Examining multi-level immune response to determine prevalence of COVID-19 in pediatric tonsillectomy

Pamela Mudd, Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA.
Nahir Romero, Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA.
Hengameh Behzadpour, Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA.
Qin Xu, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Md Sohel Rana, Division of Surgery, Children's National Hospital, Washington, DC, USA.
Lyuba Gitman, Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA.
Diego Preciado, Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA.
Maria Karkanitsa, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Maryland, USA.
Jacquelyn Spathies, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Maryland, USA.
Kaitlyn Sadtler, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Maryland, USA.
Heather Kalish, Trans-NIH Shared Resource on Biomedical Engineering and Physical Science, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Maryland, USA.
Pamela L. Schwartzberg, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Kalpana Manthiram, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.

Document Type

Journal Article

Publication Date

9-14-2022

Journal

The Laryngoscope

DOI

10.1002/lary.30382

Keywords

COVID; COVID disparity; SARS-CoV-2; immune; pediatric; tonsils

Abstract

OBJECTIVE: To determine the prevalence of COVID-19 in a cohort of children undergoing tonsillectomy through assessment of B cell immune responses to SARS-CoV-2 in both peripheral blood and tonsil tissue. METHODS: In this cohort study at a tertiary pediatric hospital (Children's National Hospital) in Washington, DC, we recruited 100 children undergoing tonsillectomy from late September 2020 to January 2021. Serum, peripheral blood cells, and tonsil tissue were collected and examined for immune reactivity to SARS-CoV-2. Parent-reported clinical histories were compared to antibody and B-cell responses. RESULTS: Among 100 children undergoing tonsillectomy, 19% had evidence of immune responses to SARS-CoV-2 (CoV2+), indicating prior COVID-19. In all seropositive participants, we detected SARS-CoV-2 specific B cells in both peripheral blood mononuclear cells and tonsils, providing evidence for tissue-specific immunity in these children. Of the 19, 63% reported no known history of COVID-19, and an additional 3 were asymptomatic or unaware of an acute infection when detected on pre-surgery screen. Hispanic children represented 74% of CoV2+ subjects compared to 37% of the full cohort. 100% of CoV2+ children lived in a zip code with poverty level >10%. CONCLUSIONS: Nearly one-fifth of children undergoing tonsillectomy at an urban U.S. hospital had evidence of prior COVID-19 during the early pandemic, with the majority unaware of prior infection. Our results underscore the ethnic and socio-economic disparities of COVID-19. We found concordant evidence of humoral immune responses in children in both blood and tonsil tissue, providing evidence of local immune responses in the upper respiratory tract. LEVEL OF EVIDENCE: 3 Laryngoscope, 2022.

Department

Pediatrics

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