Correlation of SARS-CoV-2 Serology and Clinical Phenotype Amongst Hospitalised Children in a Tertiary Children’s Hospital in India

Abstract

Introduction Children usually present with minimal or no symptoms of COVID-19 infection. Antibody responses to SARS-CoV-2 in children from low- and middle-income countries (LMIC) have not been well described. We describe the prevalence of anti-SARS-CoV-2 antibodies and clinical phenotype of seropositive children admitted to a tertiary children’s hospital in South India. Methods To determine the seropositivity and describe the clinical characteristics of COVID-19 infection amongst hospitalised children, we performed a prospective clinical data collection and blood sampling of children admitted to Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India over 4 months of the COVID-19 pandemic. In seropositive children, we compared antibody titres between children with and without PIMS-TS. Results Of 463 children, 91 (19.6%) were seropositive. The median (range) age of seropositive children was 5 years (1 month–17 years). Clinical presentation was consistent with Paediatric inflammatory multisystem syndrome associated or related with SARS-CoV-2 infection (PIMS-TS) in 48% (44/91) of seropositive children. The median (range) antibody titre was 54.8 (11.1–170.9) AU/ml among all seropositive children. The median antibody titre among the children with PIMS-TS (60.3 AU/mL) was significantly (p = 0.01) higher when compared to the children without PIMS-TS (54.8 AU/mL). Conclusion We describe the antibody responses to SARS-CoV-2 amongst hospitalised children in a LMIC tertiary children’s hospital. Almost half of the seropositive children had PIMS-TS. Antibody levels may be helpful in the diagnosis and disease stratification of PIMS-TS. LAY SUMMARY Children usually present with minimal or no symptoms of COVID-19 infection. However, Multisystem Inflammatory Syndrome in Children (MIS-C) or Paediatric inflammatory multisystem syndrome associated or related with SARS-CoV-2 infection (PIMS-TS) has emerged as a distinctive paediatric illness related to SARS-CoV-2. Recently, antibody testing for SARS-CoV-2 is being used increasingly as a diagnostic test for PIMS-TS. However, data on the antibody responses to SARS-CoV-2 in children are sparse. We, therefore, attempted to identify the seropositivity and describe the clinical spectrum of COVID-19 infection amongst infants and children getting hospitalised in a children’s hospital in south India. Nearly one-fifth of the hospitalised children tested serology positive over 4 months. Antibody levels in children with PIMS-TS were significantly higher in comparison to the other two groups (acute COVID-19 infection and children without PIMS-TS). Results from our study suggest that all children are at risk of COVID-19 infection though they may present with mild illness or no symptoms. We also observed that antibody testing may have a possible role in diagnosis of PIMS-TS.

Serological prevalence of SARS-CoV-2 antibody among children and young age (between age 2-17 years) group in India: An interim result from a large multi-centric population-based seroepidemiological study

“…One hospital-based study in Chennai had reported 19.6% prevalence in the age group of 1 month to 17 years. [13] Delhi Urban: During the first wave of the pandemic in India, the worst affected areas were the large urban areas, including Delhi. We collected the data during the second fortnight of March 2021.…”

“…One hospital-based study in Chennai had reported 19.6% prevalence in the age group of 1 month to 17 years. [13]…”

Seroprevalence of IgG antibodies against SARS-CoV-2 in India, March 2020 to August 2021: a systematic review and meta-analysis

“…;Prakash et al, 2021b;Prakash et al, 2021c;Prakash et al, 2021d;Rafi et al, 2021;Ray et al, 2020;Satpati et al, 2020;Selvaraju et al, 2021;Sen et al, 2021;N. Sharma et al, 2020.;Siddiqui et al, 2020;Singhal et al, 2020;Siva Ganesa Karthikeyan et al, 2021;Velumani et al, 2021;Venkataraman et al, 2021) with 831,010 participants in the first wave (COVID-19sero survey-III (July 2021) -Tamil Nadu, 2021.; Misra et al, 2021;Selvaraju et al, personal communication;M. V. Murhekar, et al, 2021) with 74,369 participants in the second wave included in the systematic review and meta-analysis after full-text scrutiny (Figure 1, Supplementary table 1).…”

Assessment of COVID-19 Incidence and the Ability to Synthesise Anti-SARS-CoV-2 Antibodies of Paediatric Patients with Primary Immunodeficiency

“…In a study conducted by Venkatamaran et al in India, the authors evaluated humoral immune response associated with anti-SARS-CoV-2 antibody synthesis in hospitalised patients by comparing antibody titres between children with and without PIMS-TS [ 26 ]. Almost half of seropositive children had PIMS-TS.…”