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. 2023 Feb:56:101786.
doi: 10.1016/j.eclinm.2022.101786. Epub 2022 Dec 28.

SARS-CoV-2 seroprevalence in children worldwide: A systematic review and meta-analysis

Reza Naeimi  1 , Mahdi Sepidarkish  2 , Abolfazl Mollalo  3 , Hamid Parsa  4 , Sanaz Mahjour  5 , Fatemeh Safarpour  1 , Mustafa Almukhtar  6 , Amal Mechaal  7 , Hiam Chemaitelly  8   9   10 , Behnam Sartip  5 , Elika Marhoommirzabak  4 , Ali Ardekani  11 , Peter J Hotez  12 , Robin B Gasser  13 , Ali Rostami  1
Affiliations

SARS-CoV-2 seroprevalence in children worldwide: A systematic review and meta-analysis

Reza Naeimi et al. EClinicalMedicine. 2023 Feb.

Abstract

Background: The higher hospitalisation rates of those aged 0-19 years (referred to herein as 'children') observed since the emergence of the immune-evasive SARS-CoV-2 Omicron variant and subvariants, along with the persisting vaccination disparities highlighted a need for in-depth knowledge of SARS-CoV-2 sero-epidemiology in children. Here, we conducted this systematic review to assess SARS-CoV-2 seroprevalence and determinants in children worldwide.

Methods: In this systematic review and meta-analysis study, we searched international and preprinted scientific databases from December 1, 2019 to July 10, 2022. Pooled seroprevalences were estimated according to World Health Organization (WHO) regions (at 95% confidence intervals, CIs) using random-effects meta-analyses. Associations with SARS-CoV-2 seroprevalence and sources of heterogeneity were investigated using sub-group and meta-regression analyses. The protocol used in this study has been registered in PROSPERO (CRD42022350833).

Findings: We included 247 studies involving 757,075 children from 70 countries. Seroprevalence estimates varied from 7.3% (5.8-9.1%) in the first wave of the COVID-19 pandemic to 37.6% (18.1-59.4%) in the fifth wave and 56.6% (52.8-60.5%) in the sixth wave. The highest seroprevalences in different pandemic waves were estimated for South-East Asia (17.9-81.8%) and African (17.2-66.1%) regions; while the lowest seroprevalence was estimated for the Western Pacific region (0.01-1.01%). Seroprevalence estimates were higher in children at older ages, in those living in underprivileged countries or regions, and in those of minority ethnic backgrounds.

Interpretation: Our findings indicate that, by the end of 2021 and before the Omicron wave, around 50-70% of children globally were still susceptible to SARS-CoV-2 infection, clearly emphasising the need for more effective vaccines and better vaccination coverage among children and adolescents, particularly in developing countries and minority ethnic groups.

Funding: None.

Keywords: COVID-19; Children; Meta-analysis; SARS-CoV-2; Seroprevalence; Serum antibodies.

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Conflict of interest statement

All authors declare no competing interests. Prof. Hotez is a co-inventor of a COVID-19 recombinant protein vaccine technology owned by Baylor College of Medicine (BCM) that was recently licensed by Baylor Ventures non-exclusively and with no patent restrictions to several companies committed to advance vaccines for low- and middle-income countries. These include Biological E (India–CORBEVAX) and BioFarma (Indonesia–INDOVAC), Incepta (Bangladesh). He has no involvement in license negotiations conducted by BCM. Similar to other research universities, a long-standing BCM policy provides its faculty and staff, who make discoveries and that result in a commercial license, a share of any royalty income. To date, BCM has not distributed any royalty income to the co-inventors on the COVID-19 recombinant protein vaccine technology.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart—showing the literature search strategy and the numbers of peer-reviewed articles included in, and excluded from, this study.
Fig. 2
Fig. 2
Meta-regression analyses of SARS-CoV-2 seroprevalence data for children (0–19 years of age) in eligible, peer-reviewed and published studies according to: (A) start date of sampling (showing a statistically significant upward trend in seroprevalence during pandemic waves), (B) end date of sampling (showing a statistically significant upward trend in seroprevalence during pandemic waves), (C) country's income status (showing a statistically significant downward trend in seroprevalence in countries with higher level of income), and (D) human development index (HDI) (showing a statistically significant downward trend in seroprevalence in countries with higher HDIs).
Fig. 3
Fig. 3
Display of geographically referenced SARS-CoV-2 seroprevalence in children (0–19 years) worldwide—based on data from eligible, peer-reviewed studies published from December 1, 2019 to July 10, 2022.
See this image and copyright information in PMC

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