Abstract
Children are strikingly underrepresented in COVID-19 case counts1–3. In the United States, children represent 22% of the population but only 1.7% of confirmed SARS-CoV-2 cases1. One possibility is that symptom-based viral testing is less likely to identify infected children, since they often experience milder disease than adults1,4–7. To better assess the frequency of pediatric SARS-CoV-2 infection, we serologically screened 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 had 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.
Competing Interest Statement
H.Y.C. is a consultant for Merck and Glaxo Smith Kline and receives research funding from Sanofi Pasteur, outside of the submitted work. N.P.K. is a co-founder, shareholder, and chair of the scientific advisory board of Icosavax, Inc. Mount Sinai has licensed serological assays to commercial entities and has filed for patent protection for serological assays. J.A.E. is a consultant for Sanofi Pasteur and Meissa Vaccines. The other authors declare no conflicts of interest.
Funding Statement
This work was supported by the NIAID / NIH (R01AI141707 and R01AI140891 to J.D.B., HHSN272201700059C to D.V., and F30AI149928 to K.H.D.C.), the NIMGS/NIH (R01GM120553 to D.V.), the Bill & Melinda Gates Foundation (OPP1156262 to N.P.K.), a Pew Biomedical Scholars Award (to D.V.) and Burroughs Wellcome Investigators in the Pathogenesis of Infectious Diseases awards (to D.V. and J.D.B.). J.D.B. is an Investigator of the Howard Hughes Medical Institute. Work in the Krammer laboratory was partially supported by the NIAID Centers of Excellence for Influenza Research and Surveillance (CEIRS) contract HHSN272201400008C, Collaborative Influenza Vaccine Innovation Centers (CIVIC) contract 75N93019C00051 and philanthropic donations.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
The sample collection and this study were approved by the Institutional Review Boards of Seattle Children's Hospital and the University of Washington.
All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.
Yes
Data Availability
Data are available a supplemental files posted with this pre-print.
