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 childrenMore about Open Access at the Crick
Authors listAnnabel 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
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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 Research.email@example.com or visit the SRS website.
Journal Journal of Infection
Issue number 4