Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Jun:257:113358.
doi: 10.1016/j.jpeds.2023.02.005. Epub 2023 Feb 22.

Leveraging Serologic Testing to Identify Children at Risk For Post-Acute Sequelae of SARS-CoV-2 Infection: An Electronic Health Record-Based Cohort Study from the RECOVER Program

Asuncion Mejias  1 , Julia Schuchard  2 , Suchitra Rao  3 , Tellen D Bennett  3 , Ravi Jhaveri  4 , Deepika Thacker  5 , L Charles Bailey  2 , Dimitri A Christakis  6 , Nathan M Pajor  7 , Hanieh Razzaghi  2 , Christopher B Forrest  2 , Grace M Lee  8
Affiliations
Case Reports

Leveraging Serologic Testing to Identify Children at Risk For Post-Acute Sequelae of SARS-CoV-2 Infection: An Electronic Health Record-Based Cohort Study from the RECOVER Program

Asuncion Mejias et al. J Pediatr. 2023 Jun.

Abstract

Using an electronic health record-based algorithm, we identified children with Coronavirus disease 2019 (COVID-19) based exclusively on serologic testing between March 2020 and April 2022. Compared with the 131 537 polymerase chain reaction-positive children, the 2714 serology-positive children were more likely to be inpatients (24% vs 2%), to have a chronic condition (37% vs 24%), and to have a diagnosis of multisystem inflammatory syndrome in children (23% vs <1%). Identification of children who could have been asymptomatic or paucisymptomatic and not tested is critical to define the burden of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 infection in children.

Keywords: COVID-19 serology; PEDSnet; anti-N antibodies; anti-S antibodies; chronic COVID-19 syndrome; late sequelae of COVID-19; long COVID; long-haul COVID-19; long-term COVID-19; post-acute COVID-19; post-acute sequelae of COVID-19; post-acute sequelae of SARS-CoV-2 infection; post–COVID-19 syndrome.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Number and positivity rates of SARS-CoV-2 antibody tests performed during the COVID-19 pandemic. A, Monthly number of serologic tests performed with a valid (positive or negative) result. The y-axis represents the number of tests performed by type of test over time (x-axis). Other serologic tests include undifferentiated IgG (the vast majority) and IgA tests. B, Monthly percentage of positive test results by type of test are plotted on the y-axis. IgG anti-N antibodies are depicted in red, IgM antibodies are in blue, IgG anti-S/RBD antibodies are in green and other serology tests, including undifferentiated IgG and IgA anti-SARS-CoV-2, are in purple. IgM positivity rates increased from 7% pre-alpha (March 2020 to February 2021) to 14% in the alpha phase, 15% in the delta phase, and 13% in the omicron phase (P < .001). The increase was also significant for IgG anti-N, IgG anti-S/RBD, and other serologic tests as the pandemic evolved (P < .001). C, Percentage of serologic tests with positive results by month (IgG anti-N in red, undifferentiated IgG in blue; IgG anti-S/RBD in green) according to age, stratified in 4 groups: <5 years, 5-11 years, 12-15 years, and 16-< 21 years. Vertical lines indicate the date of vaccine approval for each specific group.
Figure 2
Figure 2
Flow diagram of patient selection based on serology and PCR testing. Of all patients with a COVID-19 test performed, after excluding missing data and negative or inconclusive results, 135 661 patients had a positive test result (97% by PCR and 3% by serology testing exclusively). Of these, one-third were excluded after applying age-specific cutoffs for vaccine approval.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Hanson K.E., Caliendo A.M., Arias C.A., Englund J.A., Lee M.J., Loeb M., et al. Infectious Diseases Society of America guidelines on the diagnosis of COVID-19. Clin Infect Dis. 2020:ciab048. - PMC - PubMed
    1. Godfred-Cato S., Bryant B., Leung J., Oster M.E., Conklin L., Abrams J., et al. COVID-19-associated multisystem inflammatory syndrome in children–United States, March-July 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1074–1080. - PMC - PubMed
    1. Hanson K.E., Caliendo A.M., Arias C.A., Englund J.A., Hayden M.K., Lee M.J., et al. Infectious diseases Society of America guidelines on the diagnosis of COVID-19:serologic testing. Clin Infect Dis. 2020:ciaa1343. - PMC - PubMed
    1. Forrest C.B., Burrows E.K., Mejias A., Razzaghi H., Christakis D., Jhaveri R., et al. Severity of acute COVID-19 in children <18 years old March 2020 to December 2021. Pediatrics. 2022;149 e2021055765. - PubMed
    1. Forrest C.B., Margolis P., Seid M., Colletti R.B. PEDSnet: how a prototype pediatric learning health system is being expanded into a national network. Health Aff. 2014;33:1171–1177. - PubMed

Publication types

Substances

Supplementary concepts