Seroconversion rate and socio-economic and ethnic risk factors for SARS-CoV-2 infection in children in a population-based cohort, Germany, June 2020 to February 2021

  1. Folke Brinkmann
  2. Hans H Diebner
  3. Chantal Matenar
  4. Anne Schlegtendal
  5. Lynn Eitner
  6. Nina Timmesfeld
  7. Christoph Maier
  8. Thomas Lücke

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Socio-economic and ethnic background have been discussed as possible risk factors for SARS-CoV-2 infections in children. Improved knowledge could lead to tailored prevention strategies and help improve infection control.

Aim

We aimed to identify risk factors for SARS-CoV-2 infections in children in the first and second wave of the pandemic.

Methods

We performed an observational population-based cohort study in children (6 months–18 years) scheduled for legally required preventive examination and their parents in a metropolitan region in Germany. Primary endpoint was the SARS-CoV-2 seroconversion rate during the study period. Risk factors assessed included age, pre-existing medical conditions, socio-economic factors and ethnicity.

Results

We included 2,124 children and their parents. Seroconversion rates among children in all age groups increased 3–4-fold from June 2020 to February 2021. Only 24 of 58 (41%) seropositive children reported symptoms. In 51% of infected children, at least one parent was also SARS-CoV-2-positive. Low level of parental education (OR = 3.13; 95% CI: 0.72–13.69) non-significantly increased the risk of infection. Of the total cohort, 38.5% had a migration background, 9% of Turkish and 5% of Middle Eastern origin, and had the highest risk for SARS-CoV-2 infections (OR = 6.24; 95% CI: 1.38–28.12 and OR = 6.44 (95% CI: 1.14–36.45) after adjustment for other risk factors.

Conclusion

In the second half of 2020, seroprevalence for SARS-CoV-2 in children increased especially in families with lower-socioeconomic status. Culture-sensitive approaches are essential to limit transmission and could serve as a blueprint for vaccination strategies.

Article activity feed

  1. Version published to 10.2807/1560-7917.es.2022.27.37.2101028
  2. ScreenIT

    SciScore for 10.1101/2021.10.21.21265322: (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
    Serum samples were analysed for SARS-CoV-2 IgM and IgG antibodies (ECLIA, Roche).
    SARS-CoV-2
    suggested: None
    IgM
    suggested: None
    IgG
    suggested: None

    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:
    Limitations: Paediatric patients were recruited only from three regions (counties) in Western Germany and not all paediatric practices in the area participated. In addition, initially low seroprevalence rates could have introduced a bias. Genetic risk factors could predispose certain populations to infections with SARS-CoV-2, which was not considered in this study. The proportion of children from Turkish families, in contrast to those of other origins, was lower than expected at 9% (see table 1), whereas ca. 20% of the families in the regions studied are of Turkish origin. However, this rather indicates an underestimation of the true infection rate in this group. Another limitation might be the use of surrogate parameters for the assessment of living conditions and income like number of rooms etc. Different educational grades might have posed difficulties in answering questions about educational status and might have also led to an underestimation of the corresponding risk factor. We attempted to reduce a possible bias through semi structured interviews to validate the answers drawn from the internet-based questionnaire.

    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.

    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.

  3. Version published to 10.1101/2021.10.21.21265322v1 on medRxiv