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Cooper DM, Zulu MZ, Jankeel A, Ibraim IC, Ardo J, Kasper K, Stephens D, Meyer A, Stehli A, Condon C, Londoño ME, Schreiber CM, Lopez NV, Camplain RL, Weiss M, Golden C, Radom-Aizik S, Boden-Albala B, Chau C, Messaoudi I, Ulloa ER. SARS-CoV-2 acquisition and immune pathogenesis among school-aged learners in four diverse schools. Pediatr Res 2021; 90:1073-1080. [PMID: 34304252 PMCID: PMC8308070 DOI: 10.1038/s41390-021-01660-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Understanding SARS-CoV-2 infection in children is necessary to reopen schools safely. METHODS We measured SARS-CoV-2 infection in 320 learners [10.5 ± 2.1 (sd); 7-17 y.o.] at four diverse schools with either remote or on-site learning. Schools A and B served low-income Hispanic learners; school C served many special-needs learners, and all provided predominantly remote instruction. School D served middle- and upper-income learners, with predominantly on-site instruction. Testing occurred in the fall (2020), and 6-8 weeks later during the fall-winter surge (notable for a tenfold increase in COVID-19 cases). Immune responses and mitigation fidelity were also measured. RESULTS We found SARS-CoV-2 infections in 17 learners only during the surge. School A (97% remote learners) had the highest infection (10/70, 14.3%, p < 0.01) and IgG positivity rates (13/66, 19.7%). School D (93% on-site learners) had the lowest infection and IgG positivity rates (1/63, 1.6%). Mitigation compliance [physical distancing (mean 87.4%) and face-covering (91.3%)] was remarkably high at all schools. Documented SARS-CoV-2-infected learners had neutralizing antibodies (94.7%), robust IFN-γ + T cell responses, and reduced monocytes. CONCLUSIONS Schools can implement successful mitigation strategies across a wide range of student diversity. Despite asymptomatic to mild SARS-CoV-2 infection, children generate robust humoral and cellular immune responses. IMPACT Successful COVID-19 mitigation was implemented across a diverse range of schools. School-associated SARS-CoV-2 infections reflect regional rates rather than remote or on-site learning. Seropositive school-aged children with asymptomatic to mild SARS-CoV-2 infections generate robust humoral and cellular immunity.
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Affiliation(s)
- Dan M Cooper
- Institute for Clinical and Translational Science, University of California Irvine, Irvine, CA, USA
- Department of Pediatrics, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Michael Z Zulu
- Center for Virus Research, University of California Irvine, School of Biological Sciences, Irvine, CA, USA
| | - Allen Jankeel
- Center for Virus Research, University of California Irvine, School of Biological Sciences, Irvine, CA, USA
| | - Izabela Coimbra Ibraim
- Center for Virus Research, University of California Irvine, School of Biological Sciences, Irvine, CA, USA
| | - Jessica Ardo
- Children's Hospital of Orange County, Orange, CA, USA
| | | | - Diana Stephens
- Institute for Clinical and Translational Science, University of California Irvine, Irvine, CA, USA
| | - Andria Meyer
- Institute for Clinical and Translational Science, University of California Irvine, Irvine, CA, USA
| | - Annamarie Stehli
- Department of Pediatrics, Pediatric Exercise and Genomics Research Center, University of California Irvine, Irvine, CA, USA
| | - Curt Condon
- Orange County Health Care Agency, Santa Ana, CA, USA
| | - Mary E Londoño
- University of California Irvine School of Medicine, Irvine, CA, USA
| | - Casey M Schreiber
- Children's Hospital of Orange County, Orange, CA, USA
- University of California Irvine Health, Orange, CA, USA
| | - Nanette V Lopez
- Department of Health Sciences, Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, USA
| | - Ricky L Camplain
- Department of Health Sciences, Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, USA
| | - Michael Weiss
- Children's Hospital of Orange County, Orange, CA, USA
| | | | - Shlomit Radom-Aizik
- Department of Pediatrics, Pediatric Exercise and Genomics Research Center, University of California Irvine, Irvine, CA, USA
| | | | - Clayton Chau
- Orange County Health Care Agency, Santa Ana, CA, USA
| | - Ilhem Messaoudi
- Center for Virus Research, University of California Irvine, School of Biological Sciences, Irvine, CA, USA
| | - Erlinda R Ulloa
- Department of Pediatrics, University of California Irvine School of Medicine, Irvine, CA, USA.
- Children's Hospital of Orange County, Orange, CA, USA.
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