. 2023 Jan 19;108(2):123-130.

doi: 10.1136/archdischild-2022-324375.

Community seroprevalence of SARS-CoV-2 in children and adolescents in England, 2019-2021

Helen Ratcliffe¹, K S Tiley², Nick Andrews³, Gayatri Amirthalingam⁴, I Vichos², E Morey², N L Douglas², S Marinou², Emma Plested², Parvinder Aley², Eva P Galiza⁵, Saul N Faust^{6

7}, S Hughes⁸, Clare S Murray^{8

9}, Marion Roderick¹⁰, Fiona Shackley¹¹, Sam J Oddie¹², Tim Lees¹³, D P J Turner¹⁴, M Raman¹⁵, Stephen Owens^{16

17}, Paul Turner¹⁸, H Cockerill¹⁹, J Lopez Bernal⁴, E Linley²⁰, Ray Borrow²⁰, Kevin Brown²¹, Mary Elizabeth Ramsay⁴, M Voysey², Matthew D Snape²

Affiliations

¹ Department of Paediatrics, University of Oxford, Oxford, UK helen.ratcliffe@paediatrics.ox.ac.uk.
² Department of Paediatrics, University of Oxford, Oxford, UK.
³ Statistics, Modelling and Economics Department, Health Protection Agency, London, UK.
⁴ Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK.
⁵ St George's Vaccine Institute, St. George's University Hospitals NHS Foundation Trust, London, UK.
⁶ Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
⁷ NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁸ Department of Paediatrics, Royal Manchester Children's Hospital, Manchester, UK.
⁹ Respiratory Group, University of Manchester, Manchester, UK.
¹⁰ Paediatric Infectious Diseases and Immunology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
¹¹ Immunology, Allergy and Infectious Diseases, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK.
¹² Bradford Neonatology, Bradford Teaching Hospitals NHS Foundation Trust, West Yorkshire, UK.
¹³ Paediatric Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹⁴ School of Life Sciences, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁵ Department of Paediatrics, University Hospitals Plymouth NHS Trust, Plymouth, UK.
¹⁶ Paediatric Immunology and Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
¹⁷ Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
¹⁸ Section of Paediatrics, Imperial College London, London, UK.
¹⁹ Department of Paediatrics, West Suffolk NHS Foundation Trust, Bury Saint Edmunds, UK.
²⁰ Vaccine Evaluation Unit, UK Health Security Agency, London, UK.
²¹ Virus Reference Department, Public Health England, Colindale, UK.

PMID: 35858775
PMCID: PMC9887370
DOI: 10.1136/archdischild-2022-324375

Community seroprevalence of SARS-CoV-2 in children and adolescents in England, 2019-2021

Helen Ratcliffe et al. Arch Dis Child. 2023.

. 2023 Jan 19;108(2):123-130.

doi: 10.1136/archdischild-2022-324375.

Authors

Affiliations

¹ Department of Paediatrics, University of Oxford, Oxford, UK helen.ratcliffe@paediatrics.ox.ac.uk.
² Department of Paediatrics, University of Oxford, Oxford, UK.
³ Statistics, Modelling and Economics Department, Health Protection Agency, London, UK.
⁴ Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK.
⁵ St George's Vaccine Institute, St. George's University Hospitals NHS Foundation Trust, London, UK.
⁶ Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
⁷ NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁸ Department of Paediatrics, Royal Manchester Children's Hospital, Manchester, UK.
⁹ Respiratory Group, University of Manchester, Manchester, UK.
¹⁰ Paediatric Infectious Diseases and Immunology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
¹¹ Immunology, Allergy and Infectious Diseases, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK.
¹² Bradford Neonatology, Bradford Teaching Hospitals NHS Foundation Trust, West Yorkshire, UK.
¹³ Paediatric Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹⁴ School of Life Sciences, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁵ Department of Paediatrics, University Hospitals Plymouth NHS Trust, Plymouth, UK.
¹⁶ Paediatric Immunology and Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
¹⁷ Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
¹⁸ Section of Paediatrics, Imperial College London, London, UK.
¹⁹ Department of Paediatrics, West Suffolk NHS Foundation Trust, Bury Saint Edmunds, UK.
²⁰ Vaccine Evaluation Unit, UK Health Security Agency, London, UK.
²¹ Virus Reference Department, Public Health England, Colindale, UK.

PMID: 35858775
PMCID: PMC9887370
DOI: 10.1136/archdischild-2022-324375

Abstract

Objective: To understand community seroprevalence of SARS-CoV-2 in children and adolescents. This is vital to understanding the susceptibility of this cohort to COVID-19 and to inform public health policy for disease control such as immunisation.

Design: We conducted a community-based cross-sectional seroprevalence study in participants aged 0-18 years old recruiting from seven regions in England between October 2019 and June 2021 and collecting extensive demographic and symptom data. Serum samples were tested for antibodies against SARS-CoV-2 spike and nucleocapsid proteins using Roche assays processed at UK Health Security Agency laboratories. Prevalence estimates were calculated for six time periods and were standardised by age group, ethnicity and National Health Service region.

Results: Post-first wave (June-August 2020), the (anti-spike IgG) adjusted seroprevalence was 5.2%, varying from 0.9% (participants 10-14 years old) to 9.5% (participants 5-9 years old). By April-June 2021, this had increased to 19.9%, varying from 13.9% (participants 0-4 years old) to 32.7% (participants 15-18 years old). Minority ethnic groups had higher risk of SARS-CoV-2 seropositivity than white participants (OR 1.4, 95% CI 1.0 to 2.0), after adjusting for sex, age, region, time period, deprivation and urban/rural geography. In children <10 years, there were no symptoms or symptom clusters that reliably predicted seropositivity. Overall, 48% of seropositive participants with complete questionnaire data recalled no symptoms between February 2020 and their study visit.

Conclusions: Approximately one-third of participants aged 15-18 years old had evidence of antibodies against SARS-CoV-2 prior to the introduction of widespread vaccination. These data demonstrate that ethnic background is independently associated with risk of SARS-CoV-2 infection in children.

Trial registration number: NCT04061382.

Keywords: COVID-19; epidemiology; healthcare disparities; paediatrics.

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Conflict of interest statement

Competing interests: MDS acts on behalf of the University of Oxford as an investigator on studies funded or sponsored by vaccine manufacturers, including AstraZeneca, GlaxoSmithKline, Pfizer, Novavax, Janssen, Medimmune and MCM. He receives no personal financial payment for this work. SNF acts on behalf of University Hospital Southampton National Health Service (NHS) Foundation Trust as an investigator or providing consultative advice, or both, on clinical trials and studies of COVID-19 and other vaccines funded or sponsored by vaccine manufacturers including Janssen, Pfizer, AstraZeneca, GlaxoSmithKline, Novavax, Seqirus, Sanofi, Medimmune, Merck and Valneva. He receives no personal financial payment for this work. MR and EL, through the Immunisation Department, provide vaccine manufacturers (including Pfizer) with post-marketing surveillance reports about pneumococcal and meningococcal disease which the companies are required to submit to the UK Licensing authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports. PA acts on behalf of the University of Oxford as the director of operations at the Oxford Vaccine Group and has received funding from the Vaccine Taskforce via the NIHR and AstraZeneca.

Figures

**Figure 1**
Overall SARS-CoV-2 seroprevalence (RocheS (anti-SARS-CoV-2 IgG spike protein antibodies) and RocheN (anti-SARS-CoV-2 IgG nucleocapsid antibodies)) by time period October 2019–June 2021 in England, adjusted for age, National Health Service region and ethnicity. Error bars indicate 95% CI. (1) First national lockdown came into force (26 March 2020). Schools closed with only children of key workers attending school. (2) Phased reopening of schools (1 June 2020). Pupils aged 5, 6 and 11 years returned to school. 16- and 18-year-olds were allowed to attend in limited times. (3) Variant of concern – B.1.1.7 (Alpha) first detected in the UK and sequenced in September 2020. (4) Second national lockdown came into force (5th November 2020). Schools closed with only children of key workers attending school (5) Second national lockdown came to an end (2 December 2020) (6) Variant of concern B.1.351 (Beta) variant first detected in South Africa and was first sequenced in December 2020. (7) Third national lockdown came into force (6 January 2021). Schools closed with only children of key workers attending school. (8) Variant of concern – P.1 (Gamma) first detected in Japan in travellers from Brazil in January 2021 and was first detected in the UK in February 2021. (9) Primary and secondary schools reopen in England (8 March 2021). (10) Variant of concern B.1.617.2 (Delta) variant first detected in India were first detected in the United Kingdom in mid-April 2021. All legal limits on social contact removed (21 June 2021).

**Figure 2**
SARS-CoV-2 seroprevalence (RocheS (anti-SARS-CoV-2 IgG spike protein antibodies) and RocheN (anti-SARS-CoV-2 IgG nucleocapsid antibodies)) by age group and time period October 2019–June 2021 in England, adjusted for National Health Service region and ethnicity. Error bars indicate 95% CI.

**Figure 3**
SARS-CoV-2 seroprevalence (RocheS (anti-SARS-CoV-2 IgG spike protein antibodies) and RocheN (anti-SARS-CoV-2 IgG nucleocapsid antibodies)) by region and time period October 2019–June 2021 in England, adjusted for age and ethnicity. Error bars indicate 95% CI.

**Figure 4**
Summary of symptoms reported by participants seropositive on RocheS (anti-SARS-CoV-2 IgG spike protein antibodies) by age group.

See this image and copyright information in PMC

References

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Community seroprevalence of SARS-CoV-2 in children and adolescents in England, 2019-2021

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Community seroprevalence of SARS-CoV-2 in children and adolescents in England, 2019-2021

Authors

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Conflict of interest statement

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