Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 was first emerged in Wuhan, China has become a global pandemic disease since December 2019. The most common clinical symptom is fever, however, the prevalence and characteristics of fever in adult and paediatric COVID-19 patients is still inadequate to establish a conclusion. The present study is designed to perform a systematic review and meta-analysis to determine the overall pooled prevalence of fever and chills along with fever characteristics (low, medium, and high temperature) in both adult and paediatric COVID-19 patients.

This systematic review searched PubMed, Scopus, ScienceDirect and Google Scholar databases between 1st December 2019 and 3rd April 2020 without language restrictions. The investigators included both adult (≥18 years) and paediatric (<18 years) COVID-19 patients and used random-effects model for the meta-analysis to extract the pooled prevalence and risk ratio (RR) with 95% confidence intervals (CIs). The Joanna Briggs Institute critical appraisal tools were used for quality evaluation of included studies. Heterogeneity was measured using the I² statistic and Cochrans Q test. Robustness of the pooled estimates was determined by different subgroups and sensitivity analyses.

The authors identified 2055 studies, of which 197 studies were involved in the systematic review and 167 studies with 17142 adults and 373 paediatrics were used in the meta-analysis. Overall, the pooled prevalence of fever in adult and paediatric COVID-19 patients were 79.43% [95% CI: 77.05-81.80, I2 = 95%] and 45.86% [95% CI: 35.24-56.48, I2 = 78%], respectively. In addition, 14.45% [95% CI: 10.59-18.32, I2 = 88%] of the adult COVID-19 patients were also reported having chills. The prevalence of medium-grade fever (44.33%) was higher in contrast to low- (38.16%) and high-grade fever (14.71%) in adult COVID-19 patients. The risk of both low (RR: 2.34, 95% CI: 1.69-3.22, I₂ = 84%) and medium grade fever (RR: 2.79, 95% CI: 2.21-3.51, I₂ = 75%) were remarkably higher in comparison to high-grade fever, though, there was no noteworthy difference between low- and medium-grade fever (RR: 1.17, 95% CI: 0.94-1.44, I₂ = 87%). Approximately, 88.8% of the enrolled studies were of high-quality. The sensitivity analyses showed that data regarding prevalence of fever for both adult and paediatric patients were reliable and robust.

Thus, the study summarized that fever was highly prevalent in adult COVID-19 patients. On the contrary, study concluded that 54.14% of paediatric COVID-19 patients did not reported fever as an initial clinical feature. Furthermore, prevalence and risk of high-grade fever a[appeared to be lower than low and medium-grade.

Source: Islam MA, Kundu S, Alam SS, Hossan T, Kamal MA, Hassan R. Prevalence and characteristics of fever in adult and paediatric patients with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis of 17515 patients. PLoS One. 2021 Apr 6;16(4):e0249788.