A cross-sectional investigation of SARS-CoV-2 seroprevalence and associated risk factors in children and adolescents in the United States. Academic Article uri icon


  • BACKGROUND: Pediatric SARS-CoV-2 data remain limited and seropositivity rates in children were reported as <1% early in the pandemic. Seroepidemiologic evaluation of SARS-CoV-2 in children in a major metropolitan region of the US was performed. METHODS: Children and adolescents 19 years were enrolled in a cross-sectional, observational study of SARS-CoV-2 seroprevalence from July-October 2020 in Northern Virginia, US. Demographic, health, and COVID-19 exposure information was collected, and blood analyzed for SARS-CoV-2 spike protein total antibody. Risk factors associated with SARS-CoV-2 seropositivity were analyzed. Orthogonal antibody testing was performed, and samples were evaluated for responses to different antigens. RESULTS: In 1038 children, the anti-SARS-CoV-2 total antibody positivity rate was 8.5%. After multivariate logistic regression, significant risk factors included Hispanic ethnicity, public or absent insurance, a history of COVID-19 symptoms, exposure to person with COVID-19, a household member positive for SARS-CoV-2 and multi-family or apartment dwelling without a private entrance. 66% of seropositive children had no symptoms of COVID-19. Secondary analysis included orthogonal antibody testing with assays for 1) a receptor binding domain specific antigen and 2) a nucleocapsid specific antigen had concordance rates of 80.5% and 79.3% respectively. CONCLUSIONS: A much higher burden of SARS-CoV-2 infection, as determined by seropositivity, was found in children than previously reported; this was also higher compared to adults in the same region at a similar time. Contrary to prior reports, we determined children shoulder a significant burden of COVID-19 infection. The role of children's disease transmission must be considered in COVID-19 mitigation strategies including vaccination.

published proceedings

  • PLoS One

altmetric score

  • 0.75

author list (cited authors)

  • Levorson, R. E., Christian, E., Hunter, B., Sayal, J., Sun, J., Bruce, S. A., ... Hourigan, S. K.

citation count

  • 17

complete list of authors

  • Levorson, Rebecca E||Christian, Erica||Hunter, Brett||Sayal, Jasdeep||Sun, Jiayang||Bruce, Scott A||Garofalo, Stephanie||Southerland, Matthew||Ho, Svetlana||Levy, Shira||Defillipi, Christopher||Peake, Lilian||Place, Frederick C||Hourigan, Suchitra K

editor list (cited editors)

  • Nasrallah, G. K.

publication date

  • January 2021