SARS-CoV-2 seroprevalence in children worldwide: A systematic review and meta-analysis

BACKGROUND: The higher hospitalisation rates of those aged 0–19 years (referred to herein as ‘children’) observed since the emergence of the immune-evasive SARS-CoV-2 Omicron variant and subvariants, along with the persisting vaccination disparities highlighted a need for in-depth knowledge of SARS-CoV-2 sero-epidemiology in children. Here, we conducted this systematic review to assess SARS-CoV-2 seroprevalence and determinants in children worldwide. METHODS: In this systematic review and meta-analysis study, we searched international and preprinted scientific databases from December 1, 2019 to July 10, 2022. Pooled seroprevalences were estimated according to World Health Organization (WHO) regions (at 95% confidence intervals, CIs) using random-effects meta-analyses. Associations with SARS-CoV-2 seroprevalence and sources of heterogeneity were investigated using sub-group and meta-regression analyses. The protocol used in this study has been registered in PROSPERO (CRD42022350833). FINDINGS: We included 247 studies involving 757,075 children from 70 countries. Seroprevalence estimates varied from 7.3% (5.8–9.1%) in the first wave of the COVID-19 pandemic to 37.6% (18.1–59.4%) in the fifth wave and 56.6% (52.8–60.5%) in the sixth wave. The highest seroprevalences in different pandemic waves were estimated for South-East Asia (17.9–81.8%) and African (17.2–66.1%) regions; while the lowest seroprevalence was estimated for the Western Pacific region (0.01–1.01%). Seroprevalence estimates were higher in children at older ages, in those living in underprivileged countries or regions, and in those of minority ethnic backgrounds. INTERPRETATION: Our findings indicate that, by the end of 2021 and before the Omicron wave, around 50–70% of children globally were still susceptible to SARS-CoV-2 infection, clearly emphasising the need for more effective vaccines and better vaccination coverage among children and adolescents, particularly in developing countries and minority ethnic groups. FUNDING: None.