Serological identification of SARS-CoV-2 infections among children visiting a hospital during the initial Seattle outbreak

Children are strikingly underrepresented in COVID-19 case counts(1–3). In the United States, children represent 22% of the population but only 1.7% of confirmed SARS-CoV-2 cases(1). One possibility is that symptom-based viral testing is less likely to identify infected children, since they often experience milder disease than adults(1,4–7). To better assess the frequency of pediatric SARS-CoV-2 infection, we serologically screened 1,775 residual samples from Seattle Children’s Hospital collected from 1,076 children seeking medical care during March and April of 2020. Only one child was seropositive in March, but seven were seropositive in April for a period seroprevalence of ≈ 1%. Most seropositive children (6/8) were not suspected of having had COVID-19. The sera of seropositive children had neutralizing activity, including one that neutralized at a dilution >1:18,000. Therefore, an increasing number of children seeking medical care were infected by SARS-CoV-2 during the early Seattle outbreak despite few positive viral tests.