Seroprevalence of SARS-CoV-2 antibodies in children: a prospective multicentre cohort study

Abstract

BackgroundStudies based on molecular testing of oral/nasal swabs underestimate SARS-CoV-2 infection due to issues with test sensitivity, test timing and selection bias. The objective of this study was to report the presence of SARS-CoV-2 antibodies, consistent with previous infection.DesignThis multicentre observational cohort study, conducted between 16 April to 3 July 2020 at 5 UK sites, recruited children of healthcare workers, aged 2–15 years. Participants provided blood samples for SARS-CoV-2 antibody testing and data were gathered regarding unwell contacts and symptoms.Results1007 participants were enrolled, and 992 were included in the final analysis. The median age of participants was 10·1 years. There were 68 (6.9%) participants with positive SARS-CoV-2 antibody tests indicative of previous SARS-CoV-2 infection. Of these, 34/68 (50%) reported no symptoms prior to testing. The presence of antibodies and the mean antibody titre was not influenced by age. Following multivariable analysis four independent variables were identified as significantly associated with SARS-CoV-2 seropositivity: known infected household contact OR=10.9 (95% CI 6.1 to 19.6); fatigue OR=16.8 (95% CI 5.5 to 51.9); gastrointestinal symptoms OR=6.6 (95% CI 3.0 to 13.8); and changes in sense of smell or taste OR=10.0 (95% CI 2.4 to 11.4).DiscussionChildren demonstrated similar antibody titres in response to SARS-CoV-2 irrespective of age. Fatigue, gastrointestinal symptoms and changes in sense of smell or taste were the symptoms most strongly associated with SARS-CoV-2 antibody positivity.Trial registration numberNCT0434740.

A cross-sectional study of screening for coronavirus disease 2019 (COVID-19) at the pediatric emergency department in Vilnius during the first wave of the pandemic

“…One child did not meet the COVID-19 clinical criteria recommended by European Centre for Disease Prevention and Control (ECDC) [12], presenting with vomiting and dehydration only. Increasingly, data suggest that gastrointestinal symptoms play an important role in children [13][14][15]. In our study, four of eight COVID-19 positive patients had gastrointestinal symptoms, and three with no respiratory symptoms.…”

Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents

“…there has been some uncertainty about which symptoms indicate likely COVID-19 in CYP, as some recent studies have suggested that other symptoms such as gastrointestinal symptoms 6 or fatigue 6 7 may be common in CYP with COVID-19. Policy on case definitions and testing policy for COVID-19 in CYP requires evidence on which symptoms are most commonly associated with test positivity, but also those that are not.…”

COVID ‐19, children and schools: overlooked and at risk

“…Nasal angiotensin‐converting enzyme 2 expression increases with age, 50,51 suggesting that younger children could be less susceptible to infection than older children. This is supported by some studies 8,13 but questioned by others which show similar attack rates 12,15,36 . Whether young and older children transmit the virus similarly is unknown and requires urgent clarification.…”

“…Detecting paediatric cases may be particularly difficult because of the high prevalence of asymptomatic infection in children. In a prospective seroprevalence study of the children of health care workers in the United Kingdom, 50% of infections were asymptomatic 36 . In a study of paediatric cases largely identified via contact tracing in South Korea, 66% of symptomatic children had symptoms which had been mild enough to go unrecognised, and only 9% were diagnosed at the time of symptom onset 17 …”