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Seroprevalence of SARS-CoV-2 in self-reported COVID-19-free children
Hsiao-Lun Huang1, Chun-Yi Lu2, Yun-Chung Liu2
1Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Many children have undetected COVID-19 (SARS-CoV-2) infections, with serological evidence revealing prior exposure. Household contact, especially with mothers, significantly increases the risk of infection in children.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Epidemiology
Background:
- COVID-19 (Coronavirus disease 2019) presents significant risks to children.
- Undetected cases of SARS-CoV-2 (Severe acute respiratory syndrome-related coronavirus 2) infection in children complicate disease burden assessment.
- This study addresses the gap in understanding asymptomatic or unreported pediatric infections.
Purpose of the Study:
- To determine the proportion of children with serological evidence of prior SARS-CoV-2 infection despite reporting no previous diagnosis.
- To identify risk factors associated with seropositivity in children.
Main Methods:
- Recruitment of children under 19 years old with no reported history of SARS-CoV-2 infection (November 2022 - February 2023).
- SARS-CoV-2 antibody testing for IgG antibodies against nucleocapsid (N) and spike (S) proteins.
- Collection of demographic and household contact information.
Main Results:
- Overall anti-N antibody positivity was 9.2% (24/260) in children reporting no prior infection, with rates varying by age (4%-25%).
- Household contact, particularly with mothers, significantly elevated the likelihood of antibody positivity.
- The cumulative infection rate reached 41.9% by January 2024 for children initially negative for anti-N antibodies.
Conclusions:
- Previously undisclosed SARS-CoV-2 infections are common in children.
- Household transmission is a major driver of pediatric COVID-19 seropositivity.
- Clinicians should maintain vigilance for SARS-CoV-2 in children, even those without reported prior exposure.
Introduction:
COVID-19 poses risks and leads to complications for vulnerable populations, including children. Unreported cases of COVID-19 among children hinder our understanding of the true disease burden. In this study, we aimed to investigate the proportion of children who report no prior infection to SARS-CoV-2 but who nevertheless exhibit serological evidence of prior infection.
Methods:
Between November 2022 and February 2023, we recruited children and adolescents under 19 years of age who lacked a prior history of SARS-CoV-2 infection. Participants underwent SARS-CoV-2 antibody testing to assess the presence of IgG antibodies specific to nucleocapsid (N) and spike (S) proteins. Demographic and contact information were also collected.
Results:
Among 260 COVID-19-free children, the overall anti-N antibody positivity rate, which varied across age groups (4%-25%), was 9.2% (24/260). Contact with individuals who were positive for COVID-19, particularly the children's mothers, significantly increased the likelihood of antibody positivity. The median age of the 34 children who remained unvaccinated against COVID-19 was lower than that of the children who were vaccinated (6.5 vs. 9 years; p < 0.001). Until January 2024, the overall infection rate was 41.9% (99/236) among children who were negative for anti-N antibodies, irrespective of vaccination status or the presence of chronic disease.
Conclusion:
We discovered previously undisclosed cases of SARS-CoV-2 infection among children. The risk of seropositivity increases substantially with household contact. Regarding children who report no prior exposure to COVID-19, clinicians must remain vigilant, as SARS-CoV-2 remains a concern.
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