SARS-CoV-2 seroprevalence among learners in grades 1-7, their parents and teachers in KwaZulu-Natal, South Africa: A crosssectional study

Reshmi Dassaye^1*Terusha Chetty^1,2Brodie Daniels¹Trisha Ramraj¹Zakir Gaffoor¹Elizabeth Spooner¹Ncengani Mthethwa¹Duduzile Faith Nsibande¹Vuyolwethu Magasana¹Khanya Mohlabi¹Isaac Singini³Nomonde Gwebushe³Kubashni Woeber^1,4Ameena Goga^1,5

• ¹HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
• ²Department of Public Health Medicine, University of KwaZulu Natal, Durban, KwaZulu-Natal, South Africa
• ³Biostatistics Unit, South African Medical Research Council, Durban, South Africa
• ⁴Grants, Innovation and Product Development Unit, SAMRC, Durban, South Africa
• ⁵Department of Paediatrics and Child Health, School of Medicine, University of Pretoria, Pretoria, South Africa

There is limited information on SARS-CoV-2 seroprevalence among children and adolescents in LMIC school settings. We aimed to assess 1) the seroprevalence of SARS-CoV-2 antibodies, 2) prevalence of self-reported or confirmed SARS-CoV-2 prior infections and, 3) COVID-19 symptoms (including long-COVID) among a cohort of primary school learners, their parents and teachers in a semi-rural school setting approximately 3-years into the COVID-19 pandemic. Methods: Learners in grades 1-7 attending two pre-selected schools in close proximity in the Ndwedwe area, iLembe district, KwaZulu-Natal, South Africa, their parents and teachers were invited to enroll into the COVID Kids Schools Study (CoKiDSS)a cross-sectional survey conducted between May -August 2023. All participants provided informed consent, completed a questionnaire and provided a fingerprick of blood for SARS-CoV-2 antibody testing using the COVID-19 IgG/IgM Rapid Test . Statistical methods included descriptive analysis, jackknifeestimated seroprevalence and incidence (unadjusted and sensitivity-adjusted), and logistic regression using generalized linear models. Results: A total of 645 participants (i.e., 456 learners, 147 parents and 42 teachers) were enrolled into the survey. Overall SARS-CoV-2 IgG seroprevalence was 78% unadjusted to 81% adjusted with an increasing seropositivity trend, from learners to teachers (76% unadjusted to 79% adjusted in learners, 79% unadjusted to 82% adjusted in parents and 93% unadjusted to 97% adjusted in teachers). About 2.6% of learners tested IgM seropositive. Interestingly, 17% of the participants, including 20% learners, tested negative for SARS-CoV-2 antibodies. While only 16 participants (2.5% -2 learners, 10 parents, and 4 teachers) self-reported a prior confirmed SARS-CoV-2 infection. Of these 2 learners (100%), 8 parents (80%) and 4 teachers (100%) reported COVID-19 like symptoms that persisted for ≥28-days.We reported high SARS-CoV-2 IgG seroprevalence among learners in grades 1-7, their parents and teacher approximately 3 years into the COVID-19 pandemic. which may be attributed to the snowball effect of multiple waves of infection in South Africa. However, only a small proportion of participants self-reported prior COVID-19 infection. This may be due to 1) recall bias and participants' perception of low susceptibility to and severity of COVID-19, 2) limited access to SARS-CoV-2 testing, and/or 3) a high prevalence of asymptomatic infections.