SARS-CoV-2 Serostatus and COVID-19 Illness Characteristics by Variant Time Period in Non-Hospitalized Children and Adolescents
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Population
2.3. Study Procedures
2.4. Study Measures
2.5. Statistical Analysis
3. Results
4. Discussion
Study Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- American Academy of Pediatrics and the Children’s Hospital Association. Children and COVID-19: State Data Report. Available online: https://downloads.aap.org/AAP/PDF/AAP%20and%20CHA%20-%20Children%20and%20COVID-19%20State%20Data%20Report%2010.7%20FINAL.pdf (accessed on 20 February 2023).
- Centers for Disease Control and Prevention. COVID Data Tracker. Variant Proportions. Available online: https://covid.cdc.gov/covid-data-tracker/#variant-proportions (accessed on 20 February 2023).
- Lu, X.; Zhang, L.; Du, H.; Lu, X.; Zhang, L.; Du, H.; Zhang, J.; Li, Y.; Qu, J.; Zhang, W.; et al. SARS-CoV-2 Infection in Children. N. Engl. J. Med. 2020, 382, 1663–1665. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Ludvigsson, J.F. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020, 109, 1088–1095. [Google Scholar] [CrossRef] [PubMed]
- Feldstein, L.R.; Rose, E.B.; Horwitz, S.M.; Collins, J.P.; Newhams, M.M.; Son, M.B.F.; Newburger, J.W.; Kleinman, L.C.; Heidemann, S.M.; Martin, A.A.; et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N. Engl. J. Med. 2020, 383, 334–346. [Google Scholar] [CrossRef] [PubMed]
- Rowley, A.H. Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children. Nat. Rev. Immunol. 2020, 20, 453–454. [Google Scholar] [CrossRef]
- Delahoy, M.J.; Ujamaa, D.; Whitaker, M.; O’Halloran, A.; Anglin, O.; Burns, E.; Cummings, C.; Holstein, R.; Kambhampati, A.K.; Milucky, J.; et al. Hospitalizations Associated with COVID-19 Among Children and Adolescents—COVID-NET, 14 States, 1 March 2020–14 August 2021. MMWR Morb. Mortal. Wkly. Rep. 2021, 70, 1255–1260. [Google Scholar] [CrossRef]
- Buitrago-Garcia, D.; Egli-Gany, D.; Counotte, M.J.; Imeri, H.; Araujo-Chaveron, L.; Arevalo-Rodriguez, I.; Ciapponi, A.; Cevik, M.; Hauser, A.; Alam, M.I.; et al. Occurrence and transmission potential of asymptomatic and presymptomatic SARS-CoV-2 infections: A living systematic review and meta-analysis. PLoS Med. 2020, 17, e1003346. [Google Scholar] [CrossRef]
- Laws, R.L.; Chancey, R.J.; Rabold, E.M.; Chu, V.T.; Lewis, N.M.; Fajans, M.; Reses, H.E.; Duca, L.M.; Dawson, P.; Conners, E.E.; et al. Symptoms and Transmission of SARS-CoV-2 Among Children—Utah and Wisconsin, March–May 2020. Pediatrics 2021, 147, e2020027268. [Google Scholar] [CrossRef]
- Assaker, R.; Colas, A.E.; Julien-Marsollier, F.; Bruneau, B.; Marsac, L.; Greff, B.; Tri, N.; Fait, C.; Brasher, C.; Dahmani, S. Presenting symptoms of COVID-19 in children: A meta-analysis of published studies. Br. J. Anaesth. 2020, 125, e330–e332. [Google Scholar] [CrossRef]
- Viner, R.M.; Ward, J.L.; Hudson, L.D.; Ashe, M.; Patel, S.V.; Hargreaves, D.; Whittaker, E. Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents. Arch. Dis. Child. 2020, 106, 802–807. [Google Scholar] [CrossRef]
- Molteni, E.; Sudre, C.H.; Canas, L.D.S.; Bhopal, S.S.; Hughes, R.C.; Chen, L.; Deng, J.; Murray, B.; Kerfoot, E.; Antonelli, M.; et al. Illness Characteristics of COVID-19 in Children Infected with the SARS-CoV-2 Delta Variant. Children 2022, 9, 652. [Google Scholar] [CrossRef]
- World Health Organization. Population-Based Age-Stratified Seroepidemiological Investigation Protocol for Coronavirus 2019 (COVID-19) Infection. Version 2.0. 2020. Available online: https://apps.who.int/iris/handle/10665/332188 (accessed on 20 February 2023).
- Roche. Elecsys® Anti-SARS-CoV-2. Package Insert 2020-07, V9.0; Material Numbers 09203095190 and 09203079190. US Food and Drug Administration. Available online: https://www.fda.gov/media/137605/download (accessed on 20 February 2023).
- Roche. Elecsys® Anti-SARS-CoV-2 S. Package Insert 2020-12, V1.0; Material Numbers 09289267190 and 09289275190. US Food and Drug Administration. Available online: https://www.fda.gov/media/144037/download (accessed on 20 February 2023).
- Harris, P.A.; Taylor, R.; Thielke, R.; Payne, J.; Gonzalez, N.; Conde, J.G. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J. Biomed. Inform. 2009, 42, 377–381. [Google Scholar] [CrossRef][Green Version]
- Harris, P.A.; Taylor, R.; Minor, B.L.; Elliott, V.; Fernandez, M.; O’Neal, L.; McLeod, L.; Delacqua, G.; Delacqua, F.; Kirby, J.; et al. The REDCap consortium: Building an international community of software platform partners. J. Biomed. Inform. 2019, 95, 103208. [Google Scholar] [CrossRef]
- PhenX Toolkit. Available online: https://www.phenxtoolkit.org/covid19 (accessed on 20 February 2023).
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Behavioral Risk Factor Surveillance System. Available online: https://www.healthypeople.gov/2020/data-source/behavioral-risk-factor-surveillance-system (accessed on 20 February 2023).
- United States Census Bureau. Questions Asked on the Form. Available online: https://www.census.gov/acs/www/about/why-we-ask-each-question/ (accessed on 20 February 2023).
- Kuczmarski, R.J.; Ogden, C.L.; Guo, S.S.; Grummer-Strawn, L.M.; Flegal, K.M.; Mei, Z.; Wei, R.; Curtin, L.R.; Roche, A.F.; Johnson, C.L. 2000 CDC Growth Charts for the United States: Methods and Development. Vital Health Stat. 2002, 246, 1–190. [Google Scholar]
- Centers for Disease Control and Prevention. About Child and Teen BMI. Available online: https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html#HowIsBMICalculated (accessed on 20 February 2023).
- Viner, R.M.; Mytton, O.T.; Bonell, C.; Melendez-Torres, G.J.; Ward, J.; Hudson, L.; Waddington, C.; Thomas, J.; Russell, S.; van der Klis, F.; et al. Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults: A Systematic Review and Meta-analysis. JAMA Pediatr. 2020, 175, 143–156. [Google Scholar] [CrossRef]
- Dingens, A.S.; Crawford, K.H.D.; Adler, A.; Steele, S.L.; Lacombe, K.; Eguia, R.; Amanat, F.; Walls, A.C.; Wolf, C.R.; Murphy, M.; et al. Serological identification of SARS-CoV-2 infections among children visiting a hospital during the initial Seattle outbreak. Nat. Commun. 2020, 11, 4378. [Google Scholar] [CrossRef]
- Hobbs, C.V.; Drobeniuc, J.; Kittle, T.; Williams, J.; Byers, P.; Satheshkumar, P.S.; Inagaki, K.; Stephenson, M.; Kim, S.S.; Patel, M.M.; et al. Estimated SARS-CoV-2 Seroprevalence Among Persons Aged <18 Years—Mississippi, May–September 2020. MMWR Morb. Mortal. Wkly. Rep. 2021, 7, 312–315. [Google Scholar]
- Smith, B.K.; Janowski, A.B.; Danis, J.E.; Harvey, I.B.; Zhao, H.; Dai, Y.N.; Farnsworth, C.W.; Gronowski, A.M.; Roper, S.; Fremont, D.H.; et al. Seroprevalence of SARS-CoV-2 Antibodies in Children and Adults in St. Louis, Missouri, USA. mSphere 2021, 6, e01207–e01220. [Google Scholar] [CrossRef]
- Bloomfield, M.; Pospisilova, I.; Cabelova, T.; Sediva, A.; Ibrahimova, M.; Borecka, K.; Magner, M. Searching for COVID-19 Antibodies in Czech Children-A Needle in the Haystack. Front. Pediatr. 2020, 8, 597736. [Google Scholar] [CrossRef]
- Tönshoff, B.; Müller, B.; Elling, R.; Renk, H.; Meissner, P.; Hengel, H.; Garbade, S.F.; Kieser, M.; Jeltsch, K.; Grulich-Henn, J.; et al. Prevalence of SARS-CoV-2 Infection in Children and Their Parents in Southwest Germany. JAMA Pediatr. 2021, 175, 586. [Google Scholar] [CrossRef]
- Snoeck, C.J.; Vaillant, M.; Abdelrahman, T.; Satagopam, V.P.; Turner, J.D.; Beaumont, K.; Gomes, C.P.C.; Fritz, J.F.; Schröder, V.E.; Kaysen, A.; et al. Prevalence of SARS-CoV-2 infection in the Luxembourgish population the CON-VINCE study. medRxiv 2020. [Google Scholar] [CrossRef]
- Shakiba, M.; Hashemi Nazari, S.S.; Mehrabian, F.; Rezvani, S.M.; Ghasempour, Z.; Heidarzadeh, A. Seroprevalence of COVID-19 virus infection in Guilan province, Iran. medRxiv 2020. [Google Scholar] [CrossRef]
- Stringhini, S.; Wisniak, A.; Piumatti, G.; Azman, A.S.; Lauer, S.A.; Baysson, H.; De Ridder, D.; Petrovic, D.; Schrempft, S.; Marcus, K.; et al. Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): A population-based study. Lancet 2020, 396, 313–319. [Google Scholar] [CrossRef] [PubMed]
- Herzog, S.; de Bie, J.; Abrams, S.; Wouters, I.; Ekinci, E.; Patteet, L.; Coppens, A.; De Spiegeleer, S.; Beutels, P.; Van Damme, P.; et al. Seroprevalence of IgG antibodies against SARS coronavirus 2 in Belgium: A prospective cross-sectional study of residual samples. medRxiv 2020. [Google Scholar] [CrossRef]
- Tonzel, J.L.; Sokol, T. COVID-19 Outbreaks at Youth Summer Camps—Louisiana, June–July 2021. MMWR Morb. Mortal. Wkly. Rep. 2021, 70, 1425–1426. [Google Scholar] [CrossRef]
- Dattner, I.; Goldberg, Y.; Katriel, G.; Yaari, R.; Gal, N.; Miron, Y.; Ziv, A.; Sheffer, R.; Hamo, Y.; Huppert, A. The role of children in the spread of COVID-19: Using household data from Bnei Brak, Israel, to estimate the relative susceptibility and infectivity of children. PLoS Comput. Biol. 2021, 17, e1008559. [Google Scholar] [CrossRef]
- Ong, S.W.X.; Chiew, C.J.; Ang, L.W.; Mak, T.M.; Cui, L.; Toh, M.P.H.S.; Lim, Y.D.; Lee, P.H.; Lee, T.H.; Chia, P.Y.; et al. Clinical and virological features of SARS-CoV-2 variants of concern: A retrospective cohort study comparing B.1.1.7 (Alpha), B.1.31 (Beta), and B.1.617.2 (Delta). Clin. Infect. Dis. 2021, 75, e1128–e1136. [Google Scholar] [CrossRef]
- Twohig, K.A.; Nyberg, T.; Zaidi, A.; Thelwall, S.; Sinnathamby, M.A.; Aliabadi, S.; Seaman, S.R.; Harris, R.J.; Hope, R.; Lopez-Bernal, J.; et al. Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7)variants of concern: A cohort study. Lancet Infect. Dis. 2021, 22, 35–42. [Google Scholar] [CrossRef]
- Howard, L.M.; Garguilo, K.; Gillon, J.; LeBlanc, K.; Seegmiller, A.C.; Schmitz, J.E.; Byrne, D.W.; Domenico, H.J.; Moore, R.P.; Webber, S.; et al. The first 1000 symptomatic pediatric SARSCoV-2 infections in an integrated health care system: A prospective cohort study. BMC Pediatr. 2021, 21, 403. [Google Scholar] [CrossRef]
- Veneti, L.; Salamanca, B.V.; Seppälä, E.; Starrfelt, J.; Storm, M.L.; Bragstad, K.; Hungnes, O.; Bøås, H.; Kvåle, R.; Vold, L.; et al. No difference in risk of hospitalisation between reported cases of the SARS-CoV-2 Delta variant and Alpha variant in Norway. medRxiv 2021. [Google Scholar] [CrossRef]
- Pollán, M.; Pérez-Gómez, B.; Pastor-Barriuso, R.; Oteo, J.; Hernán, M.A.; Pérez-Olmeda, M.; Sanmartín, J.L.; Fernández-García, A.; Cruz, I.; Fernández de Larrea, N.; et al. Prevalence of SARS-CoV-2 in Spain (ENE-COVID): A nationwide, population-based seroepidemiological study. Lancet 2020, 396, 535–544. [Google Scholar] [CrossRef]
- Ratcliffe, H.; Tiley, K.S.; Andrews, N.; Amirthalingam, G.; Vichos, I.; Morey, E.; Douglas, N.L.; Marinou, S.; Plested, E.; Aley, P.; et al. Community seroprevalence of SARS-CoV-2 in children and adolescents in England, 2019–2021. Arch. Dis. Child. 2022, 108, 123–130. [Google Scholar] [CrossRef]
- Ben-Tov, A.; Lotan, R.; Gazit, S.; Perez, G.; Mizrahi-Reuveni, M.; Patalon, T. Dynamics in COVID-19 symptoms during different waves of the pandemic among children infected with SARS-CoV-2 in the ambulatory setting. Eur. J. Pediatr. 2022, 181, 3309–3318. [Google Scholar] [CrossRef]
- Stokes, E.K.; Zambrano, L.D.; Anderson, K.N.; Marder, E.P.; Raz, K.M.; Felix, S.E.B.; Tie, Y.; Fullerton, K.E. Coronavirus disease 2019 case surveillance—United States, 22 January–30 May 2020. Morb. Mortal. Wkly. Rep. 2020, 69, 759. [Google Scholar] [CrossRef]
- Duarte-Salles, T.; Vizcaya, D.; Pistillo, A.; Casajust, P.; Sena, A.G.; Lai, L.Y.H.; Prats-Uribe, A.; Ahmed, W.-U.-R.; Alshammari, T.M.; Alghoul, H.; et al. Thirty-day outcomes of children and adolescents with COVID-19: An international experience. Pediatrics 2021, 148, e2020042929. [Google Scholar] [CrossRef]
- Link-Gelles, R.; Levy, M.E.; Gaglani, M.; Casajust, P.; Sena, A.G.; Lai LY, H.; Prats-Uribe, A.; Ahmed, W.U.; Alshammari, T.M.; Alghoul, H.; et al. Effectiveness of 2, 3, and 4 COVID-19 mRNA Vaccine Doses Among Immunocompetent Adults During Periods when SARS-CoV-2 Omicron BA.1 and BA.2/BA.2.12.1 Sublineages Predominated—VISION Network, 10 States, December 2021–June 2022. MMWR Morb. Mortal. Wkly. Rep. 2022, 71, 931–939. [Google Scholar] [CrossRef]
- Plumb, I.D.; Feldstein, L.R.; Barkley, E.; Posner, A.B.; Bregman, H.S.; Hagen, M.B.; Gerhart, J.L. Effectiveness of COVID-19 mRNA Vaccination in Preventing COVID-19–Associated Hospitalization Among Adults with Previous SARS-CoV-2 Infection—United States, June 2021–February 2022. MMWR Morb. Mortal. Wkly. Rep. 2022, 71, 549–555. [Google Scholar] [CrossRef]
- Fowlkes, A.L.; Yoon, S.K.; Lutrick, K.; Gwynn, L.; Burns, J.; Grant, L.; Phillips, A.L.; Ellingson, K.; Ferraris, M.V.; LeClair, L.B.; et al. Effectiveness of 2-Dose BNT162b2 (Pfizer BioNTech) mRNA Vaccine in Preventing SARS-CoV-2 Infection Among Children Aged 5–11 Years and Adolescents Aged 12–15 Years—PROTECT Cohort, July 2021–February 2022. MMWR Morb. Mortal. Wkly. Rep. 2022, 71, 422–428. [Google Scholar] [CrossRef]
- Klein, N.P.; Stockwell, M.S.; Demarco, M.; Gaglani, M.; Kharbanda, A.B.; Irving, S.A.; Rao, S.; Grannis, S.J.; Dascomb, K.; Murthy, K.; et al. Effectiveness of COVID-19 Pfizer-BioNTech BNT162b2 mRNA Vaccination in Preventing COVID-19–Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Nonimmunocompromised Children and Adolescents Aged 5–17 Years—VISION Network, 10 States, April 2021–January 2022. MMWR Morb. Mortal. Wkly. Rep. 2022, 71, 352–358. [Google Scholar]
Age | |
---|---|
Mean (SD) | 12.8 (3.8) |
Age Group, Years, n (%) | |
5-to-9 year olds | 863 (22.1) |
10-to-14 year olds | 1588 (40.6) |
15-to-19 year olds | 1460 (37.3) |
Sex, n (%) 1 | |
Female | 1980 (50.6) |
Male | 1926 (49.2) |
None of these describe me | 1 (0.0) |
Ethnicity, n (%) 2 | |
Hispanic | 865 (22.1) |
Non-Hispanic | 2949 (75.4) |
Unknown/Other | 57 (1.5) |
Race, n (%) 3 | |
Non-Hispanic White | 3275 (83.7) |
Non-Hispanic Black | 92 (2.4) |
Asian | 222 (5.7) |
Multiracial | 196 (5.0) |
American Indian or Alaskan Native | 18 (0.5) |
Hawaiian or Other Pacific Islander | 4 (0.1) |
Residential Density, n (%) | |
Urban | 3526 (90.2) |
Rural | 385 (9.8) |
Body Mass Index, n (%) 4 | |
Underweight | 162 (4.1) |
Healthy | 2326 (59.5) |
Overweight | 587 (15.0) |
Obesity | 569 (14.5%) |
N Antibody Status | |
Negative | 1673 (42.8) |
Positive | 2238 (57.2) |
Number of Reported Infections, n (%) | |
0 | 2591 (66.2) |
1 | 1161 (29.7) |
2 | 145 (3.7) |
≥ 3 | 14 (0.3) |
Vaccination Status | |
Full | 1476 (37.74) |
Partial | 2328 (59.52) |
None | 107 (2.74) |
COVID-19 Disease Severity | |
Mild | 730 (18.67) |
Severe | 14 (0.36) |
Missing | 3167 (80.98) |
Odds Ratio (95% CI) a | p Value | |
---|---|---|
Variant period | ||
Delta | REF | – |
Pre-Delta | 2.65 (2.25–3.12) | <0.001 |
Omicron | 2.50 (2.11–2.96) | <0.001 |
Omicron BA.2 | 0.95 (0.75–1.21) | 0.688 |
Age groups, years | ||
Ages 5-to-9 | REF | – |
Ages 10-to-14 | 1.34 (1.12–1.59) | 0.001 |
Ages 15-to-19 | 1.41 (1.17–1.69) | <0.001 |
Sex b | ||
Female | REF | – |
Male | 0.87 (0.77–0.99) | 0.037 |
Ethnicity | ||
Hispanic | REF | – |
Non-Hispanic | 1.22 (1.04–1.43) | 0.014 |
Missing | 1.27 (0.81–2.00) | 0.294 |
BMI, categorical c | ||
Healthy | REF | – |
Underweight | 1.02 (0.74–1.39) | 0.925 |
Overweight | 1.01 (0.85–1.21) | 0.879 |
Obesity | 1.16 (0.97–1.39) | 0.110 |
Missing | 0.95 (0.72–1.26) | 0.731 |
Residential density | ||
Urban | REF | – |
Rural | 0.99 (0.80–1.24) | 0.956 |
Vaccination status | ||
Fully vaccinated | REF | – |
Unvaccinated | 1.71 (1.47–2.00) | <0.001 |
Partially vaccinated | 1.05 (0.68–1.62) | 0.830 |
Number of previous infections | ||
None | REF | – |
One | 0.68 (0.54–0.85) | <0.001 |
Two or more | 0.68 (0.38–1.24) | 0.209 |
Odds Ratio (95% CI) a | p Value | |
---|---|---|
Variant period | ||
Delta | REF | – |
Pre-Delta | 0.27 (0.19–0.38) | <0.001 |
Omicron | 1.73 (1.04–2.90) | 0.036 |
Omicron BA.2 | 5.81 (2.19–15.37) | <0.001 |
Sex | ||
Female | REF | – |
Male | 0.77 (0.58–1.03) | 0.073 |
Ethnicity | ||
Hispanic | REF | – |
Non-Hispanic | 1.15 (0.81–1.64) | 0.697 |
Missing | 1.25 (0.45–3.47) | 0.674 |
BMI, categorical b | ||
Healthy | REF | – |
Underweight | 1.20 (0.56–2.54) | 0.541 |
Overweight | 1.17 (0.77–1.75) | 0.460 |
Obesity | 1.21 (0.79–1.84) | 0.379 |
Missing | 0.59 (0.31–1.11) | 0.103 |
Residential density | ||
Urban | REF | – |
Rural | 0.79 (0.50–1.25) | 0.317 |
Vaccination status | ||
Fully vaccinated | REF | – |
Unvaccinated | 1.11 (0.65–1.90) | 0.881 |
Partially vaccinated | 1.19 (0.38–3.69) | 0.768 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Messiah, S.E.; Swartz, M.D.; Abbas, R.A.; Talebi, Y.; Kohl, H.W., III; Valerio-Shewmaker, M.; DeSantis, S.M.; Yaseen, A.; Kelder, S.H.; Ross, J.A.; Padilla, L.N.; Gonzalez, M.O.; Wu, L.; Lakey, D.; Shuford, J.A.; Pont, S.J.; Boerwinkle, E. SARS-CoV-2 Serostatus and COVID-19 Illness Characteristics by Variant Time Period in Non-Hospitalized Children and Adolescents. Children 2023, 10, 818. https://doi.org/10.3390/children10050818
Messiah SE, Swartz MD, Abbas RA, Talebi Y, Kohl HW III, Valerio-Shewmaker M, DeSantis SM, Yaseen A, Kelder SH, Ross JA, Padilla LN, Gonzalez MO, Wu L, Lakey D, Shuford JA, Pont SJ, Boerwinkle E. SARS-CoV-2 Serostatus and COVID-19 Illness Characteristics by Variant Time Period in Non-Hospitalized Children and Adolescents. Children. 2023; 10(5):818. https://doi.org/10.3390/children10050818
Chicago/Turabian StyleMessiah, Sarah E., Michael D. Swartz, Rhiana A. Abbas, Yashar Talebi, Harold W. Kohl, III, Melissa Valerio-Shewmaker, Stacia M. DeSantis, Ashraf Yaseen, Steven H. Kelder, Jessica A. Ross, Lindsay N. Padilla, Michael O. Gonzalez, Leqing Wu, David Lakey, Jennifer A. Shuford, Stephen J. Pont, and Eric Boerwinkle. 2023. "SARS-CoV-2 Serostatus and COVID-19 Illness Characteristics by Variant Time Period in Non-Hospitalized Children and Adolescents" Children 10, no. 5: 818. https://doi.org/10.3390/children10050818