Severe acute respiratory syndrome corona virus-2 among children in India: can the risk of outbreak be prevented during the subsequent waves of COVID-19 pandemic?

Rajath Rao, Binod Kumar Pati, Srikanta Kanungo, Santosh Kumar Nirala, Bijaya Nanda Naik


The COVID-19 pandemic believed to be originated from Wuhan, China has devastated the health and wealth of the entire world with multiple waves. An age shifting phenomenon towards younger age has been observed with SARS-CoV-2 (severe acute respiratory syndrome corona virus-2) with subsequent waves across the world including India. With vaccination being already in place for adults and elderly, younger especially children less than 18 years may be assumed to be susceptible to SARS-CoV-2 in the subsequent waves. However, few research suggests that children are less susceptible to SARS-CoV-2 due to immature sinuses in the nasopharynx and less number of ACE-2 receptors to which generally the SARS-CoV-2 attaches. On the other hand, poor health and nutrition status of the children, unreached target of immunization services, poor sanitation and fragile health system in India makes children more vulnerable to SARS-CoV-2. Children may get affected if new variant of virus emerges during the subsequent waves. So, we need to prepare to protect the children who if at all get affected during the third wave of COVID-19 by preventing infection among adult and elderly, strengthening the health system and immunizing the children.



Keywords: SARS-COV-2;COVID 19 in Children;Third wave;COVID 19 vaccine;MIS-C

Full Text:



WHO. Fact sheet: Naming the coronavirus disease (COVID-19) and the virus that causes it. Available at: Accessed on 19 June 2021.

WHO. Fact sheet: Coronavirus (COVID-19) Dashboard, 2021. Available at: Accessed on 19 June 2021.

Johnson NPAS, Mueller J. Updating the accounts: global mortality of the 1918-1920 “Spanish” influenza pandemic. Bull Hist Med. 2002;76(1):105-15.

Zimmermann P, Curtis N. Coronavirus infections in children including COVID-19: an overview of the epidemiology, clinical features, diagnosis, treatment and prevention options in children. Pediatr Infect Dis J. 2020;39(5):355-68.

Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020;145(6).

Viner RM, Mytton OT, Bonell C, Melendez-Torres GJ, Ward J, Hudson L, et al. Susceptibility to SARS-CoV-2 infection among children and adolescents compared with adults: a systematic review and meta-analysis. JAMA Pediatr. 2021;175(2):143-56.

National Family Health Survey. Available at: Accessed on 19 June 2021.

Jain VK, Iyengar K, Vaish A, Vaishya R. Differential mortality in COVID-19 patients from India and western countries. Diabetes Metab Syndr. 2020;14(5):1037-41.

Smith GD, Spiegelhalter D. Shielding from covid-19 should be stratified by risk. BMJ. 2020;369:2063.

Rypdal K, Bianchi FM, Rypdal M. Intervention fatigue is the primary cause of strong secondary waves in the COVID-19 pandemic. Int J Environ Res Public Health. 2020;17(24):9592.

National Centre for Disease Control (NCDC). Fact sheet: Dashboard, 2021. Available at: Accessed on 19 June 2021.

Outlook. Fact sheet: Second wave victim demographics same as the first: centre. Available at: Accessed on 19 June 2021.

Hippich et al. A public health antibody screening indicates a marked increase of SARS-CoV-2 exposure rate in children during the second wave. Letter. 2021;2(5):571-2.

Iftimie S, López-Azcona AF, Vallverdú I, Hernández-Flix S, Febrer G, Parra S, et al. First and second waves of coronavirus disease-19: a comparative study in hospitalized patients in Reus, Spain. Plos One. 2021;16(3):0248029.

Saito S, Asai Y, Matsunaga N, Hayakawa K, Terada M, Ohtsu H, et al. First and second COVID-19 waves in Japan: a comparison of disease severity and characteristics. J Infect. 2021;82(4):84.

BBC. Fact sheet: Why children are not immune to COVID-19. Available at: Accessed on 19 June 2021.

Live Science. Fact sheet: Scientists figure out how new coronavirus breaks into human cells. Available at: Accessed on 19 June 2021.

Patel AB, Verma A. Nasal ACE2 levels and COVID-19 in children. JAMA. 2020;323(23):2386.

Yeh SH, Mink CM. Shift in the epidemiology of pertussis infection: an indication for pertussis vaccine boosters for adults? Drugs. 2006;66(6):731-41.

Pemberton-Ross P, Smith TA, Hodel EM, Kay K, Penny MA. Age-shifting in malaria incidence as a result of induced immunological deficit: a simulation study. Malaria J. 2015;14(1):287.

Li S, Ma C, Hao L, Su Q, An Z, Ma F, et al. Demographic transition and the dynamics of measles in six provinces in China: a modeling study. PLoS Med. 2017;14(4):1002255.

Liguoro I, Pilotto C, Bonanni M, Ferrari ME, Pusiol A, Nocerino A, et al. SARS-COV-2 infection in children and newborns: a systematic review. Eur J Pediatr. 2020:1-18.

Irfan O, Muttalib F, Tang K, Jiang L, Lassi ZS, Bhutta Z. Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis. Arch Dis Child. 2021;106(5):440-8.

Protocol for Management of COVID-19 in the Paediatric Age Group. Available at: Accessed on 20 June 2021.

Mehta NS, Mytton OT, Mullins EWS, Fowler TA, Falconer CL, Murphy OB, et al. SARS-CoV-2 (COVID-19): what do we know about children? A systematic review. Clin Infect Dis. 2020;71(9):2469-79.

IAP. Fact sheet: COVID-19 management guidelines for pediatrician V1.1, 2021. Available at: Accessed on 20 June 2021.

WHO. Fact sheet: Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19, 2021. Available at: Accessed on 20 June 2021.

Khan EA. COVID-19 in children: epidemiology, presentation, diagnosis and management. J Pak Med Assoc. 2020;70(3)(5):108-12.

Maltezou HC, Magaziotou I, Dedoukou X, Eleftheriou E, Raftopoulos V, Michos A, et al. Children and adolescents with SARS-CoV-2 infection: epidemiology, clinical course and viral loads. Pediatr Infect Dis J. 2020;39(12):388-92.

Shekerdemian LS, Mahmood NR, Wolfe KK, Riggs BJ, Ross CE, McKiernan CA, et al. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. 2020;174(9):868.

Parri N, Magistà AM, Marchetti F, Cantoni B, Arrighini A, Romanengo M, et al. Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian pediatric research networks. Eur J Pediatr. 2020;179(8):1315-23.

Götzinger F, Santiago-García B, Noguera-Julián A, Lanaspa M, Lancella L, Carducci FIC, et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre COHORT study. Lancet Child Adolesc Health. 2020;4(9):653-61.

Kim L, Whitaker M, O’Halloran A, Kambhampati A, Chai SJ, Reingold A, et al. Hospitalization rates and characteristics of children aged <18 years hospitalized with laboratory-confirmed COVID-19 - COVID-NET, 14 States, March 1-July 25, 2020. MMWR. 2020;69(32):1081-8.

Bixler D, Miller AD, Mattison CP, Taylor B, Komatsu K, Pompa XP, et al. SARS-CoV-2-associated deaths among persons aged <21 years - United States, February 12-July 31, 2020. MMWR. 2020;69(37):1324-9.

Praveen PA, Tandon N. Childhood obesity and type 2 diabetes in India. WHO South East Asia J Pub Health. 2016;5(1):17.

Bellino S, Punzo O, Rota MC, Manso MD, Urdiales AM, Andrianou X, et al. COVID-19 disease severity risk factors for pediatric patients in Italy. Pediatrics. 2020;146(4).

Zar HJ, Dawa J, Fischer GB, Castro-Rodriguez JA. Challenges of COVID-19 in children in low and middle-income countries. Paediat Respirat Rev. 2020;35:70-4.

Heald-Sargent T, Muller WJ, Zheng X, Rippe J, Patel AB, Kociolek LK. Age-related differences in nasopharyngeal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) levels in patients with mild to moderate coronavirus disease 2019 (COVID-19). JAMA Pediatr. 2020;174(9):902-3.

Posfay-Barbe KM, Wagner N, Gauthey M, Moussaoui D, Loevy N, Diana A, et al. COVID-19 in children and the dynamics of infection in families. Pediatr. 2020;146(2):20201576.

Lopez AS, Hill M, Antezano J, Vilven D, Rutner T, Bogdanow L, et al. Transmission dynamics of COVID-19 outbreaks associated with child care facilities-Salt Lake City, Utah, April-July 2020. MMWR. 2020;69(37).

Esteve A, Permanyer I, Boertien D, Vaupel JW. National age and co-residence patterns shape covid-19 vulnerability. 2020.

The Week. Fact sheet: COVID-19 and paediatric trials: by when will our children be vaccinated? Available at: Accessed on 20 June 2021.

The Times of India. Fact sheet: Covaxin trail on children: paediatric trials of covaxin may begin in June. Available at: Accessed on 20 June 2021.

Healio. Fact sheet: Pfizer fully enrolls pediatric COVID-19 vaccine trial with more than 2K kids Available at: Accessed on 20 June 2021.

Statista. Fact sheet: India-COVID-19 cases by age group 2020. Available at: Accessed on 20 June 2021.