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Examining multi-level immune response to determine prevalence of COVID-19 in pediatric tonsillectomy
Pamela Mudd1,2, Nahir Romero1,2, Hengameh Behzadpour1
1Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA.
Insights
Nearly 20% of children undergoing tonsillectomy showed prior COVID-19 infection, often without awareness. This study highlights disparities and confirms immune responses in blood and tonsil tissue.
Area of Science:
- Pediatric immunology
- Infectious diseases
- Epidemiology
Background:
- COVID-19 (Coronavirus Disease 2019) significantly impacted global health, including pediatric populations.
- Understanding the prevalence and immune response to SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) in children is crucial.
- Tonsillectomy provides a unique opportunity to study localized immune responses in the upper respiratory tract.
Purpose of the Study:
- To determine the prevalence of prior COVID-19 infection in children undergoing tonsillectomy.
- To assess B cell immune responses to SARS-CoV-2 in peripheral blood and tonsil tissue.
- To investigate potential ethnic and socioeconomic disparities in COVID-19 prevalence among pediatric patients.
Main Methods:
- A cohort of 100 children undergoing tonsillectomy at a tertiary pediatric hospital was recruited.
- Serum, peripheral blood cells, and tonsil tissue were collected and analyzed for SARS-CoV-2 specific immune reactivity.
- Parent-reported clinical histories were correlated with antibody and B-cell responses.
Main Results:
- 19% of the cohort (19 out of 100 children) exhibited immune responses indicating prior COVID-19.
- SARS-CoV-2 specific B cells were detected in both peripheral blood and tonsil tissue of seropositive children.
- A significant proportion of infected children (63%) were unaware of a prior COVID-19 diagnosis; 74% of infected children were Hispanic, and 100% resided in high-poverty zip codes.
Conclusions:
- Prior COVID-19 infection was prevalent in nearly one-fifth of children undergoing tonsillectomy, with most being asymptomatic or unaware.
- The study identified significant ethnic and socioeconomic disparities in COVID-19 prevalence.
- Concordant humoral immune responses in blood and tonsil tissue suggest localized immunity in the upper respiratory tract.
Objective:
To determine the prevalence of COVID-19 in a cohort of children undergoing tonsillectomy through assessment of B cell immune responses to SARS-CoV-2 in both peripheral blood and tonsil tissue.
Methods:
In this cohort study at a tertiary pediatric hospital (Children's National Hospital) in Washington, DC, we recruited 100 children undergoing tonsillectomy from late September 2020 to January 2021. Serum, peripheral blood cells, and tonsil tissue were collected and examined for immune reactivity to SARS-CoV-2. Parent-reported clinical histories were compared to antibody and B-cell responses.
Results:
Among 100 children undergoing tonsillectomy, 19% had evidence of immune responses to SARS-CoV-2 (CoV2+), indicating prior COVID-19. In all seropositive participants, we detected SARS-CoV-2 specific B cells in both peripheral blood mononuclear cells and tonsils, providing evidence for tissue-specific immunity in these children. Of the 19, 63% reported no known history of COVID-19, and an additional 3 were asymptomatic or unaware of an acute infection when detected on pre-surgery screen. Hispanic children represented 74% of CoV2+ subjects compared to 37% of the full cohort. 100% of CoV2+ children lived in a zip code with poverty level >10%.
Conclusions:
Nearly one-fifth of children undergoing tonsillectomy at an urban U.S. hospital had evidence of prior COVID-19 during the early pandemic, with the majority unaware of prior infection. Our results underscore the ethnic and socio-economic disparities of COVID-19. We found concordant evidence of humoral immune responses in children in both blood and tonsil tissue, providing evidence of local immune responses in the upper respiratory tract.
Level Of Evidence:
3 Laryngoscope, 133:1993-1999, 2023.
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