Estimated SARS-CoV-2 Seroprevalence in Children and Adolescents in Mississippi, May Through September 2020

  1. Charlotte V. Hobbs
  2. Jan Drobeniuc
  3. Theresa Kittle
  4. John Williams
  5. Paul Byers
  6. Subbian S. Panayampalli
  7. Meagan Stephenson
  8. Sara S. Kim
  9. Manish M. Patel
  10. Brendan Flannery
  11. CDC COVID-19 Response Team
  12. CDC COVID-19 Task Force Microbial Pathogenesis and Immune Response Laboratory.

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Abstract

Case-based tracking of COVID-19 in children and adolescents may underestimate infection, and compared with adults there is little pediatric SARS-CoV-2 seroprevalence data. To assess evidence of previous SARS-CoV-2 infections among children and adolescents in Mississippi, serologic testing for antibodies to SARS-CoV-2 was conducted on a convenience sample of residual serum specimens collected for routine laboratory testing by an academic medical center laboratory during May 17 through September 19, 2020. Seroprevalence by calendar month was standardized to the state population by race/ethnicity; cumulative numbers of infections were estimated by extrapolating seroprevalence to all those aged <18 years in Mississippi. Serum specimens from 1,603 individuals were tested; 175 (10.9%) were positive for SARS-CoV-2 antibodies. Among 1,579 (98.5%) individuals for whom race/ethnicity was known, the number testing positive was 16 (23.2%) of 69 Hispanic individuals, 117 (13.0%) of 901 non-Hispanic Black individuals and 30 (5.3%) of 565 non-Hispanic White individuals. Population-weighted seroprevalence estimates among those aged <18 years increased from 2.6% in May to 16.9% in September 2020. Cumulative numbers of infections extrapolated from seroprevalence data, however, were estimated at 117,805 (95% confidence interval [CI] = 68,771–168,708), suggesting that cases in children and adolescents are much higher than what was reported to the Mississippi State Department of Health (9,044 cases during this period). Further data to appreciate the burden of pediatric disease to inform public health policy is urgently needed.

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  1. ScreenIT

    SciScore for 10.1101/2021.02.05.21250792: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: ¶¶ The project was also reviewed and approved by the University of Mississippi Medical Center Institutional Review Board through the expedited review procedure.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Specimens with adequate volume (≥ 0.3 mL) were tested using a qualitative VITROS anti–SARS-CoV-2 total antibody in vitro diagnostic test using the automated VITROS 3600 Immunodiagnostic System (Ortho Clinical Diagnostics)
    anti–SARS-CoV-2
    suggested: None
    An automatically calculated ratio of test sample signal to cutoff value (S/C) <1.0 was interpreted as nonreactive and S/C ≥ 1.0 was interpreted as reactive for anti–SARS-CoV-2 total antibody (6).
    anti–SARS-CoV-2 total antibody ( 6
    suggested: None
    Samples with volumes <0.3 mL were tested to determine seropositivity using an enzyme linked immunosorbent assay (ELISA) developed by CDC to measure total SARS-CoV-2 antibodies against the extracellular domain of the SARS-CoV-2 spike protein (2).
    SARS-CoV-2 spike protein ( 2
    suggested: None
    Software and Algorithms
    SentencesResources
    Statistical analyses were conducted using SAS (version 9.4; SAS Institute).
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    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:
    The findings in this report are subject to at least four limitations. First, seropositivity among a convenience sample of sera from one laboratory might not be representative of seropositivity among individuals aged <18 years in Mississippi; therefore, comparisons between these estimates of cumulative SARS-CoV-2 infections and reported COVID-19 cases in Mississippi should be interpreted with caution. Second, individuals who have blood collected for routine laboratory testing might differ from the general pediatric population in underlying health conditions, access to care or adherence to prevention measures, including use of masks and social distancing. However, compared with more representative serosurveys, residual sera from commercial laboratories have previously been shown to provide an approximate measure of community seroprevalence (3). Third, misclassification of antibody status was possible due to possible imperfect sensitivity and specificity of the assays used in the report. Finally, selecting the first seropositive specimen from individuals testing positive at any time point rather than randomly selected specimens might have overestimated population seroprevalence. Alternatively, seroprevalence could be underestimated if participants who were infected had not yet mounted an antibody response or if antibody titers had declined since infection (8,9), and it is also noted that positive antibody status in the infant group could reflect SARS-CoV-2 immunoglobulin G place...

    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

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  2. Version published to 10.1101/2021.02.05.21250792v1 on medRxiv