Correlation of SARS-CoV-2 serology and clinical phenotype amongst hospitalised children in a tertiary children’s hospital in India

  1. Aishwarya Venkataraman
  2. S Balasubramanian
  3. Sulochana Putilibai
  4. S Lakshan Raj
  5. Sumanth Amperayani
  6. S Senthilnathan
  7. Anand Manoharan
  8. Arokia Sophi
  9. R Amutha
  10. Kalaimaran Sadasivam
  11. Anu Goenka
  12. A V Ramanan

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Abstract

Introduction

Children usually present with minimal or no symptoms of SARS-CoV-2 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 SARS-CoV-2 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 temporally associated 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 PIM-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 SARS-CoV-2 infection. However, Paediatric inflammatory multisystem syndrome temporally associated 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 is sparse. We therefore, attempted to identify the seropositivity and describe the clinical spectrum of SARS-CoV-2 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 SARS-CoV-2 infection and children without PIMS-TS). Results from our study suggest that all children are at risk of SARS-CoV-2 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.

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  1. ScreenIT

    SciScore for 10.1101/2021.01.29.21250660: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: Informed consent and ethical approval: Informed consent was obtained from caregivers, and assent was obtained from children where appropriate.
    IACUC: The study was approved by the KKCTH CHILDS Trust Medical Research Foundation ethics committee and was registered at Clinical Trials Registry India (CTRI/2020/09/028040)
    Randomizationnot detected.
    BlindingStudy staff involved in serological assays were blinded to clinical data.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    SARS-CoV-2 Antibody assay and RT-PCR test: Antibodies were quantified in plasma using iFlash® SARS-CoV-2 IgG and IgM chemiluminescence antibody assay (CLIA)
    SARS-CoV-2 IgG
    suggested: None
    Software and Algorithms
    SentencesResources
    All statistical analyses were performed using SPSS version 24.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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: We detected the following sentences addressing limitations in the study:
    Despite limitations, our study has strong implications. Firstly, a seropositivity of 19.6% among our cohort of children displays a strong correlation with the general population prevalence. Second, our results suggests that quantitative antibody analysis may be helpful in disease stratification. However, further immunological studies are needed to understand the pathogenesis of SARS-CoV2 infection and disease among children.

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.01.29.21250660v1 on medRxiv
  3. Version published to 10.1093/tropej/fmab015