Simulated Identification of Silent COVID-19 Infections Among Children and Estimated Future Infection Rates With Vaccination

April 23, 2021

Seyed M. Moghadas, PhD1; Meagan C. Fitzpatrick, PhD2,3; Affan Shoukat, PhD3; Kevin Zhang, MD4; Alison P. Galvani, PhD3

JAMA Netw Open

Given that children can serve as significant sources of silent COVID-19 transmission (pre-symptomatic or asymptomatic) and that they can’t yet receive COVID-19 vaccines, Moghadas et al conducted a simulation to understand infection identification strategies needed among children to suppress future population outbreaks. Assuming 40% vaccine coverage among adults, an effective reproduction number of 1.2, and a population of similar demographics to that of the US, the authors analyzed the proportion of silent COVID-19 infections among children that would need to be identified and the speed at which it would be required to maintain an overall attack rate of less than 5%. Based on these parameters, identification of at least 11% of silent infections among children within two days of infection would be necessary to maintain a population attack rate ≤ 5%. A greater proportion of infections would need to be identified if done with a greater delay (14% within three days or 41% within four days) to reach the same target. If efforts are not implemented to identify silent infections among children, a 10.8% population attack rate (95% CI 10.5-11.2%) will result. In order to maintain a 5% overall attack rate and not detect any silent infections among children, at least 81% of children – in addition to the 40% of adults – would need to be vaccinated. Given that such high vaccination rates among children are unlikely to be reached soon, targeted interventions to identify silent infections among children are required to prevent future outbreaks.

Moghadas SM, Fitzpatrick MC, Shoukat A, Zhang K, Galvani AP. Simulated Identification of Silent COVID-19 Infections Among Children and Estimated Future Infection Rates With Vaccination. JAMA Netw Open 2021; 4: e217097.

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