Cross-reactive immunity against the SARS-CoV-2 Omicron variant is low in pediatric patients with prior COVID-19 or MIS-C

Juanjie Tang; Tanya Novak; Julian Hecker; Gabrielle Grubbs; Fatema Tuz Zahra; Lorenza Bellusci; Sara Pourhashemi; Janet Chou; Kristin Moffitt; Natasha B Halasa; Stephanie P Schwartz; Tracie C Walker; Keiko M Tarquinio; Matt S Zinter; Mary A Staat; Shira J Gertz; Natalie Z Cvijanovich; Jennifer E Schuster; Laura L Loftis; Bria M Coates; Elizabeth H Mack; Katherine Irby; Julie C Fitzgerald; Courtney M Rowan; Michele Kong; Heidi R Flori; Aline B Maddux; Steven L Shein; Hillary Crandall; Janet R Hume; Charlotte V Hobbs; Adriana H Tremoulet; Chisato Shimizu; Jane C Burns; Sabrina R Chen; Hye Kyung Moon; Christoph Lange; Adrienne G Randolph; Surender Khurana

doi:10.1038/s41467-022-30649-1

Cross-reactive immunity against the SARS-CoV-2 Omicron variant is low in pediatric patients with prior COVID-19 or MIS-C

Nat Commun. 2022 May 27;13(1):2979. doi: 10.1038/s41467-022-30649-1.

Authors

Juanjie Tang^#¹, Tanya Novak^#^{2

3}, Julian Hecker^#⁴, Gabrielle Grubbs^#¹, Fatema Tuz Zahra¹, Lorenza Bellusci¹, Sara Pourhashemi¹, Janet Chou^{5

6}, Kristin Moffitt^{5

7}, Natasha B Halasa⁸, Stephanie P Schwartz⁹, Tracie C Walker⁹, Keiko M Tarquinio¹⁰, Matt S Zinter¹¹, Mary A Staat¹², Shira J Gertz¹³, Natalie Z Cvijanovich¹⁴, Jennifer E Schuster¹⁵, Laura L Loftis¹⁶, Bria M Coates¹⁷, Elizabeth H Mack¹⁸, Katherine Irby¹⁹, Julie C Fitzgerald²⁰, Courtney M Rowan²¹, Michele Kong²², Heidi R Flori²³, Aline B Maddux²⁴, Steven L Shein²⁵, Hillary Crandall²⁶, Janet R Hume²⁷, Charlotte V Hobbs²⁸, Adriana H Tremoulet²⁹, Chisato Shimizu²⁹, Jane C Burns²⁹, Sabrina R Chen², Hye Kyung Moon², Christoph Lange³⁰, Adrienne G Randolph^{2

3

5}, Surender Khurana³¹

Affiliations

¹ Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, 20993, USA.
² Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, 02115, USA.
³ Department of Anesthesia, Harvard Medical School, Boston, MA, 02115, USA.
⁴ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
⁵ Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
⁶ Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
⁷ Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, 02115, USA.
⁸ Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
⁹ Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital, Chapel Hill, NC, 27514, USA.
¹⁰ Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA.
¹¹ Department of Pediatrics, Divisions of Critical Care and Bone Marrow Transplantation, University of California, San Francisco, San Francisco, CA, 94158, USA.
¹² Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
¹³ Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, NJ, 07039, USA.
¹⁴ Division of Critical Care Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, CA, 94609, USA.
¹⁵ Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, 64108, USA.
¹⁶ Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA.
¹⁷ Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA.
¹⁸ Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA.
¹⁹ Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR, 72202, USA.
²⁰ Division of Critical Care, Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA.
²¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, 46202, USA.
²² Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, 35233, USA.
²³ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children's Hospital and University of Michigan, Ann Arbor, MI, 48109, USA.
²⁴ Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, 80045, USA.
²⁵ Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, 44106, USA.
²⁶ Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, 84113, USA.
²⁷ Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, 55454, USA.
²⁸ Department of Pediatrics, Department of Microbiology, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, 39202, USA.
²⁹ Kawasaki Disease Research Center, Rady Children's Hospital and Department of Pediatrics, UCSD School of Medicine, La Jolla, CA, 92093, USA.
³⁰ Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
³¹ Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, 20993, USA. Surender.Khurana@fda.hhs.gov.

^# Contributed equally.

Abstract

Neutralization capacity of antibodies against Omicron after a prior SARS-CoV-2 infection in children and adolescents is not well studied. Therefore, we evaluated virus-neutralizing capacity against SARS-CoV-2 Alpha, Beta, Gamma, Delta and Omicron variants by age-stratified analyses (<5, 5-11, 12-21 years) in 177 pediatric patients hospitalized with severe acute COVID-19, acute MIS-C, and in convalescent samples of outpatients with mild COVID-19 during 2020 and early 2021. Across all patients, less than 10% show neutralizing antibody titers against Omicron. Children <5 years of age hospitalized with severe acute COVID-19 have lower neutralizing antibodies to SARS-CoV-2 variants compared with patients >5 years of age. As expected, convalescent pediatric COVID-19 and MIS-C cohorts demonstrate higher neutralization titers than hospitalized acute COVID-19 patients. Overall, children and adolescents show some loss of cross-neutralization against all variants, with the most pronounced loss against Omicron. In contrast to SARS-CoV-2 infection, children vaccinated twice demonstrated higher titers against Alpha, Beta, Gamma, Delta and Omicron. These findings can influence transmission, re-infection and the clinical disease outcome from emerging SARS-CoV-2 variants and supports the need for vaccination in children.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adolescent
Antibodies, Viral
COVID-19* / complications
Child
Child, Preschool
Humans
Membrane Glycoproteins
Neutralization Tests
SARS-CoV-2*
Spike Glycoprotein, Coronavirus
Systemic Inflammatory Response Syndrome
Viral Envelope Proteins

Substances

Antibodies, Viral
Membrane Glycoproteins
Spike Glycoprotein, Coronavirus
Viral Envelope Proteins
spike protein, SARS-CoV-2

Supplementary concepts

SARS-CoV-2 variants
pediatric multisystem inflammatory disease, COVID-19 related

Abstract

Publication types

MeSH terms

Substances

Supplementary concepts

Grants and funding