SARS-CoV-2 acquisition and immune pathogenesis among school-aged learners in four diverse schools

Dan M. Cooper, Michael Z. Zulu, Allen Jankeel, Izabela Coimbra Ibraim, Jessica Ardo, Kirsten Kasper, Diana Stephens, Andria Meyer, Annamarie Stehli, Curt Condon, Mary E. Londoño, Casey M. Schreiber, Nanette V. Lopez, Ricky L. Camplain, Michael Weiss, Charles Golden, Shlomit Radom-Aizik, Bernadette Boden-Albala, Clayton Chau, Ilhem MessaoudiErlinda R. Ulloa

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Understanding SARS-CoV-2 infection in children is necessary to reopen schools safely. Methods: We measured SARS-CoV-2 infection in 320 learners [10.5 ± 2.1 (sd); 7–17 y.o.] at four diverse schools with either remote or on-site learning. Schools A and B served low-income Hispanic learners; school C served many special-needs learners, and all provided predominantly remote instruction. School D served middle- and upper-income learners, with predominantly on-site instruction. Testing occurred in the fall (2020), and 6–8 weeks later during the fall-winter surge (notable for a tenfold increase in COVID-19 cases). Immune responses and mitigation fidelity were also measured. Results: We found SARS-CoV-2 infections in 17 learners only during the surge. School A (97% remote learners) had the highest infection (10/70, 14.3%, p < 0.01) and IgG positivity rates (13/66, 19.7%). School D (93% on-site learners) had the lowest infection and IgG positivity rates (1/63, 1.6%). Mitigation compliance [physical distancing (mean 87.4%) and face-covering (91.3%)] was remarkably high at all schools. Documented SARS-CoV-2-infected learners had neutralizing antibodies (94.7%), robust IFN-γ + T cell responses, and reduced monocytes. Conclusions: Schools can implement successful mitigation strategies across a wide range of student diversity. Despite asymptomatic to mild SARS-CoV-2 infection, children generate robust humoral and cellular immune responses. Impact: Successful COVID-19 mitigation was implemented across a diverse range of schools.School-associated SARS-CoV-2 infections reflect regional rates rather than remote or on-site learning.Seropositive school-aged children with asymptomatic to mild SARS-CoV-2 infections generate robust humoral and cellular immunity.

Original languageEnglish (US)
Pages (from-to)1073-1080
Number of pages8
JournalPediatric Research
Issue number5
StatePublished - Nov 2021

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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