Severe Acute Respiratory Syndrome Coronavirus 2 Seroprevalence and Reported Coronavirus Disease 2019 Cases in US Children, August 2020–May 2021

  1. Alexia Couture
  2. B Casey Lyons
  3. Megha L Mehrotra
  4. Lynn Sosa
  5. Ngozi Ezike
  6. Farah S Ahmed
  7. Catherine M Brown
  8. Stephanie Yendell
  9. Ihsan A Azzam
  10. Božena J Katić
  11. Anna Cope
  12. Kristen Dickerson
  13. Jolianne Stone
  14. L Brannon Traxler
  15. John R Dunn
  16. Lora B Davis
  17. Carrie Reed
  18. Kristie E N Clarke
  19. Brendan Flannery
  20. Myrna D Charles

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Abstract

Background

Case-based surveillance of pediatric coronavirus disease 2019 (COVID-19) cases underestimates the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections among children and adolescents. Our objectives were to estimate monthly SARS-CoV-2 antibody seroprevalence and calculate ratios of SARS-CoV-2 infections to reported COVID-19 cases among children and adolescents in 8 US states.

Methods

Using data from the Nationwide Commercial Laboratory Seroprevalence Survey, we estimated monthly SARS-CoV-2 antibody seroprevalence among children aged 0–17 years from August 2020 through May 2021. We calculated and compared cumulative incidence of SARS-CoV-2 infection extrapolated from population-standardized seroprevalence of antibodies to SARS-CoV-2, cumulative COVID-19 case reports since March 2020, and infection-to-case ratios among persons of all ages and children aged 0–17 years for each state.

Results

Of 41 583 residual serum specimens tested, children aged 0–4, 5–11, and 12–17 years accounted for 1619 (3.9%), 10 507 (25.3%), and 29 457 (70.8%), respectively. Median SARS-CoV-2 antibody seroprevalence among children increased from 8% (range, 6%–20%) in August 2020 to 37% (range, 26%–44%) in May 2021. Estimated ratios of SARS-CoV-2 infections to reported COVID-19 cases in May 2021 ranged by state from 4.7–8.9 among children and adolescents to 2.2–3.9 for all ages combined.

Conclusions

Through May 2021 in selected states, the majority of children with serum specimens included in serosurveys did not have evidence of prior SARS-CoV-2 infection. Case-based surveillance underestimated the number of children infected with SARS-CoV-2 more than among all ages. Continued monitoring of pediatric SARS-CoV-2 antibody seroprevalence should inform prevention and vaccination strategies.

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  1. Version published to 10.1093/ofid/ofac044
  2. ScreenIT

    SciScore for 10.1101/2021.09.26.21263756: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    1, 2 In brief, CDC partnered with three commercial laboratories to test a random sample of residual sera submitted for routine clinical testing for the presence of SARS-CoV-2 antibodies using one of three commercial assays authorized under EUA: Elecsys® Anti-SARS-CoV-2 Assay (N protein; Roche, Indianapolis, IN) and ARCHITECT™ SARS-CoV-2 IgG Assay (N protein; Abbott, Chicago, IL), both targeting the viral N protein, and VITROS® Anti-SARS-CoV-2 IgG Assay (spike (S) protein; Ortho-Clinical Diagnostics, Raritan, NJ) targeting the viral spike protein.
    Anti-SARS-CoV-2 IgG
    suggested: None
    From February to May 2021, when COVID-19 vaccination was becoming more widely available, all serum specimens from states included in this analysis were tested for either pan-immunoglobulin (Ig) (Roche Elecsys) or IgG-specific (Abbott ARCHITECT) anti-nucleocapsid antibodies.
    either pan-immunoglobulin (Ig) (Roche Elecsys)
    suggested: None
    anti-nucleocapsid
    suggested: None
    Software and Algorithms
    SentencesResources
    1, 2 In brief, CDC partnered with three commercial laboratories to test a random sample of residual sera submitted for routine clinical testing for the presence of SARS-CoV-2 antibodies using one of three commercial assays authorized under EUA: Elecsys® Anti-SARS-CoV-2 Assay (N protein; Roche, Indianapolis, IN) and ARCHITECT™ SARS-CoV-2 IgG Assay (N protein; Abbott, Chicago, IL), both targeting the viral N protein, and VITROS® Anti-SARS-CoV-2 IgG Assay (spike (S) protein; Ortho-Clinical Diagnostics, Raritan, NJ) targeting the viral spike protein.
    Abbott
    suggested: (Abbott, RRID:SCR_010477)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.09.26.21263756v1 on medRxiv