SARS-CoV-2 Seroepidemiology in Children and Adolescents

Abstract

ObjectivesPediatric SARS-CoV-2 data remain limited and seropositivity rates in children were reported as <1% early in the pandemic. Seroepidemiologic evaluation of SARS-CoV-2 in children in a major metropolitan region of the United States was performed.MethodsChildren and adolescents ≤19 years were enrolled in a cross-sectional, observational study of SARS-CoV-2 seroprevalence from July-October 2020 in Northern Virginia, United States. Demographic, health, and COVID-19 exposure information was collected, and blood was analyzed for SARS-CoV-2 spike protein total antibody. Risk factors associated with SARS-CoV-2 seropositivity were analyzed. Orthogonal antibody testing was performed, and samples were evaluated for responses to different antigens.ResultsIn 1038 children, the anti-SARS-CoV-2 total antibody positivity rate was 8.5%. After multivariate logistic regression, significant risk factors included Hispanic ethnicity, public or absent insurance, a history of COVID-19 symptoms, exposure to person with COVID-19, a household member positive for SARS-CoV-2 and multi-family or apartment dwelling without a private entrance. 66% of seropositive children had no symptoms of COVID-19. Orthogonal antibody testing with a receptor binding domain specific antigen revealed a high concordance of 80.5%. Children also demonstrated a robust immune response to the nucleocapsid antigen.ConclusionsA much higher burden of SARS-CoV-2 infection, as determined by seropositivity, was found in children than previously reported; this was also higher compared to adults in the same region at a similar time. Contrary to prior reports, we determined children shoulder a significant burden of COVID-19 infection. The role of children’s disease transmission must be considered in COVID-19 mitigation strategies including vaccination.Article Summary8.5% of children had SARS-CoV-2 antibodies in Fall 2020, double the adult rate. The role of pediatric infection is important to consider in mitigation strategies.What’s Known on This SubjectSARS-CoV-2 pediatric seroepidemiologic data is limited. Reported viral rates underestimate the burden of infection in children due to mild or asymptomatic disease. Limited cohorts of children suggest low seropositivity rates compared to adults.What This Study AddsUS children in the largest SARS-CoV-2 seroepidemiology study to date had double the rate of antibodies compared to adults. Most children were asymptomatic. Risk factors include age, ethnicity and living conditions. Most children made antibodies to different antigens of SARS-CoV-2.

Seroprevalence of SARS-CoV-2 Antibodies in Children and Adolescents: Results From a Population-Based Survey in 10 Colombian Cities

“…41 Our findings are in accordance with other seroprevalence studies, where socioeconomic contexts are found to play a lead role in terms of SARS-CoV-2 exposure risk and infection. Higher exposure rates have been found in ethnic minority populations, 30,42 children living in poverty, inadequate dwelling conditions, 42 among others. These contextual factors should be accounted for when planning public health interventions aimed to mitigate SARS-CoV-2 impacts.…”

Seroprevalence and SARS-CoV-2 invasion in general populations: A scoping review over the first year of the pandemic

“…Risk factors. The most densely populated centres were the most affected by COVID-19 [8,16,20,32,40,41,48,50,53,55,56,59,71,76,78,81,86,87,88,91,92,94,95,101,102,106,[115][116][117][118][119][120][121][122][123][124][125][126]. Sex was examined in 14 studies, which found mostly no significant difference (one a higher seroprevalence in men and 6 a higher seroprevalence in women).…”

“…The seroprevalence was two times higher with low than high education [91]. Thirteen studies showed that the risk of seropositivity increased by about 30% with a confirmed COVID-19 case in the household [23,32,36,47,55,59,68,75,79,88,92,125,136]. Ten studies showed that the risk of seropositivity increased with the number of children in the household [16,25,55,71,77,88,116,120,125,133].…”

“…Thirteen studies showed that the risk of seropositivity increased by about 30% with a confirmed COVID-19 case in the household [23,32,36,47,55,59,68,75,79,88,92,125,136]. Ten studies showed that the risk of seropositivity increased with the number of children in the household [16,25,55,71,77,88,116,120,125,133]. The highest seroprevalence was found in the most deprived areas [59,67,68,86,92,104,126,[130][131][132][133]139,140].…”