SARS-CoV-2 and serological responses in a South African birth cohort

The epidemiology of SARS-CoV-2 in children, spectrum of illness and risk factors are poorly understood. Further, recent data suggest that prior endemic coronavirus infection (nHCoV) may protect against SARS-CoV-2 infection or disease. We will leverage the Drakenstein Child Health Study birth cohort, capitalizing on a very well phenotyped population with high cohort retention, comprehensive longitudinal measurement of risk factors and a large biobank of samples, to prospectively investigate the epidemiology and risk factors for COVID-19 in children and serological responses (including false-positive testing with SARS-CoV-2 assays and cross-protective immunity). Further, since we have longitudinally documented infection with the four endemic coronaviruses in this cohort, we are uniquely placed to investigate the potential protective effect of nHCoV infection on SARSCoV-2. All children in the Drakenstein cohort (n=900) will have study visits at three timepoints (0, 3 and 6 months) to collect clinical and risk factor data and specimens (nasal and serum) for SARS-CoV-2 testing. Children with intercurrent illness will also have nasal, blood and an induced sputum specimen collected and tested. Risk factors for infection or disease will be collected, including environmental, nutritional, sociodemographic, maternal health, infectious exposures (including TB infection) and underlying illness. We will also test the most recent biobanked serum from each child collected before the COVID-19 epidemic (before March 2020) as well as selected biobanked convalescent serum samples from children with confirmed recent endemic (-229E, -NL63, -OC43, and -HKU1) coronavirus infection with serological tests for SARS-CoV-2, to investigate cross-reactive antibody responses and potential protection against SARS-CoV-2.