS\u2010CoV\u20102 in amniotic fluid, umbilical cord blood, and neonatal pharynx swab and breast milk samples at first lactation and detected no virus. All patients in the study were in the late stages of pregnancy; as such, evidence of intrauterine vertical transmission was insufficient. Nevertheless, the possibility of early or mid\u2010gestational vertical transmission could not be determined. In addition, the study did not collect vaginal mucosal samples or birth canal shedding samples; therefore, it was not possible to analyze whether SARS\u2010CoV\u20102 infection could be transmitted during vaginal delivery.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0053\"> 53 <\/a> It is also uncertain whether breastfeeding leads to vertical transmission from mother to child. There is no direct evidence of vertical mother\u2010to\u2010child transmission; however, newborns can be infected through close contact. Zhu et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0054\"> 54 <\/a> considered neonates to be at high risk for SARS\u2010CoV\u20102 infection if they met the following criteria: the mother experienced persistent fever before, during, or after childbirth, and routine laboratory investigations revealed a decrease in lymphocyte ratio; chest CT revealed lung infiltration, based on viral nucleic acid test results and epidemiological history suggesting that the mother is a confirmed\/highly suspected case (remove other viral and bacterial infections, mycoplasma infections, puerperal fever, breast swelling, mastitis, and other obstetric conditions); newborn whose mother has clinical manifestations or epidemiological history of infection, but not sufficiently suspicious to definitively diagnose; newborns with a history of infection epidemiology, including those from community sources and obstetric mother\u2010infant same\u2010room sources, family members or caregivers, and visitors who are diagnosed\/highly suspected with SARS\u2010CoV\u20102 infection; and, finally, newborns living in or visiting environments at high risk for SARS\u2010CoV\u20102 infection.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0054\"> 54 <\/a><\/p>\n<p id=\"__p17\" class=\"p p-last\">In summary, although there is no direct evidence that SARS\u2010CoV\u20102 can be transmitted vertically from mother to child, special attention should be devoted to the prevention of neonatal infection in pregnant women with confirmed COVID\u201019. \u201cThe Expert Recommendations for the Prevention and Control of the New\u2010type Coronary Virus Infections in Neonatrics 2019\u201d aim at strengthening preventive measures, effectively blocking the transmission of maternal, iatrogenic, and community\u2010derived SARS\u2010CoV\u20102 infections, comprehensively promoting effective control of the epidemic and safeguarding lives and health. Hospitals must devote attention to the health of all neonatal medical staff and actively administer training and, at the same time, perform hospital cleaning and disinfection to ensure that newborns admitted for separate treatment are not exposed to infection risk.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0001\"> 1 <\/a><\/p>\n<\/div>\n<\/div>\n<div id=\"jmv25807-sec-0130\" class=\"sec\">\n<h3 id=\"jmv25807-sec-0130title\">3.5. Changes in incidence during the timeline<\/h3>\n<p id=\"__p18\" class=\"p p-first-last\">Before 23 January 2020, the incidence of COVID\u201019 increased exponentially, which basically corresponded to the spring transportation period, and the growth of suspected cases was slightly lower than that of diagnosed cases for 2 to 3 days.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0033\"> 33 <\/a> According to incomplete statistics, as of 24:00\u2009hours on 31 January 2020, China reported a total of 74 confirmed cases involving children.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0023\"> 23 <\/a> As of 15 February 2020, incomplete statistics reported 300 cumulatively confirmed cases involving children nationally (excluding Hubei region).<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0013\"> 13 <\/a> Thirty days after the report of the first confirmed case of COVID\u201019, the epidemic spread to the entire country (the first confirmed imported COVID\u201019 patient in Guangdong province on 19 January 2020, was the first confirmed patient outside Hubei province<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0035\"> 35 <\/a>). The first epidemic peak occurred between 24 and 26 January 2020, and then gradually decreased from 1 February 2020.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0035\"> 35 <\/a> Shen et al<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0055\"> 55 <\/a> evaluated the role of the Wuhan \u201climit inflow and outflow\u201d strategy in controlling the epidemic through mathematical models. The study predicted that \u201climit inflow and outflow\u201d could reduce all cases of infection and by nearly 70%, assuming that all individuals wore a mask after \u201climit inflow and outflow\u201d and that masks could reduce the risk for infection by 90%. Limit inflow and outflow, the establishment of the Raytheon Mountain, Fire God Mountain, and Fang Cabin Hospitals, delayed resumption of work, suspension of classes,<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0056\"> 56 <\/a> and enhanced etiological detection in various places all affected changes in morbidity.<\/p>\n<\/div>\n<div id=\"jmv25807-sec-0140\" class=\"sec sec-last\">\n<h3 id=\"jmv25807-sec-0140title\">3.6. COVID\u201019 mortality rate<\/h3>\n<p id=\"__p19\" class=\"p p-first-last\">According to preliminary statistics, the mortality rate among COVID\u201019 patients is 2.38% in China, 4.05% in Wuhan (China), and 0.25% in other countries and regions outside China. Comparing available mortality data of SARS\u2010CoV\u20102 with that of SARS\u2010CoV (9.6% [774\/8098]) and MERS\u2010CoV (34% [858\/2494]), the mortality of patients with SARS\u2010CoV\u20102 nationwide was lower.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0057\"> 57 <\/a> A study analyzing the demographic and clinical characteristics of diagnostic cases using descriptive statistical medical records used the total number of confirmed deaths\/diagnosed cases to indicate crude mortality. At the same time, the density of mortality was calculated using the number of deaths in diagnosed cases\/cumulative number of days observed in diagnosed cases. In this study, which analyzed 44\u2009672 confirmed cases, a total of 1023 died, corresponding to a crude mortality rate of 2.3% and a mortality density of 0.015\/10 person days.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0035\"> 35 <\/a><\/p>\n<\/div>\n<\/div>\n<div id=\"jmv25807-sec-0150\" class=\"tsec sec\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/div>\n<h2 id=\"jmv25807-sec-0150title\" class=\"head no_bottom_margin ui-helper-clearfix\">4.\u2003CLINICAL CHARACTERISTICS<\/h2>\n<p id=\"__p20\" class=\"p p-first\">In children with COVID\u201019, fever and cough are the most common clinical manifestations, with some accompanied by fatigue, myalgia, nasal congestion, runny nose, sneezing, sore throat, headache, dizziness, vomiting, and abdominal pain. A few children do not exhibit fever, but only manifest cough or diarrhea, and even fewer can be asymptomatic carriers. Some children and newborns exhibit atypical symptoms, manifested as vomiting, diarrhea, and other gastrointestinal symptoms, or only asthma and shortness of breath.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0010\"> 10 <\/a>, <a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0058\"> 58 <\/a> The first severe case of childhood infection reported in Wuhan, China, started with gastrointestinal symptoms, exhibited no obvious early respiratory manifestations, but progressed rapidly to acute respiratory distress syndrome.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0021\"> 21 <\/a> According to clinical characteristics of existing pediatric cases, children with COVID\u201019 can be divided into five clinical types: asymptomatic infection, mild, common, severe, and critically severe.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0011\"> 11 <\/a> One published study reported that among 134 children diagnosed, 89 exhibited fever (high fever [n\u2009=\u200911], low and medium fever [n\u2009=\u200917], and unknown [n\u2009=\u200961]), and 28 exhibited no fever. Fever duration was mostly 1 to 2 days, and the longest was 8 days. Most routine blood examinations were normal, and C\u2010reactive protein levels were normal or transiently increased (three cases &gt;\u200920\u2009mg\/L [23, 27, and 47\u2009mg\/L, respectively]).<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0058\"> 58 <\/a> Of 54 patients with pulmonary imaging data, 38 (70.4%) exhibited ground\u2010glass opacities or exudates, infiltrative lesions; 4 (7.4%) exhibited enhanced lung texture; and 12 (22.2%) had no abnormalities. Five patients, who were negative at the time of throat swab virus nucleic acid testing, were children: two at 9 days after illness; and three at 12 days after illness. Two critically ill patients had a history of underlying disease, and one was after congenital heart disease 7 months with moderate malnutrition; the one other had bilateral hydronephrosis and left kidney stones. Of the 134 confirmed cases of disease in children, if chest imaging was used as the basis for the diagnosis of pneumonia, 36 patients exhibited the common type (26.9%, including seven cases, were subclinical); two cases were critically ill (1.5%); nine cases were completely asymptomatic with normal lung imaging and asymptomatic infection (6.7%); and 87 cases were mild (64.9%).<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0027\"> 27 <\/a> The data show that the prevalence of disease in children less than or equal to 18 years of age is relatively low, accounting for \u223c2.4% of all reported cases,<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0059\"> 59 <\/a> and clinical characteristics of adult cases (severe symptoms and long detoxification time). In comparison, most children diagnosed with the disease experience mild symptoms, faster recovery, shorter detoxification time, and good prognosis. Xu et al conducted nucleic acid tests on 745 children and 3174 adults with a history of close contact with COVID\u201019 patients or whose family members have confirmed COVID\u201019. They found that only 10 children tested positive, accounting for 1.3% of the total number of children, and 111 adults tested positive, accounting for 3.5%. Among these 10 children with COVID\u201019, body temperature, routine blood tests, and chest computed tomography tests showed that, compared with adults, children with COVID\u201019 were less ill and exhibited less obvious symptoms, and were not typical.<a class=\" ref\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#jmv25807-bib-0051\"> 51 <\/a> Although the incidence of critical illness in children is low, the current incidence is sufficient to alert pediatricians. In is important to identify children with COVID\u201019, especially those with underlying\/comorbid disease(s), and to treat them early.<\/p>\n<p id=\"__p21\" class=\"p p-last\">In summary, special attention should be devoted to children because they are a special group of patients. Through analysis of the epidemiological history of a small number of child cases of COVID\u201019, and a fuller grasp of the epidemiological characteristics of SARS\u2010CoV\u20102, it will be possible to provide more effective preventive measures and treatment policies, and lay a solid foundation for winning the battle against this epidemic.<\/p>\n<\/div>\n<div id=\"jmv25807-sec-0170\" class=\"tsec sec\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/div>\n<h2 id=\"jmv25807-sec-0170title\" class=\"head no_bottom_margin ui-helper-clearfix\">CONFLICT OF INTERESTS<\/h2>\n<p id=\"__p22\" class=\"p p-first-last\">The authors declare that there are no conflict of interests.<\/p>\n<\/div>\n<div id=\"jmv25807-sec-0160\" class=\"tsec sec\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/div>\n<h2 id=\"jmv25807-sec-0160title\" class=\"head no_bottom_margin ui-helper-clearfix\">ACKNOWLEDGMENTS<\/h2>\n<div class=\"sec\">\n<p id=\"__p23\">This study was supported by the Basic Research Project of Sichuan Province (NO.2019YJ0690) and the Major Science and Technology Projects in Sichuan Province (NO.2019YFS0531).<\/p>\n<\/div>\n<\/div>\n<div id=\"idm140406742389712\" class=\"tsec sec\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/div>\n<h2 id=\"idm140406742389712title\" class=\"head no_bottom_margin ui-helper-clearfix\">Notes<\/h2>\n<p id=\"__p2\"><span id=\"jmv25807-cit-0060\" class=\"mixed-citation\"> She J, Liu L, Liu W. <span class=\"ref-title\">COVID\u201019 epidemic: Disease characteristics in children<\/span>. <span class=\"ref-journal\">J Med Virol<\/span>. 2020;1\u20138. 10.1002\/jmv.25807 <span class=\"nowrap\">[<a class=\"int-reflink\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6842407\/\">PMC free article<\/a>]<\/span> [<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/31502247\" target=\"pmc_ext\" rel=\"noopener noreferrer\">PubMed<\/a>] [<a href=\"https:\/\/dx.doi.org\/10.1002%2Fjmv.25807\" target=\"pmc_ext\" rel=\"noopener noreferrer\">CrossRef<\/a>]<\/span><\/p>\n<\/div>\n<div id=\"jmv25807-bibl-0001\" class=\"tsec sec\">\n<div class=\"goto jig-ncbiinpagenav-goto-container\"><a class=\"tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading\" title=\"Go to other sections in this page\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7228385\/#\" aria-expanded=\"false\" aria-haspopup=\"true\">Go to:<\/a><\/div>\n<h2 id=\"jmv25807-bibl-0001title\" class=\"head no_bottom_margin ui-helper-clearfix\">REFERENCES<\/h2>\n<div id=\"reference-list\" class=\"ref-list-sec sec\">\n<div id=\"jmv25807-bib-0001\" class=\"ref-cit-blk half_rhythm\">1. <span id=\"jmv25807-cit-0001\" class=\"mixed-citation\"> Jiatong S, Wenjun L. <span class=\"ref-title\">Epidemiological characteristics and prevention and control measures of Corona Virus Disease 2019 in children<\/span>. <span class=\"ref-journal\">J Trop Med<\/span>. 2020;<span class=\"ref-vol\">20<\/span>(<span class=\"ref-iss\">2<\/span>):153\u2010156. <a href=\"http:\/\/kns.cnki.net\/kcms\/detail\/44.1503.R.20200217.1638.002.html\" target=\"_blank\" rel=\"noopener noreferrer\" 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Accessed February 29, 2020.<\/span><\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>J Med Virol. 2020 Apr 15 : 10.1002\/jmv.25807. doi:\u00a010.1002\/jmv.25807 [Epub ahead of print] PMCID: PMC7228385 PMID: 32232980 COVID\u201019 epidemic: Disease characteristics in children Jiatong She, 1 Lanqin Liu, 2 , 3 and Wenjun Liu 1 , 2 , 3 Author information Article notes Copyright and License information Disclaimer This article has been cited by other &hellip; <\/p>\n<p><a class=\"more-link btn\" href=\"https:\/\/evaggelatos.com\/?p=16676\">\u03a3\u03c5\u03bd\u03ad\u03c7\u03b5\u03b9\u03b1 \u03b1\u03bd\u03ac\u03b3\u03bd\u03c9\u03c3\u03b7\u03c2<\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-16676","post","type-post","status-publish","format-standard","hentry","category-uncategorized","item-wrap"],"_links":{"self":[{"href":"https:\/\/evaggelatos.com\/index.php?rest_route=\/wp\/v2\/posts\/16676","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/evaggelatos.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/evaggelatos.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/evaggelatos.com\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/evaggelatos.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=16676"}],"version-history":[{"count":3,"href":"https:\/\/evaggelatos.com\/index.php?rest_route=\/wp\/v2\/posts\/16676\/revisions"}],"predecessor-version":[{"id":16679,"href":"https:\/\/evaggelatos.com\/index.php?rest_route=\/wp\/v2\/posts\/16676\/revisions\/16679"}],"wp:attachment":[{"href":"https:\/\/evaggelatos.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=16676"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/evaggelatos.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=16676"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/evaggelatos.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=16676"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}