To investigate the spectrum, determinants and long-term outcome of SARS-CoV-2 in African children, immune responses and protective role of prior sHCoV

To prospectively investigate SARS-CoV-2 in African children, we will leverage 2 ongoing cohorts: (i) the Drakenstein Child Health Study (DCHS), a birth cohort study with comprehensive longitudinal measurement of risk factors, a very well phenotyped population and large biobank of samples. Children will be followed for 3 study visits with repeated sampling through the epidemic and at any intercurrent illness. (ii) study of children hospitalized with pneumonia at the largest childrens hospital in Sub-Saharan Africa. Children will be tested for SARS-CoV-2 and for other viral pathogens by PCR of nasal samples.Clinical features, risk factors, nasal specimens and blood samples (serum, Paxgene, PBMCs) will be collected in children. PCR for SARS-CoV-2 and other respiratory viruses will be done on nasal samples. Serology for SARS-CoV-2 will be done in all children; in DCHS we will also investigate the role of prior seasonal coronavirus (sHCoV) infection using biobanked samples to investigate serological responses to sHCoV and potential cross protection for SARS-CoV-2. Immune markers, cytokines and RNA expression profiles will be measured to identify SARS-CoV-2 associated inflammation compared to other viral infections or asymptomatic illness. All children will be followed at 12 months for long-term health outcomes.This study design will enable us to investigate symptomatic and asymptomatic SARS-CoV-2 and serological responses, including cross-reactivity and cross-protection from sHCoV. We will also be able to compare clinical, immunological and inflammatory profiles and long term outcome of children with COVID, with asymptomatic infection, and with other viral-pneumonia, in a LMIC community and hospital setting.