Diseases (Aug 2024)

Evaluating Immunologic and Illness Outcomes of SARS-CoV-2 Infection in Vaccinated and Unvaccinated Children Aged ≥ 5 Years, in a Multisite Longitudinal Cohort

  • Cynthia Porter,
  • Zoe L. Lyski,
  • Jennifer L. Uhrlaub,
  • Katherine D. Ellingson,
  • Zuha Jeddy,
  • Lisa Gwynn,
  • Patrick Rivers,
  • Ryan Sprissler,
  • Kurt T. Hegmann,
  • Melissa M. Coughlin,
  • Ashley L. Fowlkes,
  • James Hollister,
  • Lindsay LeClair,
  • Josephine Mak,
  • Shawn C. Beitel,
  • Sammantha Fuller,
  • Pearl Q. Zheng,
  • Molly Vaughan,
  • Ramona P. Rai,
  • Lauren Grant,
  • Gabriella Newes-Adeyi,
  • Young M. Yoo,
  • Lauren Olsho,
  • Jefferey L. Burgess,
  • Alberto J. Caban-Martinez,
  • Sarang K. Yoon,
  • Amadea Britton,
  • Manjusha Gaglani,
  • Andrew L. Phillips,
  • Matthew S. Thiese,
  • Melissa Briggs Hagen,
  • Jefferson M. Jones,
  • Karen Lutrick

DOI
https://doi.org/10.3390/diseases12080171
Journal volume & issue
Vol. 12, no. 8
p. 171

Abstract

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Hybrid immunity, as a result of infection and vaccination to SARS-CoV-2, has been well studied in adults but limited evidence is available in children. We evaluated the antibody responses to primary SARS-CoV-2 infection among vaccinated and unvaccinated children aged ≥ 5 years. Methods: A longitudinal cohort study of children aged ≥ 5 was conducted during August 2021–August 2022, at sites in Arizona, Texas, Utah, and Florida. Children submitted weekly nasal swabs for PCR testing and provided sera 14–59 days after PCR-confirmed SARS-CoV-2 infection. Antibodies were measured by ELISA against the receptor-binding domain (RBD) and S2 domain of ancestral Spike (WA1), in addition to Omicron (BA.2) RBD, following infection in children, with and without prior monovalent ancestral mRNA COVID-19 vaccination. Results: Among the 257 participants aged 5 to 18 years, 166 (65%) had received at least two mRNA COVID-19 vaccine doses ≥ 14 days prior to infection. Of these, 53 occurred during Delta predominance, with 37 (70%) unvaccinated at the time of infection. The remaining 204 infections occurred during Omicron predominance, with 53 (26%) participants unvaccinated. After adjusting for weight, age, symptomatic infection, and gender, significantly higher mean RBD AUC values were observed among the vaccinated group compared to the unvaccinated group for both WA1 and Omicron (p p = 0.021). Conclusions: Children with vaccine-induced immunity at the time of SARS-CoV-2 infection had higher antibody levels during convalescence and experienced less fever compared to unvaccinated children during infection.

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