Leveraging Serologic Testing to Identify Children at Risk For Post-Acute Sequelae of SARS-CoV-2 Infection: An Electronic Health Record-Based Cohort Study from the RECOVER Program

Abstract

Using an electronic health record-based algorithm, we identified children with Coronavirus disease 2019 (COVID-19) based exclusively on serologic testing between March 2020 and April 2022. Compared with the 131 537 polymerase chain reaction-positive children, the 2714 serology-positive children were more likely to be inpatients (24% vs 2%), to have a chronic condition (37% vs 24%), and to have a diagnosis of multisystem inflammatory syndrome in children (23% vs <1%). Identification of children who could have been asymptomatic or paucisymptomatic and not tested is critical to define the burden of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 infection in children.

Keywords: COVID-19 serology; PEDSnet; anti-N antibodies; anti-S antibodies; chronic COVID-19 syndrome; late sequelae of COVID-19; long COVID; long-haul COVID-19; long-term COVID-19; post-acute COVID-19; post-acute sequelae of COVID-19; post-acute sequelae of SARS-CoV-2 infection; post–COVID-19 syndrome.