Immunocompromised Seroprevalence and Course of Illness of SARS-CoV-2 in One Pediatric Quaternary Care Center

J Pediatric Infect Dis Soc. 2021 Apr 30;10(4):426-431. doi: 10.1093/jpids/piaa123.


Background: The burden of coronavirus disease 2019 (COVID-19) is poorly understood in pediatric patients due to frequent asymptomatic and mild presentations. Additionally, the disease prevalence in pediatric immunocompromised patients remains unknown.

Methods: This cross-sectional study tested convenience samples from pediatric patients who had clinically indicated lab work collected and an immunocompromising condition, including oncologic diagnoses, solid organ transplant (SOT), bone marrow transplant, primary immunodeficiency, and rheumatologic conditions or inflammatory bowel disease on systemic immunosuppression, for the presence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Results: We tested sera from 485 children and observed SARS-CoV-2 seroprevalence of 1.0% (Confidence Interval [CI] 95%: 0.3%-2.4%). Two patients were positive by nasopharyngeal (NP) swab Reverse transcriptase polymerase chain reaction (RT-PCR), but only 1 seroconverted. Patients with oncologic diagnoses or SOT were most likely to be tested for COVID-19 when presenting with respiratory illness as compared with other groups.

Conclusions: Seroprevalence of antibodies to SARS-CoV-2 in immunocompromised children was similar to that of an immunocompetent pediatric population (0.6%, CI 95%: 0.3%-1.1%), suggesting an adequate antibody response. However, none of the patients who tested positive for antibodies or via NP RT-PCR had more than a mild illness course and 2 patients did not have any reported illness, suggesting that SARS-CoV-2 may not cause a worse clinical outcome in immunosuppressed children, in contrast to immunocompromised adults.

Keywords: COVID-19; SARS-CoV-2; immunocompromised; pediatric; serology.

MeSH terms

  • Adolescent
  • Antibodies, Viral / blood
  • COVID-19 / diagnosis
  • COVID-19 / epidemiology*
  • COVID-19 / immunology*
  • COVID-19 Nucleic Acid Testing
  • Child
  • Child, Preschool
  • Female
  • Hospitals, Pediatric
  • Humans
  • Immunocompromised Host
  • Immunoglobulin G / blood
  • Infant
  • Male
  • Pennsylvania / epidemiology
  • SARS-CoV-2
  • Seroepidemiologic Studies
  • Spike Glycoprotein, Coronavirus / immunology


  • Antibodies, Viral
  • Immunoglobulin G
  • Spike Glycoprotein, Coronavirus
  • spike protein, SARS-CoV-2