ABSTRACT
Background: Coronavirus disease of 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first detected in the United States in January 2020. Although pediatric cases represent a small proportion of total infections in the United States (11.8%), the majority of hospitalized children have underlying medical conditions, with chronic lung disease being most common. To date, only 1 study has described the clinical manifestations of COVID-19 specifically in children with CF [1]. Our study aims to define the rates of symptomatic and asymptomatic infection in people with CF (PwCF) followed at a large pediatric CF center and to assess demographic and clinical characteristics associated with infection. Methods: All children with CF followed at Seattle Children's Hospital CF Center were eligible to enroll between July 20, 2020 and February 28, 2021. Participants or parents completed an intake survey, including demographic data, COVID-19 exposures, and information about viral/respiratory illnesses after February 1, 2020. SARS-CoV-2 serostatus was determined with a commercial assay for nucleocapsid IgG. Participants or parents were sent weekly questionnaires electronically asking about exposures to and symptoms of COVID-19 for the 12-month study enrollment period. Follow-up serology testing occurs at 6- and 12-months post-enrollment. Results: Of 125 participants, 8 had positive SARS-CoV-2 antibodies (6.4%). Five were positive on enrollment, and 3 additional PwCF were positive at 6month follow-up with testing of 38 participants to date. Among all participants, the average age at enrollment was 11.5 years (range 0-20), 49% were female, and 92% were pancreatic insufficient. Ninety percent of participants had 1 or 2 copies of Phe508del CFTR mutation. The median baselineFEV1ppwas 104%(IQR98-115, N=98). Amongthe8positivecases, 4 endorsed mild upper respiratory infection (URI) symptoms prior to testing, and the remainder were asymptomatic. While only 10% of all participants identify as Hispanic, among PwCF who were seropositive, 50% (4/8) identify as Hispanic (P = 0.002). Among positive participants, 2 have hadrepeatsero logytesting, and bothcontinueto have positive SARS-CoV-2 serologies 18-25 weeks later. Conclusion: Our data suggest that a majority of PwCF have mild to no symptoms of COVID-19 when infected. PwCF who identify as Hispanic appear to be disproportionately affected, consistent with data describing racial and ethnic disparities among patients with COVID-19 in general. Initial 6-month follow-up testing suggests antibody durability but will require further investigation.