Asymptomatic SARS-CoV-2 Infection by Age: A Global Systematic Review and Meta-analysis

Bing Wang; Prabha Andraweera; Salenna Elliott; Hassen Mohammed; Zohra Lassi; Ashley Twigger; Chloe Borgas; Shehani Gunasekera; Shamez Ladhani; Helen Siobhan Marshall

doi:10.1097/INF.0000000000003791

Asymptomatic SARS-CoV-2 Infection by Age: A Global Systematic Review and Meta-analysis

Bing Wang^*, Prabha Andraweera, Salenna Elliott, Hassen Mohammed, Zohra Lassi, Ashley Twigger, Chloe Borgas, Shehani Gunasekera, Shamez Ladhani, Helen Siobhan Marshall

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

44 Citations (Scopus)

Abstract

Background: Asymptomatic SARS-CoV-2 infections have raised concerns for public health policies to manage epidemics. This systematic review and meta-analysis aimed to estimate the age-specific proportion of asymptomatic SARS-CoV-2 infected persons globally by year of age.

Methods: We searched PubMed, Embase, medRxiv and Google Scholar on September 10, 2020, and March 1, 2021. We included studies conducted during January to December 2020, before routine vaccination against COVID-19. Because we expected the relationship between the asymptomatic proportion and age to be nonlinear, multilevel mixed-effects logistic regression (QR decomposition) with a restricted cubic spline was used to model asymptomatic proportions as a function of age.

Results: A total of 38 studies were included in the meta-analysis. In total, 6556 of 14,850 cases were reported as asymptomatic. The overall estimate of the proportion of people who became infected with SARS-CoV-2 and remained asymptomatic throughout infection was 44.1% (6556/14,850, 95% CI: 43.3%-45.0%). The predicted asymptomatic proportion peaked in children (36.2%, 95% CI: 26.0%-46.5%) at 13.5 years, gradually decreased by age and was lowest at 90.5 years of age (8.1%, 95% CI: 3.4%-12.7%).

Conclusions: Given the high rates of asymptomatic carriage in adolescents and young adults and their active role in virus transmission in the community, heightened vigilance and public health strategies are needed among these individuals to prevent disease transmission.

Original language	English
Pages (from-to)	232-239
Number of pages	8
Journal	Pediatric Infectious Disease Journal
Volume	42
Issue number	3
DOIs	https://doi.org/10.1097/INF.0000000000003791
Publication status	Published - 1 Mar 2023

Bibliographical note

Funding Information: No funding information.

Open Access: Free to read, but no Open Access licence.

Publisher Copyright: © 2023 Lippincott Williams and Wilkins. All rights reserved.

Citation: Wang, Bing PhD; Andraweera, Prabha PhD; Elliott, Salenna PhD; Mohammed, Hassen PhD; Lassi, Zohra PhD; Twigger, Ashley MBBS; Borgas, Chloe MBBS; Gunasekera, Shehani MBBS; Ladhani, Shamez PhD; Marshall, Helen Siobhan MD. Asymptomatic SARS-CoV-2 Infection by Age: A Global Systematic Review and Meta-analysis. The Pediatric Infectious Disease Journal 42(3):p 232-239, March 2023. | DOI: 10.1097/INF.0000000000003791

DOI: 10.1097/INF.0000000000003791

Keywords

2 infection
CoV
SARS
analysis
asymptomatic proportion
meta
systematic review

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

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title = "Asymptomatic SARS-CoV-2 Infection by Age: A Global Systematic Review and Meta-analysis",

abstract = "Background: Asymptomatic SARS-CoV-2 infections have raised concerns for public health policies to manage epidemics. This systematic review and meta-analysis aimed to estimate the age-specific proportion of asymptomatic SARS-CoV-2 infected persons globally by year of age. Methods: We searched PubMed, Embase, medRxiv and Google Scholar on September 10, 2020, and March 1, 2021. We included studies conducted during January to December 2020, before routine vaccination against COVID-19. Because we expected the relationship between the asymptomatic proportion and age to be nonlinear, multilevel mixed-effects logistic regression (QR decomposition) with a restricted cubic spline was used to model asymptomatic proportions as a function of age. Results: A total of 38 studies were included in the meta-analysis. In total, 6556 of 14,850 cases were reported as asymptomatic. The overall estimate of the proportion of people who became infected with SARS-CoV-2 and remained asymptomatic throughout infection was 44.1\% (6556/14,850, 95\% CI: 43.3\%-45.0\%). The predicted asymptomatic proportion peaked in children (36.2\%, 95\% CI: 26.0\%-46.5\%) at 13.5 years, gradually decreased by age and was lowest at 90.5 years of age (8.1\%, 95\% CI: 3.4\%-12.7\%). Conclusions: Given the high rates of asymptomatic carriage in adolescents and young adults and their active role in virus transmission in the community, heightened vigilance and public health strategies are needed among these individuals to prevent disease transmission.",

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author = "Bing Wang and Prabha Andraweera and Salenna Elliott and Hassen Mohammed and Zohra Lassi and Ashley Twigger and Chloe Borgas and Shehani Gunasekera and Shamez Ladhani and Marshall, \{Helen Siobhan\}",

note = "Funding Information: No funding information. Open Access: Free to read, but no Open Access licence. Publisher Copyright: {\textcopyright} 2023 Lippincott Williams and Wilkins. All rights reserved. Citation: Wang, Bing PhD; Andraweera, Prabha PhD; Elliott, Salenna PhD; Mohammed, Hassen PhD; Lassi, Zohra PhD; Twigger, Ashley MBBS; Borgas, Chloe MBBS; Gunasekera, Shehani MBBS; Ladhani, Shamez PhD; Marshall, Helen Siobhan MD. Asymptomatic SARS-CoV-2 Infection by Age: A Global Systematic Review and Meta-analysis. The Pediatric Infectious Disease Journal 42(3):p 232-239, March 2023. | DOI: 10.1097/INF.0000000000003791 DOI: 10.1097/INF.0000000000003791",

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AU - Mohammed, Hassen

AU - Lassi, Zohra

AU - Twigger, Ashley

AU - Borgas, Chloe

AU - Gunasekera, Shehani

AU - Ladhani, Shamez

AU - Marshall, Helen Siobhan

N1 - Funding Information: No funding information. Open Access: Free to read, but no Open Access licence. Publisher Copyright: © 2023 Lippincott Williams and Wilkins. All rights reserved. Citation: Wang, Bing PhD; Andraweera, Prabha PhD; Elliott, Salenna PhD; Mohammed, Hassen PhD; Lassi, Zohra PhD; Twigger, Ashley MBBS; Borgas, Chloe MBBS; Gunasekera, Shehani MBBS; Ladhani, Shamez PhD; Marshall, Helen Siobhan MD. Asymptomatic SARS-CoV-2 Infection by Age: A Global Systematic Review and Meta-analysis. The Pediatric Infectious Disease Journal 42(3):p 232-239, March 2023. | DOI: 10.1097/INF.0000000000003791 DOI: 10.1097/INF.0000000000003791

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N2 - Background: Asymptomatic SARS-CoV-2 infections have raised concerns for public health policies to manage epidemics. This systematic review and meta-analysis aimed to estimate the age-specific proportion of asymptomatic SARS-CoV-2 infected persons globally by year of age. Methods: We searched PubMed, Embase, medRxiv and Google Scholar on September 10, 2020, and March 1, 2021. We included studies conducted during January to December 2020, before routine vaccination against COVID-19. Because we expected the relationship between the asymptomatic proportion and age to be nonlinear, multilevel mixed-effects logistic regression (QR decomposition) with a restricted cubic spline was used to model asymptomatic proportions as a function of age. Results: A total of 38 studies were included in the meta-analysis. In total, 6556 of 14,850 cases were reported as asymptomatic. The overall estimate of the proportion of people who became infected with SARS-CoV-2 and remained asymptomatic throughout infection was 44.1% (6556/14,850, 95% CI: 43.3%-45.0%). The predicted asymptomatic proportion peaked in children (36.2%, 95% CI: 26.0%-46.5%) at 13.5 years, gradually decreased by age and was lowest at 90.5 years of age (8.1%, 95% CI: 3.4%-12.7%). Conclusions: Given the high rates of asymptomatic carriage in adolescents and young adults and their active role in virus transmission in the community, heightened vigilance and public health strategies are needed among these individuals to prevent disease transmission.

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Asymptomatic SARS-CoV-2 Infection by Age: A Global Systematic Review and Meta-analysis

Abstract

Bibliographical note

Keywords

UN SDGs

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