Longitudinal change in SARS-CoV-2 seroprevalence in 3-to 16-year-old children: The Augsburg Plus study

BackgroundCurrently, more than 30,200,000 COVID-19 cases have been diagnosed in Germany alone. However, data regarding prevalence of COVID-19 in children, both in Germany and internationally, are sparse. We sought to evaluate the number of infected children by measuring IgG antibodies. MethodsOropharyngeal swabs were collected between December 2020 and August 2021 to measure SARS-CoV-2, and capillary blood for the detection of SARS-CoV-2 antibodies (by rapid test NADAL (R) and filter paper test Euroimmun (R) ELISA); venous blood was taken for validation (Roche (R) ECLIA and recomLine Blot) in 365 German children aged 3-16 years from 30 schools and preschools. We used multiple serological tests because the filter paper test Euroimmun (R) ELISA performs better in terms of sensitivity and specificity than the rapid test NADAL (R). The Roche (R) ECLIA test is used to detect SARS-CoV-2 spike protein, and the recomLine Blot test is used to rule out the possibility of infection by seasonal SARS-viruses and to test for specific SARS-CoV-2 proteins (NP, RBD and S1). In addition, one parent each (n = 336), and 4-5 teachers/caregivers (n = 90) per institution were tested for IgG antibodies from capillary blood samples. The total study duration was 4 months per child, including the first follow-up after 2 months and the second after 4 months. ResultsOf 364 children tested at baseline, 3.6% (n = 13) were positive for SARS-CoV-2 IgG antibodies using Euroimmun (R) ELISA. Seven children reported previously testing positive for SARS-CoV-2; each of these was confirmed by the Roche (R) Anti-SARS-CoV-2-ECLIA (antibody to spike protein 1) test. SARS-CoV-2 IgG antibodies persisted over a 4-month period, but levels decreased significantly (p = 0.004) within this timeframe. The median IgG values were 192.0 BAU/ml [127.2; 288.2], 123.6 BAU/ml [76.6; 187.7] and 89.9 BAU/ml [57.4; 144.2] at baseline, 2 months and 4 months after baseline, respectively. During the study period, no child tested positive for SARS-CoV-2 by oropharyngeal swab. A total of 4.3% of all parents and 3.7% of teachers/caregivers tested positive for IgG antibodies by Euroimmun (R) ELISA at baseline. ConclusionWe noted a rather low seroprevalence in children despite an under-reporting of SARS-CoV-2 infections. Measurement of IgG antibodies derived from capillary blood appears to be a valid tool to detect asymptomatic infections in children. However, no asymptomatic active infection was detected during the study period of 4 months in the whole cohort. Further data on SARS-CoV-2 infections in children are needed, especially in the group of <5-year-olds, as there is currently no licensed vaccine for this age group in Germany. The Robert Koch Institute's Standing Commission on Vaccination (STIKO) recommended COVID-19 vaccination for 12-17 and 5-11 year olds in August 2021 and May 2022 respectively.

Automated summary

This study aimed to evaluate the prevalence of COVID-19 infection in German children. It found a relatively low seroprevalence in children, despite under-reporting of cases. Measurement of IgG antibodies in capillary blood appeared to be an effective tool for detecting asymptomatic infections in children. However, no asymptomatic active infections were detected during the 4-month study period in the whole cohort.