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. 2020 Dec:227:31-37.e1.
doi: 10.1016/j.jpeds.2020.08.078. Epub 2020 Sep 3.

Kinetics of Viral Clearance and Antibody Production Across Age Groups in Children with Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Burak Bahar  1 , Cyril Jacquot  2 , Yunchuan D Mo  2 , Roberta L DeBiasi  3 , Joseph Campos  2 , Meghan Delaney  2
Affiliations

Kinetics of Viral Clearance and Antibody Production Across Age Groups in Children with Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Burak Bahar et al. J Pediatr. 2020 Dec.

Abstract

Objectives: To improve understanding of transition from viral infection to viral clearance, and antibody response in pediatric patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Study design: This retrospective analysis of children tested for SARS-CoV-2 by reverse transcription (RT) polymerase chain reaction (PCR) and immunoglobulin G antibody at a quaternary-care, free-standing pediatric hospital between March 13, 2020, and June 21, 2020, included 6369 patients who underwent PCR testing and 215 patients who underwent antibody testing. During the initial study period, testing focused primarily on symptomatic children; the later study period included asymptomatic patients who underwent testing as preadmission or preprocedural screening. We report the proportion of positive and negative tests, time to viral clearance, and time to seropositivity.

Results: The rate of positivity varied over time due to viral circulation in the community and transition from targeted testing of symptomatic patients to more universal screening of hospitalized patients. Median duration of viral shedding (RT-PCR positivity) was 19.5 days and time from RT-PCR positivity to negativity was 25 days. Of note, patients aged 6 through 15 years demonstrated a longer time of RT-PCR positivity to negativity, compared with patients aged 16 through 22 years (median 32 vs 18 days, P = .015). Median time to seropositivity, by chemiluminescent testing, from RT-PCR positivity was 18 days, whereas median time to reach adequate levels of neutralizing antibodies (defined as comparable with 160 titer by plaque reduction neutralization testing) was 36 days.

Conclusions: The majority of patients demonstrated a prolonged period of viral shedding after infection with SARS CoV-2. It is unknown whether this correlates with persistent infectivity. Only 17 of 33 patients demonstrated adequate neutralizing antibodies during the time frame of specimen collection. It remains unknown whether immunoglobulin G antibody against spike structured proteins correlates with immunity, and how long antibodies and potential protection persist.

Keywords: COVID-19; SARS-CoV-2 infection; age; children; sex.

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Figures

Figure 2
Figure 2
Number of molecular (RT-PCR) and serologic tests performed during the study period.
Figure 3
Figure 3
Participant flow in the study.
Figure 4
Figure 4
Time-to-event curves for RT-PCR positivity to negativity.
Figure 5
Figure 5
Time-to-event curves for RT-PCR positivity to seropositivity (Anti-SARS-CoV-2 IgG antibody ≥15 AU/mL).
Figure 6
Figure 6
Time-to-event curves for RT-PCR positivity to reach neutralizing antibody levels (Anti-SARS-CoV-2 IgG antibody ≥80 AU/mL).
Figure 1
Figure 1
Age distribution of the patients who underwent molecular and serology testing.
See this image and copyright information in PMC

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References

    1. Zhou P., Yang X.L., Wang X.G., Hu B., Zhang L., Zhang W. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579:270–273. - PMC - PubMed
    1. World Health Organization . World Health Organization; Geneva, Switzerland: 2020. WHO Director-General's opening remarks at the media briefing on COVID-19-11 March 2020.
    1. Chen Y., Liu Q., Guo D. Emerging coronaviruses: genome structure, replication, and pathogenesis. J Med Virol. 2020;92:418–423. - PMC - PubMed
    1. Wu C., Liu Y., Yang Y., Zhang P., Zhong W., Wang Y. Analysis of therapeutic targets for SARS-CoV-2 and discovery of potential drugs by computational methods. Acta Pharm Sin B. 2020;10:766–788. - PMC - PubMed
    1. Walls A.C., Park Y.J., Tortorici M.A., Wall A., McGuire A.T., Veesler D. Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein. Cell. 2020;181:281–292.e6. - PMC - PubMed