A cross-sectional investigation of SARS-CoV-2 seroprevalence and associated risk factors in children and adolescents in the United States
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Abstract
Pediatric SARS-CoV-2 data remain limited and seropositivity rates in children were reported as <1% early in the pandemic. Seroepidemiologic evaluation of SARS-CoV-2 in children in a major metropolitan region of the US was performed.
Methods
Children and adolescents ≤19 years were enrolled in a cross-sectional, observational study of SARS-CoV-2 seroprevalence from July-October 2020 in Northern Virginia, US. Demographic, health, and COVID-19 exposure information was collected, and blood analyzed for SARS-CoV-2 spike protein total antibody. Risk factors associated with SARS-CoV-2 seropositivity were analyzed. Orthogonal antibody testing was performed, and samples were evaluated for responses to different antigens.
Results
In 1038 children, the anti-SARS-CoV-2 total antibody positivity rate was 8.5%. After multivariate logistic regression, significant risk factors included Hispanic ethnicity, public or absent insurance, a history of COVID-19 symptoms, exposure to person with COVID-19, a household member positive for SARS-CoV-2 and multi-family or apartment dwelling without a private entrance. 66% of seropositive children had no symptoms of COVID-19. Secondary analysis included orthogonal antibody testing with assays for 1) a receptor binding domain specific antigen and 2) a nucleocapsid specific antigen had concordance rates of 80.5% and 79.3% respectively.
Conclusions
A much higher burden of SARS-CoV-2 infection, as determined by seropositivity, was found in children than previously reported; this was also higher compared to adults in the same region at a similar time. Contrary to prior reports, we determined children shoulder a significant burden of COVID-19 infection. The role of children’s disease transmission must be considered in COVID-19 mitigation strategies including vaccination.
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SciScore for 10.1101/2021.01.28.21250466: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Verbal informed consent was obtained from parents and adolescents ≥18 years. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Antibodies Sentences Resources Blood was tested using the US Food and Drug Administration emergency use authorized Ortho Clinical Diagnostics VITROS Immunodiagnostic Products Anti-SARS-CoV-2 Total test (Ortho Clinical) performed on the Vitros 3600 system (Ortho Clinical Diagnostics, Raritan, NJ) to detect total antibody (IgG, IgA and IgM) responses against the SARS-CoV-2 spike protein. Anti-SARS-CoV-2suggested: NoneIgMsuggested: NoneSARS-CoV-2 spike …SciScore for 10.1101/2021.01.28.21250466: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Verbal informed consent was obtained from parents and adolescents ≥18 years. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Antibodies Sentences Resources Blood was tested using the US Food and Drug Administration emergency use authorized Ortho Clinical Diagnostics VITROS Immunodiagnostic Products Anti-SARS-CoV-2 Total test (Ortho Clinical) performed on the Vitros 3600 system (Ortho Clinical Diagnostics, Raritan, NJ) to detect total antibody (IgG, IgA and IgM) responses against the SARS-CoV-2 spike protein. Anti-SARS-CoV-2suggested: NoneIgMsuggested: NoneSARS-CoV-2 spike protein.suggested: NoneAdditionally, to assess the antibody response in children to different SARS-CoV-2 antigens, all initially reactive samples were tested using the Abbot nucleocapsid IgG antibody assay (Abbott Laboratories, Chicago, IL). Abbot nucleocapsid IgGsuggested: NoneSoftware and Algorithms Sentences Resources Additionally, to assess the antibody response in children to different SARS-CoV-2 antigens, all initially reactive samples were tested using the Abbot nucleocapsid IgG antibody assay (Abbott Laboratories, Chicago, IL). Abbott Laboratoriessuggested: NoneResults 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.
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