Rapsinski Glenn J, Freeman Megan Culler, Haidar Ghady, Belle Steven H, Hasskamp Joanne H, Wheeler Sarah E
UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, Division of Infectious Diseases, Pittsburgh, PA USA.
Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA USA.
J Clin Virol Plus. 2021 Sep;1(3):100026. doi: 10.1016/j.jcvp.2021.100026. Epub 2021 Jun 9.
Children infected with SARS-CoV-2 are often asymptomatic or have only mild symptoms, leading to underestimation of disease prevalence in symptom-based testing strategies.
This study sought to determine pediatric SARS-CoV-2 disease burden during local mitigation efforts by using antibody testing to compare seroprevalence estimates to cumulative PCR prevalence estimates.
In this cross-sectional study, we collected 1142 strict phase and 1196 relaxed phase remnant blood specimens from patients less than 19-years-old in southwestern Pennsylvania (SWPA). Patients were excluded if their residential zip code was outside the region of interest, if they were under 6-months-old, or they had recently received antibody-modifying treatments. Demographic, encounter, and laboratory electronic medical record information was extracted. Samples were tested for SARS-CoV-2 spike protein IgG using an EUA ELISA, and PCR results were recorded from county health department data. Seroprevalence and Clopper-Pearson exact 95% confidence intervals were calculated.
The observed seroprevalence of SARS-CoV-2 spike protein antibodies in children during strictest mitigation was 0.53% (95% CI 0.19, 1.14) and 0.92% (95% CI 0.46,1.64) during moderately relaxed. Strict and relaxed phase PCR-based prevalence were significantly higher, 2.87% (95% CI 1.95, 4.08) and 3.64 (95% CI 3.01, 4.38), respectively.
Estimates of pediatric seroprevalence were significantly lower than cumulative PCR prevalence estimates, and less than adult seroprevalence estimates, potentially due to biological, population, or sampling differences. Biological differences in pediatric immune responses to SARS-CoV-2 may make serosurvey interpretation challenging and these differences warrant further study.
感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的儿童通常无症状或仅有轻微症状，这导致基于症状的检测策略低估了疾病流行率。
本研究旨在通过抗体检测将血清流行率估计值与累积聚合酶链反应（PCR）流行率估计值进行比较，以确定在当地缓解措施实施期间儿童SARS-CoV-2的疾病负担。
在这项横断面研究中，我们从宾夕法尼亚州西南部（SWPA）19岁以下患者中收集了1142份严格阶段和1196份宽松阶段的残余血液样本。如果患者的居住邮政编码不在感兴趣区域内、年龄在6个月以下或最近接受过抗体修饰治疗，则将其排除。提取了人口统计学、就诊情况和实验室电子病历信息。使用紧急使用授权酶联免疫吸附测定法（EUA ELISA）检测样本中的SARS-CoV-2刺突蛋白IgG，并从县卫生部门数据中记录PCR结果。计算血清流行率和克洛普-皮尔逊精确95%置信区间。
在最严格的缓解措施期间，儿童中观察到的SARS-CoV-2刺突蛋白抗体血清流行率为0.53%（95%置信区间0.19，1.14），在适度宽松期间为0.92%（95%置信区间0.46，1.64）。基于PCR的严格阶段和宽松阶段流行率显著更高，分别为2.87%（95%置信区间1.95，4.08）和3.64（95%置信区间3.01，4.38）。
儿童血清流行率估计值显著低于累积PCR流行率估计值，且低于成人血清流行率估计值，这可能是由于生物学、人群或抽样差异所致。儿童对SARS-CoV-2免疫反应的生物学差异可能使血清学调查结果的解释具有挑战性，这些差异值得进一步研究。
