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Objective: To investigate SARS-COV-2 viral clearance and viral load kinetics in the course of infection in children aged 1-6 years in comparison with adults., Methods: Prospective cohort study of infected daycare children and staff and their close contacts in households from 11/2020 to 06/2021. Adult participants took upper respiratory tract specimen from themselves and/or their children, for PCR tests on SARS-CoV-2. Data on symptoms and exposure were used to determine the date of probable infection for each participant. We determined (a) viral clearance, and (b) viral load dynamics over time. Samples were taken from day 4-6 to day 16-18 after diagnosis of the index case in the respective daycare group (5 samples per participant)., Results: We included 40 children (1-6 years) and 67 adults (18-77 years) with SARS-CoV-2 infection. Samples were available at a mean of 4.3 points of time per participant. Among the participants, the 12-day study period fell in different periods within the individual course of infection, ranging from day 5-17 to day 15-26 after assumed infection.Children reached viral clearance at a median of 20 days after assumed infection (95% CI 17-21 days, Kaplan-Meier Analysis), adults at 23 days (95% CI 20-25 days, difference not significant). In both children and adults, viral load decreased over time with trajectories of the mean viral load not being statistically different between groups. Kaplan-Meier calculations show that from day 15 (95% CI 13-15), 50% of all participants had a viral load <1 million copies/ml, i.e. were no longer infectious or negative., Conclusion: Children aged 1-6 and adults infected with SARS-CoV-2 (wild type and Alpha variant) did not differ significantly in terms of viral load kinetics and time needed to clear the virus. Therefore, containment measures are important also in the daycare settings as long as the pandemic continues., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Sandoni, Schaffrath Rosario, Michel, Kuttig, Wurm, Damerow, Iwanowski, Finkel, Schrick, Buchholz, Haas, Varnaccia, Kubisch, Jordan, Schienkiewitz, Nitsche and Loss.)

In daycare centres, the close contact of children with other children and employees favours the transmission of infections. The majority of children <6 years attend daycare programmes in Germany, but the role of daycare centres in the SARS-CoV-2 pandemic is unclear. We investigated the transmission risk in daycare centres and the spread of SARS-CoV-2 to associated households. 30 daycare groups with at least one recent laboratory-confirmed SARS-CoV-2 case were enrolled in the study (10/2020-06/2021). Close contact persons within daycare and households were examined over a 12-day period (repeated SARS-CoV-2 PCR tests, genetic sequencing of viruses, symptom diary). Households were interviewed to gain comprehensive information on each outbreak. We determined primary cases for all daycare groups. The number of secondary cases varied considerably between daycare groups. The pooled secondary attack rate (SAR) across all 30 daycare centres was 9.6%. The SAR tended to be higher when the Alpha variant was detected (15.9% vs. 5.1% with evidence of wild type). The household SAR was 53.3%. Exposed daycare children were less likely to get infected with SARS-CoV-2 than employees (7.7% vs. 15.5%). Containment measures in daycare programmes are critical to reduce SARS-CoV-2 transmission, especially to avoid spread to associated households.

Background: The symptoms of SARS-CoV‑2 infections in children are mostly mild; however, the symptoms are highly variable. There are only a few studies on non-hospitalized children. The clinical picture described in hospitalized children cannot be transferred to non-hospitalized children and the frequency of certain symptoms in children may thus be overestimated. Furthermore, most studies include a broad age group (up to 18 years). The symptoms of younger children have so far been described in less detail., Objective: The paper aims to describe the frequency of COVID-19 symptoms in younger children (1-6 years old). Data of the two modules COALA ( Corona: Anlassbezogene Untersuchungen in Kitas ) and CATS (Corona-KiTa surveillance) of the Corona-KiTa study are evaluated and the results of the two studies are compared and discussed against the background of the different methodologies. In the COALA study, the type and frequency of symptoms of children infected with SARS-CoV‑2 are evaluated and compared to symptoms of children who tested negative for SARS-CoV‑2. Symptom frequencies of SARS-CoV‑2 infected children of the COALA study are compared with data collected from surveillance data (CATS)., Material and Methods: The COALA study investigated 30 SARS-CoV‑2 outbreaks in day care centers where at least 1 SARS-CoV‑2 case was reported between October 2020 and June 2021. Using a prospective study design, day care children who were infected with SARS-CoV‑2 and their contact persons were studied over a period of 12 days (including regular SARS-CoV‑2 testing, retrospective interviews and daily symptom reporting). The results from the COALA study were compared with data from COVID-19 surveillance cases (CATS) for the same age group and time period. In Germany, SARS-CoV‑2 cases are reported to the local health authorities by physicians and laboratories. When reporting cases symptoms can be reported as well., Results: From the COALA study, interview and reported symptom data were available for 289 children from the participating day care centers. Of 39 children with a SARS-CoV‑2 infection (wild-type, α‑variant), 64% had at least 1 symptom; of the children who tested negative for SARS-CoV‑2, 40% had at least 1 symptom. In both groups, rhinitis was the most common symptom (36% vs. 25%, n. s.). From the surveillance data (CATS), clinical information was available for 84,371 SARS-CoV‑2 positive children; fever was most common (27%) along with rhinitis (26%). Severe symptoms such as dyspnea were rarely reported in the outbreak investigations and in the surveillance data (3% and 1%, respectively)., Conclusion: Day care-aged children infected with SARS-CoV‑2 usually have mild or asymptomatic courses. Their symptoms are similar to those of children who tested negative for SARS-CoV‑2 from the same day care centers; thus, the observed COVID-19 symptoms are nonspecific. Combining data from the two modules is useful: findings from a very large database, as provided by the surveillance data, are complemented by findings from day care center outbreaks, where detailed prospective data on infected children can be compared with those of children who tested negative for SARS-CoV‑2., (© The Author(s) 2022.)