Susceptibility to COVID-19 in pediatric age: Study of cases in school-like environments

Principal Investigators

  • Iolanda Jordan

    SJD Barcelona Children's Hospital, Pediatric Intensive Care Unit

How do children transmit SARS-CoV-2 compared with adults? Answering this question is fundamental to guide evidence-based strategies for schools and for children in general. 

Our rationale

  • More than 100 countries in the world closed their schools around mid-March 2020 as a preventive measure to reduce infection and mortality during the COVID-19 pandemic.
  • Whereas the effectiveness of school closures in preventing SARS-CoV-2 spreading has been questioned, as children seem to transmit COVID-19 less than adults do, the negative impact on children has been very significant, from limiting their academic learning to increasing social inequalities and the risk of developing mental health problems.
  • School closures and strict home confinement measures enacted worldwide limited the collection of transmission data in children, enabling only studies based on very low case numbers that may not represent transmission dynamics in bigger groups.
  • Studies of large cohorts in school-like environments are needed to elucidate whether children transmit SARS-CoV-2 and to what extend at the school level. The results will be key to guide policy-makers and develop strategies for schools and children in general.

What are our main questions

  • Do children transmit SARS-CoV-2 and to what extent?
  • How do children transmit SARS-CoV-2 compared with adults? Do they have the same or higher or lower transmission rates than adults?
  • What are the transmission rates of children and adults infected with SARS-CoV-2 in a school-like environment such as a summer school or sports camp?
  •  How do PCR results from different samples (e.g. saliva, nasopharyngeal swab) compare? Can samples taken less invasively (e.g. from saliva) be used to obtain an equally accurate diagnosis as other samples?

Project design

Prospective longitudinal observational cohort study on children and staff attending school-like environments such as summer schools and sports camps in Barcelona.

The project uses different sources to find potential index cases:

  • 22 standard summer schools (n = 1905). In one, Thau summer school, both saliva and nasopharyngeal samples are collected for comparison (n =  257).
  • Symptomatic cases from 19 other summer schools and sports camps detected through epidemiological test and trace systems from the Department of Health (Generalitat de Catalunya) (n = 30).
  • Football Club (FC) Barcelona 'Barça' training camp (n = 185 children and 26 staff).

The positive cases are followed up using specific projects: a contacts study and an infectivity study.

Scientific objectives

  1. To evaluate the transmission rates of children and adults infected with SARS-CoV-2 in a summer school or sports camp environment, and in their direct family group.
    1. From children to children.
    2. From children to adults.
    3. From adults to children.
  2. To evaluate infectivity in terms of duration of viral load and isolation in different biological samples in infected children.
  3. To evaluate the serological patterns of antibodies in infected and previously exposed children.
  4. To use this information to develop mathematical models simulating the impact of children going to school as vectors of infection in different scenarios and/or future outbreaks with higher prevalence.

Cohorts and samples

Study groups:

  • Children: from 3 to 15 years old.
  • Adults of any age (≥16 years old) working at the summer schools and sports camps as caregivers or in any other role in direct contact with children (staff).
  •  Parents/family groups.

Samples taken during the study:

  • Standard summer schools including Thau (5 weekly visits to take samples from children and staff, during July 2020):
    • Saliva: SARS-CoV-2 PCR (weekly) and antibody testing (first and last sample; if any seroconversion is found, the test is conducted on previous saliva samples).
    • Nasopharyngeal swab (only in Thau summer school): SARS-CoV-2 PCR (weekly).
  • FC Barcelona training camp (weekly visits to take samples from children and staff, from August to December 2020):
    • Saliva: SARS-CoV-2 PCR (weekly).
    • Nasopharyngeal swab: SARS-CoV-2 PCR (every two weeks).
    • Blood: ELISA for antibody testing (every 12 weeks).
      Nasopharyngeal and saliva PCR results are compared.

In those children identified to be positive for SARS-CoV-2, a specific infectivity study is initiated for twelve weeks and the following samples are taken:

  • Saliva: SARS-CoV-2 PCR (weekly).
  • Nasopharyngeal swab: SARS-CoV-2 PCR (week 1-2 and, if positive at week 2, also at week 5).
  • Blood: ELISA for antibody testing  (weeks 1 and 5).
  • Blood (3-10mL): samples stored at the Biobank (serum, plasma, RNA, PBMC) and antibody testing by ELISA (week 1 and 5).
  • Stool: SARS-CoV-2 PCR in specific cases.
  • Questionnaire (health and epidemiological questions in week 1 and health only in weeks 5 and 12).

In addition, a specific research protocol will be conducted for the close contacts of the positive index cases and similar samples taken.

Research team at SJD Barcelona Children’s Hospital

  • Cristina Adroher

    Research Support. Kids Corona Platform

  • Quique Bassat

    Researcher. Infectious Disease Unit, Pediatrics Department, Research Professor at ISGlobal

  • Anna Codina

    Biobank

  • Juan José García

    Scientific Advisor. General Coordinator Kids Corona Platform, Pediatrics Department

  • Monica Girona

    Fellow. Pediatric Intensive Care

  • Mariona Fernández de Sevilla

    Researcher. Pediatrics Department

  • Clàudia Fortuny

    Researcher. Infectious Disease Unit, Pediatrics Department

  • Victòria Fumadó

    Researcher. Infectious Disease Unit, Pediatrics Department

  • Maria Hernandez

    Fellow. Hospital Pediatric Medicine

  • Eduard Gratacós

    Scientific Advisor. Kids Corona Platform

  • Cristina Jou

    Biobank

  • María Melé

    Fellow in Hospital Pediatric Medicine

  • Carmen Muñoz-Almagro

    Researcher. Microbiology Department

  • Gemma Pons

    Fellow. Hospital Pediatric Medicine

  • María Ríos

    Researcher. Infectious Disease Unit, Pediatrics Department

  • Siscu Torrents

    IT

Research team at Fundació Sant Joan de Déu (FSJD)

  • Elisenda Bonet-Carne

    Research Support. Kids Corona Platform

  • Joana Claverol

    Researcher. Clinical Research Unit

  • Daniel Cuadras

    Biostatistician

  • Marta Cubells

    Nurse. Clinical Trials Unit

  • Felipe Perez

    Researcher. Clinical Research Unit

  • Aleix Garcia-Miquel

    Research Support. Kids Corona Platform

  • Desiree Henares

    Bioinformatician

  • Guillem Hernandez

    Data Manager

  • Maite Miranda

    Nurse

Research team at ISGlobal Barcelona Institute for Global Health

  • Ruth Aguilar

    Researcher

  • Sara Ajanovic

    Researcher

  • Sara Arias

    Researcher

  • Carlota Dobaño

    Researcher

  • Pere Millat

    Researcher

Research team at UPC - BIOCOMSC and Research team at FC Barcelona

  • Daniel López Codina

    Researcher. Associate Professor · UPC - BIOCOMSC

  • Clara Prats Soler

    Researcher. Assistant Professor · UPC - BIOCOMSC

  • Gil Rodas

    Researcher · FC Barcelona

SCIENTIFIC ADVISORY BOARD

  • Prof. Saul Faust (NIHR Wellcome Trust Clinical Research Facility, University of Southampton)
  • Prof. Patricia Bruijning (University Medical Center Utrecht)
  • Prof. Antoni Trilla (Hospital Clínic Barcelona - University of Barcelona, ISGlobal)
  • Dr. Alasdair Munro (University Hospital Southampton)

EXTERNAL COLLABORATORS

The PCR analyses are being done in collaboration with Mónica Morales at the Centre de Regulació Genòmica (CRG).