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Antibody Responses in Children vs. Adults

Distinct Antibody Responses in Children vs. Adults 
     
    Research has found that children react much differently to the coronavirus than adults. Not only do children tend to recover faster from the virus than adults, but children are also more likely to be asymptomatic to the virus (See Are Schools Ready to Reopen). Despite exhibiting fewer symptoms, studies show that children carry a higher viral load than adults (See Children Carry More Coronavirus than Adults). Research on COVID-19 Immune Responses also finds that while adults have higher levels of immunity building cells and proteins, children have increased levels of IL-17A, an immune signaling receptor associated with T-cells. A study published this month in Nature Immunology takes a deeper look into the antibody responses of COVID-19 in children vs. adults.

Antibodies

    Antibodies are proteins produced by the immune system that bind to and destroy disease-causing antigens such as the coronavirus. They typically develop after a patient has been exposed to the virus and can help fight off a second infection. The (anti-spike) antibodies measured in this study were IgM, IgG, and IgA, all of which are targeted against the coronavirus.  IgM is the first antibody generated by the body as an initial response to a virus. IgG and IgA are produced later during an infection, usually in the form of serum and secretions. For more information about antibodies, how they work, and how long they last after infection see Immunity After COVID-19 Infection.

About the Study

    Although children with COVID-19 rarely exhibit severe respiratory symptoms, adults have a much higher risk of developing COVID-19 associated acute respiratory distress syndrome (ARDS) which comes with a high death rate. Meanwhile, children can develop a rare COVID-19 associated and life-threatening illness known as multisystem inflammatory syndrome or MIS-C. 
    Patients who participated in the study were taken from two major hospitals in New York City during the height of the pandemic. The 79 total individuals were divided into 4 cohorts: 
    1. Adults recruited as convalescent plasma donors who recovered from COVID-19 without hospitalization (n=19)
    2. Adults hospitalized with severe COVID-19 ARDS (n=13)
    3. Children hospitalized with MIS-C (n=16)
    4. Children who were infected with COVID-19 but did not develop MIS-C (n=31)

Study Results

    Researchers measured the levels of various antibodies for each of the 4 cohort groups. As expected, adult groups, specifically those with COVID-19 ARDS, had higher levels of antibody activity against the coronavirus. However, compared to adults, children exhibited much lower antibody responses which were largely limited to the IgG antibody. In other words, adults produced similar amounts of all 3 antibody types while children had higher levels of the IgG antibody, but still an overall lower amount of total antibodies compared to adults. Although adults with more severe diseases (ARDS) had a higher abundance of antibodies, children with different disease severities (with or without MIS-C) all showed similar antibody profiles. 


Study Implications

    Scientists have speculated why children tend to have lower antibody levels than adults. Donna Farber, an immunologist at Columbia University and one of the lead authors of the study says the results "suggest that in kids, the infection doesn't really spread a lot and doesn't kill a lot of their cells." Children clear the virus quickly and as a result, do not need a strong antibody response. Researchers believe the lower magnitude of antibody responses in children compared to adults is associated with age. 
    
    Going forward, scientists may have to adapt certain COVID-19 related developments and strategies with this new knowledge in mind. As written directly in the published study, the "results suggest a distinct infection course and immune response in children... with implications for developing age-targeted strategies for testing and protecting the population." 

Sources

1. Weisberg, Stuart P., et al. “Distinct Antibody Responses to SARS-CoV-2 in Children and Adults across the COVID-19 Clinical Spectrum.” Nature News, Nature Publishing Group, 5 Nov. 2020, www.nature.com/articles/s41590-020-00826-9. 

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