In:
Pediatrics, American Academy of Pediatrics (AAP), Vol. 146, No. 6 ( 2020-12-01)
Abstract:
We aimed to measure severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological responses in children hospitalized with multisystem inflammatory syndrome in children (MIS-C) compared with those with coronavirus disease 2019 (COVID-19), those with Kawasaki disease (KD), and hospitalized pediatric controls. METHODS: From March 17, 2020, to May 26, 2020, we prospectively identified hospitalized children with MIS-C (n = 10), symptomatic COVID-19 (n = 10), and KD (n = 5) and hospitalized controls (n = 4) at Children’s Healthcare of Atlanta. With institutional review board approval, we obtained prospective and residual blood samples from these children and measured SARS-CoV-2 spike receptor-binding domain (RBD) immunoglobulin M and immunoglobulin G (IgG), full-length spike IgG, and nucleocapsid protein antibodies using quantitative enzyme-linked immunosorbent assays and SARS-CoV-2 neutralizing antibodies using live-virus focus-reduction neutralization assays. We statistically compared the log-transformed antibody titers among groups and performed linear regression analyses. RESULTS: All children with MIS-C had high titers of SARS-CoV-2 RBD IgG antibodies, which correlated with full-length spike IgG antibodies (R2 = 0.956; P & lt; .001), nucleocapsid protein antibodies (R2 = 0.846; P & lt; .001), and neutralizing antibodies (R2 = 0.667; P & lt; .001). Children with MIS-C had significantly higher SARS-CoV-2 RBD IgG antibody titers (geometric mean titer 6800; 95% confidence interval 3495–13 231) than children with COVID-19 (geometric mean titer 626; 95% confidence interval 251–1563; P & lt; .001), children with KD (geometric mean titer 124; 95% confidence interval 91–170; P & lt; .001), and hospitalized controls (geometric mean titer 85; P & lt; .001). All children with MIS-C also had detectable RBD immunoglobulin M antibodies, indicating recent SARS-CoV-2 infection. RBD IgG titers correlated with the erythrocyte sedimentation rate (R2 = 0.512; P & lt; .046) and with hospital (R2 = 0.548; P = .014) and ICU lengths of stay (R2 = 0.590; P = .010). CONCLUSIONS: Quantitative SARS-CoV-2 serology may have a role in establishing the diagnosis of MIS-C, distinguishing it from similar clinical entities, and stratifying risk for adverse outcomes.
Type of Medium:
Online Resource
ISSN:
0031-4005
,
1098-4275
DOI:
10.1542/peds.2020-018242
Language:
English
Publisher:
American Academy of Pediatrics (AAP)
Publication Date:
2020
detail.hit.zdb_id:
1477004-0
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