Coronavirus antibody screening identifies children with mild to moderate
courses of PMIS
Abstract
Background: Children are affected rather mildly by the acute phase of
COVID-19, but predominantly in children and youths, the potentially
severe and life threatening pediatric multiorgan immune syndrome (PMIS)
occurs later on. To identify children at risk early on, we searched for
antibodies against SARS-CoV-2 and searched for early and mild symptoms
of PMIS in those with high levels of antibodies. Methods: In a
cross-sectional design, children aged 1-17 were recruited through
primary care pediatricians for the study (a), if they had an appointment
for a regular health check-up or (b), or if parents and children
volunteered to participate in the study. Two antibody tests were
performed in parallel and children with antibody levels
>97th percentile (in the commercially available test) were
screened for signs and symptoms of PMIS and SARS-CoV-2 neutralization
tests were performed. Results: We identified antibodies against
SARS-CoV-2 in 162 of 2832 eligible children (5.7%) between June and
July 2020 in three, in part strongly affected regions of Bavaria.
Approximately 60% of antibody positive children showed high levels of
antibodies. In those who participated in the follow up screening, 30%
showed some mild and minor symptoms similar to Kawasaki disease and in
three children, cardiac and neuropsychological symptoms were identified.
Symptoms correlated with high levels of non-neutralizing and
concomitantly low levels of neutralizing antibodies and lower
neutralizing capacity. Conclusions: Children exposed to SARS-CoV-2
should be screened for antibodies and those children with positive
antibody responses should undergo a stepwise assessment for late
COVID-19 effects.