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. 2021 Mar 1;4(3):e214302.
doi: 10.1001/jamanetworkopen.2021.4302.

Association of Age With SARS-CoV-2 Antibody Response

He S Yang  1   2 , Victoria Costa  1   2 , Sabrina E Racine-Brzostek  1   2 , Karen P Acker  3 , Jim Yee  2 , Zhengming Chen  4 , Mohsen Karbaschi  5 , Robert Zuk  5 , Sophie Rand  1 , Ashley Sukhu  1 , P J Klasse  6 , Melissa M Cushing  1   2 , Amy Chadburn  1   2 , Zhen Zhao  1   2
Affiliations

Association of Age With SARS-CoV-2 Antibody Response

He S Yang et al. JAMA Netw Open. .

Abstract

Importance: Accumulating evidence suggests that children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are more likely to manifest mild symptoms and are at a lower risk of developing severe respiratory disease compared with adults. It remains unknown how the immune response in children differs from that of adolescents and adults.

Objective: To investigate the association of age with the quantity and quality of SARS-CoV-2 antibody responses.

Design, setting, and participants: This cross-sectional study used 31 426 SARS-CoV-2 antibody test results from pediatric and adult patients. Data were collected from a New York City hospital from April 9 to August 31, 2020. The semiquantitative immunoglobin (Ig) G levels were compared between 85 pediatric and 3648 adult patients. Further analysis of SARS-CoV-2 antibody profiles was performed on sera from 126 patients aged 1 to 24 years.

Main outcomes and measures: SARS-CoV-2 antibody positivity rates and IgG levels were evaluated in patients from a wide range of age groups (1-102 years). SARS-CoV-2 IgG level, total antibody (TAb) level, surrogate neutralizing antibody (SNAb) activity, and antibody binding avidity were compared between children (aged 1-10 years), adolescents (aged 11-18 years), and young adults (aged 19-24 years).

Results: Among 31 426 antibody test results (19 797 [63.0%] female patients), with 1194 pediatric patients (mean [SD] age, 11.0 [5.3] years) and 30 232 adult patients (mean [SD] age, 49.2 [17.1] years), the seroprevalence in the pediatric (197 [16.5%; 95% CI, 14.4%-18.7%]) and adult (5630 [18.6%; 95% CI, 18.2%-19.1%]) patient populations was similar. The SARS-CoV-2 IgG level showed a negative correlation with age in the pediatric population (r = -0.45, P < .001) and a moderate but positive correlation with age in adults (r = 0.24, P < .001). Patients aged 19 to 30 years exhibited the lowest IgG levels (eg, aged 25-30 years vs 1-10 years: 99 [44-180] relative fluorescence units [RFU] vs 443 [188-851] RFU). In the subset cohort aged 1 to 24 years, IgG, TAb, SNAb and avidity were negatively correlated with age (eg, IgG: r = -0.51; P < .001). Children exhibited higher median (IQR) IgG levels, TAb levels, and SNAb activity compared with adolescents (eg, IgG levels: 473 [233-656] RFU vs 191 [82-349] RFU; P < .001) and young adults (eg, IgG levels: 473 [233-656] RFU vs 85 [38-150] RFU; P < .001). Adolescents also exhibited higher median (IQR) TAb levels, IgG levels, and SNAb activity than young adults (eg, TAb levels: 961 [290-2074] RFU vs 370 [125-697]; P = .006). In addition, children had higher antibody binding avidity compared with young adults, but the difference was not significant.

Conclusions and relevance: The results of this study suggest that SARS-CoV-2 viral specific antibody response profiles are distinct in different age groups. Age-targeted strategies for disease screening and management as well as vaccine development may be warranted.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Zhao reported receiving nonfinancial support in the form of seed instruments and sponsored travel from ET Healthcare during the conduct of the study and receiving grants from Siemens and Polymedco and personal fees from Roche outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Test Frequencies and Positivity Rates from April 9 to August 31, 2020
Figure 2.
Figure 2.. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Immunoglobin (Ig) G Levels From 85 Positive Pediatric and 3648 Positive Adult Patient Samples Measured on a Single Platform From April 9 to June 21, 2020
B, Whiskers indicate SD. RFU indicates relative fluorescence units.
Figure 3.
Figure 3.. Comprehensive Assessment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Antibodies in 126 Patients Aged 1 to 24 Years
%B/B0 indicates percentage of angiotensin-converting enzyme 2 protein and receptor-binding domain (RBD) binding; IgG, immuglobin G; RFU, relative fluorescence units.
Figure 4.
Figure 4.. Comparison of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Antibodies in Children (Aged 1-10 Years), Adolescents (Aged 11-18 Years), and Young Adults (Aged 19-24 Years)
Center horizontal lines indicate mean, with whiskers indicating SD; %B/B0, percentage of angiotensin-converting enzyme 2 protein and receptor-binding domain (RBD) binding; IgG, immunoglobin G; RFU, relative fluorescence units.
See this image and copyright information in PMC

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