Seroprevalence and Clinical Characteristics of SARS-CoV-2 Infection in
Children with Cystic Fibrosis
Abstract
Background: People with cystic fibrosis (PwCF) have chronic
lung disease and may be at increased risk of COVID-19-related morbidity
and mortality. This study aimed to determine seroprevalence and clinical
characteristics of SARS-CoV-2 infection in children with CF, and to
assess antibody responses following SARS-CoV-2 infection or vaccination.
Methods: Children and adolescents with CF followed at Seattle
Children’s Hospital were enrolled between July 20, 2020 and February 28,
2021. SARS-CoV-2 serostatus was determined on enrollment, at 6 and 11
months (+/-2 months) for nucleocapsid and spike IgG. Participants
completed intake and weekly surveys inquiring about SARS-CoV-2
exposures, viral/respiratory illnesses, and symptoms. Results:
Of 125 PwCF enrolled, 14 (11%) had positive SARS-CoV-2 antibodies
consistent with recent or past infection. Seropositive participants were
more likely to identify as Hispanic (29% vs 8%, p=0.04) and have
pulmonary exacerbations requiring oral antibiotics in the year prior
(71% vs 41%, p = 0.04). Five seropositive individuals (35.7%) were
asymptomatic, while six (42.9%) reported mild symptoms, primarily cough
and nasal congestion. Anti-spike protein IgG levels were approximately
10-fold higher in participants following vaccination compared with
participants who had natural infection alone (p < 0.0001) and
resembled levels previously reported in the general population.
Conclusions: A majority of PwCF have mild or no symptoms of
SARS-CoV-2 making it difficult to distinguish from baseline respiratory
symptoms. Hispanic PwCF may be disproportionately impacted, consistent
with racial and ethnic COVID-19 disparities among the general US
population. Vaccination in PwCF generated antibody responses similar to
those previously reported in the general population.