Naturally-acquired Immunity Dynamics against SARS-CoV-2 in Children and Adolescents

Abstract

ObjectivesThere are paucity of studies examining naturally acquired immunity against SARS-CoV-2 in children and adolescents, though they are generally the last group to be afforded the vaccine, and a significant portion of them are still unvaccinated. This study examined the duration of protection conferred by a previous SARS-CoV-2 infection amongst children and adolescents.DesignA retrospective study, applying two complementary approaches: a matched test-negative case control design and a retrospective cohort design.SettingNationally centralized database of Maccabi Healthcare Services, an Israeli national health fund that covers 2.5 million people.ParticipantsThe study population included between 293,743 and 458,959 individuals (depending on the model), 5-18 years of age, who were unvaccinated SARS-CoV-2 naïve persons or unvaccinated convalescent patients.Main outcomes and measuresAnalyses focused on the period of July 1 to December 13, 2021, a Delta-dominant period in Israel. We evaluated three SARS-CoV-2-related outcomes: (1) documented PCR confirmed infection or reinfection, (2) COVID-19 and (3) severe COVID-19.ResultsOverall, children and adolescents who were previously infected acquired durable protection against reinfection (symptomatic or not) with SARS-CoV-2 for at least 18 months. Importantly, no COVID-19 related deaths were recorded in either the SARS-CoV-2 naïve group or the previously infected group. Effectiveness of naturally-acquired immunity against a recurrent infection reached 89.2% (95% CI: 84.7%-92.4%) three to six months after first infection, mildly declining to 82.5% (95% CI, 79.1%-85.3%) nine months to one year after infection, then remaining rather steady for children and adolescents for up to 18 months, with a slight non-significant waning trend. Additionally, we found that ages 5-11 exhibited no significant waning of naturally acquired protection throughout the outcome period, whereas waning protection in the 12-18 age group was more prominent, but still mild.ConclusionsChildren and adolescents who were previously infected with SARS-CoV-2 remain protected against reinfection to a high degree for 18 months. Policy decision makers should consider when and if convalescent children and adolescents should be vaccinated. Nonetheless, further research is needed to examine naturally acquired immunity against emerging variants, including the Omicron.

Duration of immunity to SARS-CoV-2 in children after natural infection or vaccination in the omicron and pre-omicron era: A systematic review of clinical and immunological studies

“…Overall, they found that children had a lower risk of reinfections compared with adults (72.53 per 100 000 vs 21.53 per 100 000), and a similar rate of hospitalisations or pediatric intensive care unit (PICU) admissions in children during the first or second infection (2.7% and 2.4% hospitalisations during first and second episode, and seven and four PICU admissions, respectively). A similar preprint from Israel during Delta period showed that previously infected children remained protected against reinfection to a high degree for 18 months, although in this case severity of reinfections was not reported ( 49 ).…”