Endemic coronavirus infections are associated with strong homotypic immunity in a US cohort of children from birth to 4 years

Ardythe L Morrow; Daniel C Payne; Shannon C Conrey; Meredith McMorrow; Monica M McNeal; Liang Niu; Allison R Burrell; Elizabeth P Schlaudecker; Claire Mattison; Rachel M Burke; Emily DeFranco; Zheyi Teoh; Jens Wrammert; Lydia J Atherton; Natalie J Thornburg; Mary A Staat

doi:10.1093/jpids/piae016

Endemic coronavirus infections are associated with strong homotypic immunity in a US cohort of children from birth to 4 years

J Pediatric Infect Dis Soc. 2024 Mar 5:piae016. doi: 10.1093/jpids/piae016. Online ahead of print.

Authors

Ardythe L Morrow^{1

2}, Daniel C Payne³, Shannon C Conrey^{1

2}, Meredith McMorrow³, Monica M McNeal¹, Liang Niu², Allison R Burrell^{1

2}, Elizabeth P Schlaudecker¹, Claire Mattison³, Rachel M Burke³, Emily DeFranco⁴, Zheyi Teoh¹, Jens Wrammert^{5

6}, Lydia J Atherton³, Natalie J Thornburg³, Mary A Staat¹

Affiliations

¹ Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
² Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
³ Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁴ Department of Obstetrics & Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
⁵ Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA.
⁶ Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, USA.

PMID: 38442245
DOI: 10.1093/jpids/piae016

Abstract

Background: The endemic coronaviruses OC43, HKU1, NL63 and 229E cause cold-like symptoms and are related to SARS-CoV-2, but their natural histories are poorly understood. In a cohort of children followed from birth to 4 years, we documented all coronavirus infections, including SARS-CoV-2, to understand protection against subsequent infections with the same virus (homotypic immunity) or a different coronavirus (heterotypic immunity).

Methods: Mother-child pairs were enrolled in metropolitan Cincinnati during the third trimester of pregnancy in 2017-18. Mothers reported their child's socio-demographics, risk factors, and weekly symptoms. Mid-turbinate nasal swabs were collected weekly. Blood was collected at 6 weeks, 6, 12, 18, 24 months and annually thereafter. Infections were detected by testing nasal swabs by an RT-PCR multi-pathogen panel and by serum IgG responses. Health care visits were documented from pediatric records. Analysis was limited to 116 children with high sample adherence. Re-consent for monitoring SARS-CoV-2 infections from June 2020 through November 2021 was obtained for 74 (64%) children.

Results: We detected 345 endemic coronavirus infections (1.1 infections/child-year) and 21 SARS-CoV-2 infections (0.3 infections/child-year). Endemic coronavirus and SARS-CoV-2 infections were asymptomatic or mild. Significant protective homotypic immunity occurred after a single infection with OC43 (77%) and HKU1 (84%), and after two infections with NL63 (73%). No heterotypic protection against endemic coronaviruses or SARS-CoV-2 was identified.

Conclusions: Natural coronavirus infections were common and resulted in strong homotypic immunity but not heterotypic immunity against other coronaviruses, including SARS-CoV-2. Endemic coronavirus and SARS-CoV-2 infections in this US cohort were typically asymptomatic or mild.

Keywords: 229E; HKU1; NL63; OC43; SARS-CoV-2; birth cohort; endemic coronaviruses; immunity; natural history; pediatrics; preventive efficacy.

© The Author(s) 2024. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.