Abstract
Children are strikingly underrepresented in COVID-19 case counts. In the United States, children represent 22% of the population but only 1.7% of confirmed SARS-CoV-2 cases as of April 2, 2020. One possibility is that symptom-based viral testing is less likely to identify infected children, since they often experience milder disease than adults. Here, to better assess the frequency of pediatric SARS-CoV-2 infection, we serologically screen 1,775 residual samples from Seattle Children’s Hospital collected from 1,076 children seeking medical care during March and April of 2020. Only one child was seropositive in March, but seven were seropositive in April for a period seroprevalence of ≈1%. Most seropositive children (6/8) were not suspected of having had COVID-19. The sera of seropositive children have neutralizing activity, including one that neutralized at a dilution > 1:18,000. Therefore, an increasing number of children seeking medical care were infected by SARS-CoV-2 during the early Seattle outbreak despite few positive viral tests.
Highlights
Children are strikingly underrepresented in COVID-19 case counts
We serologically screened 1775 residual serum samples from Seattle Children’s Hospital that were collected between March 3 and April 24, 2020 following approval from the Human Subjects Institutional Review Board. These samples were collected from 1076 unique children who visited the hospital and received blood draws for any reason, including respiratory illnesses, surgery, or ongoing medical care
We used a multi-assay serological testing approach based on an enzyme-linked immunosorbent assay (ELISA) protocol that recently received emergency use authorization from New York State and the FDA15,16, we increased stringency by adding a second-validation ELISA and confirming putative seropositives with the Abbott SARS-CoV-2 IgG chemiluminescent microparticle immunoassay (CMIA), which identifies IgG antibodies to the nucleocapsid protein, and has been shown to have 99.9% specificity and 100% sensitivity for samples taken greater than 17 days post symptom onset[17]
Summary
Children are strikingly underrepresented in COVID-19 case counts. In the United States, children represent 22% of the population but only 1.7% of confirmed SARS-CoV-2 cases as of April 2, 2020. We first screened all sera at a 1:50 dilution in an ELISA for IgG binding to the SARS-CoV-2 spike receptor-binding domain (RBD) and compared the results to a negative control consisting of a pool of sera collected in 2017 and 2018 (Fig. 1a).
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