Research Technician Columbia University Irving Medical Center New York, New York, United States
Background: Severe COVID-19 in adults is associated with high levels of SARS-CoV-2 specific antibodies in plasma and the airway. While children have largely fared better during acute infection, rare cases of COVID-19 respiratory failure do occur. Children are known to produce decreased amounts and breadth of antibodies following SARS-CoV-2 infection, but defining the local pediatric immune response to COVID-19 is challenging due to limited access to airway samples during acute infection. Objective: We sought to determine if local and systemic antibody responses during acute COVID-19 was associated with respiratory failure in children. Design/Methods: We recruited children (n=22, median age 7 years; range 0.02-17) admitted to the Morgan Stanley Children’s Hospital of New York (Columbia University Irving Medical Center/New York Presbyterian) for acute COVID-19. Subjects were separated into respiratory failure requiring non-invasive (BiPAP/CPAP) or invasive mechanical ventilation (n=9) versus non-respiratory failure (n=13) cohorts for analysis. Adults (n=10, median age 57 years; range 18-95) admitted for COVID-19 respiratory failure were used as a comparator group. We performed enzyme-linked immunosorbent assays (ELISA) on airway and plasma samples to quantify levels of anti-Spike (S) and anti-Nucleocapsid (N) IgG, IgA, and IgM antibodies across cohorts. Results: Children who developed respiratory failure had similar levels of anti-S and anti-N IgG, IgM, and IgA antibodies compared to children who did not have respiratory failure. Compared to adults, children had lower amounts of anti-S and anti-N IgG and IgM levels in both plasma and the airway. Interestingly, levels of anti-S IgA were similar between children and adults.
Conclusion(s): These results indicate that antibody levels in children are not associated with development of respiratory failure during acute COVID-19 presentation. Decreased antibody levels in children is consistent with prior reports, however the similar levels of anti-S IgA, the principal mediator of protection at mucosal sites, suggests children may prioritize localized immune responses.
