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National and regional prevalence of SARS-CoV-2 antibodies in primary and secondary school children in England: the School Infection Survey, a national open cohort study, November 2021SARS-CoV-2 antibody prevalence in school children.

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journal contribution
posted on 2023-04-05, 13:40 authored by Annabel A Powell, Georgina Ireland, Rebecca Leeson, Andrea Lacey, Ben Ford, John Poh, Samreen Ijaz, Justin Shute, Peter Cherepanov, Richard Tedder, Christian Bottomley, Fiona Dawe, Punam Mangtani, Peter Jones, Patrick Nguipdop-Djomo, Shamez N Ladhani, COVID-19 Schools Infection Survey Group, Shazaad Ahmad, Frances Baawuah, Joanne Beckmann, Andrew Brent, Bernadette Brent, Joanna Garstang, Ifeanyichukwu O Okike, Kevin Brown, Mary Ramsay, Chris Bonell, Sarah Cook, Charlotte Warren-Gash, Jody Phelan, James Hargreaves, Sinead Langan, Neisha Sundaram, Elliot McClenaghan, Gillian McKay, John Edmunds, Paul Fine
BACKGROUND: SARS-CoV-2 infection rates are likely to be underestimated in children because of asymptomatic or mild infections. We aim to estimate national and regional prevalence of SARS-CoV-2 antibodies in primary (4-11-year-olds) and secondary (11-18-year-olds) school children between 10 November and 10 December 2021. METHODS: Cross-sectional surveillance in England using two stage sampling, firstly stratifying into regions and selecting local authorities, then selecting schools according to a stratified sample within selected local authorities. Participants were sampled using a novel oral fluid validated assay for SARS-CoV-2 spike and nucleocapsid IgG antibodies. RESULTS: 4,980 students from 117 state-funded schools (2,706 from 83 primary schools, 2,274 from 34 secondary schools) provided a valid sample. After weighting for age, sex and ethnicity, and adjusting for assay accuracy, the national prevalence of SARS-CoV-2 antibodies in primary school students, who were all unvaccinated, was 40.1% (95%CI; 37.3-43.0). Antibody prevalence increased with age (p<0.001) and were higher in urban than rural schools (p=0.01). In secondary school students, the adjusted, weighted national prevalence of SARS-CoV-2 antibodies was 82.4% (95%CI; 79.5-85.1); including 71.5% (95%CI; 65.7-76.8) in unvaccinated and 97.5% (95%CI; 96.1-98.5) in vaccinated students. Antibody prevalence increased with age (p<0.001), and was not significantly different in urban versus rural students (p=0.1). CONCLUSIONS: In November 2021, using a validated oral fluid assay, national SARS-CoV-2 seroprevalence was estimated to be 40.1% in primary school students and 82.4% in secondary school students. In unvaccinated children this was approximately three-fold higher than confirmed infections highlighting the importance of seroprevalence studies to estimate prior exposure. DATA AVAILABILITY: De-identified study data are available for access by accredited researchers in the ONS Secure Research Service (SRS) for accredited research purposes under part 5, chapter 5 of the Digital Economy Act 2017. For further information about accreditation, contact or visit the SRS website.


Crick (Grant ID: 10061, Grant title: Cherepanov FC001061)