Predictors of SARS-CoV-2 seropositivity prior to COVID-19 vaccination among children 0-4 years and their household members in the SEARCh Study

Background

Estimates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in young children and risk factors for seropositivity are scarce. Using data from a prospective cohort study of households during the pre-coronavirus disease 2019 (COVID-19) vaccine period, we estimated SARS-CoV-2 seroprevalence by age and evaluated risk factors for SARS-CoV-2 seropositivity.

Methods

The SARS-CoV-2 Epidemiology and Response in Children (SEARCh) study enrolled 175 Maryland households (690 participants) with ≥1 child aged 0–4 years during November 2020–March 2021; individuals vaccinated against COVID-19 were ineligible. At enrollment, participants completed questionnaires about sociodemographic and health status and work, school, and daycare attendance. Participants were tested for SARS-CoV-2 antibodies in sera. Logistic regression models with generalized estimating equations (GEE) to account for correlation within households assessed predictors of individual- and household-level SARS-CoV-2 seropositivity.

Results

Of 681 (98.7%) participants with enrollment serology results, 55 (8.1%; 95% confidence interval [CI], 6.3%–10.4%) participants from 21 (12.0%) households were seropositive for SARS-CoV-2. Among seropositive participants, fewer children than adults reported being tested for SARS-CoV-2 infection before enrollment (odds ratio [OR] = 0.23; 95% CI, .06–.73). Seropositivity was similar by age (GEE OR vs 0–4 years: 1.19 for 5–17 years, 1.36 for adults; P = .16) and was significantly higher among adults working outside the home (GEE adjusted OR = 2.2; 95% CI, 1.1–4.4) but not among children attending daycare or school.

Conclusions

Before study enrollment, children and adults in this cohort had similar rates of SARS-CoV-2 infection as measured by serology. An adult household member working outside the home increased a household's odds of SARS-CoV-2 infection, whereas a child attending daycare or school in person did not.

Accuracy of tobramycin levels obtained from central venous access devices in patients with cystic fibrosis is technique dependent

OBJECTIVE

Patients with cystic fibrosis (CF) frequently require prolonged aminoglycoside antibiotic therapy administered via central venous access devices (CVADs). Therefore, the effect of the volume of saline flush used prior to drawing blood on tobramycin levels obtained from CVADs was investigated to determine the potential for inappropriate drug dosing decisions.

PATIENTS AND METHODS

This was a prospective study comparing tobramycin levels in blood samples obtained simultaneously from CVADs and from venipuncture. Two saline flushing protocols were tested. During Phase I, CVADs were flushed with 3 mL of normal saline. The saline flush volume was increased to 10 to 20 mL during Phase II. All patients had CF and ranged in age from 10 months to 20 years.

RESULTS

Twenty-eight paired peak levels were collected from 19 patients during Phase I of the study, and 30 paired samples were obtained from 20 patients using the revised collection protocol during Phase II. The median (range) peak tobramycin level obtained from CVADs using the original flushing protocol was 13.1 (3.4 to 52.0) compared to 9.5 (3.1 to 46.4) microg/mL for those drawn peripherally. Use of CVAD-obtained levels would have caused inappropriate dosing changes in 43% of cases. Increasing the saline flush volume improved the accuracy of the tobramycin levels obtained from CVADs. Median peak tobramycin levels using the modified flushing protocol were 17.3 (3.6 to 47.0) and 19.0 (3.3 to 42.1) microg/mL obtained from a CVAD or venipuncture, respectively. The intraclass correlation coefficient for this protocol was 0.90 (lower 95% confidence limit = 0.80). Additionally, 87% of these CVAD-obtained levels provided accurate information for clinical decision making.

CONCLUSIONS

Peak tobramycin levels drawn from CVADs flushed with a small flush volume are falsely elevated compared to those obtained by peripheral venipuncture. The use of a larger saline flush greatly improves the accuracy of these levels. Therefore, care should be taken to base clinical decisions on tobramycin levels obtained by peripheral venipuncture or following an appropriate large volume saline flush.