key: cord-1019540-9if98crz
authors: Preßler, Julia; Fill Malfertheiner, Sara; Kabesch, Michael; Buntrock‐Döpke, Heike; Häusler, Sebastian; Ambrosch, Andreas; Wellmann, Sven
title: Postnatal SARS‐CoV‐2 Infection and Immunological Reaction: A Prospective Family Cohort Study
date: 2020-06-09
journal: Pediatr Allergy Immunol
DOI: 10.1111/pai.13302
sha: 8176acd93a35a60800323f611a7a0f4114b66492
doc_id: 1019540
cord_uid: 9if98crz

The coronavirus disease 2019 (COVID‐19) caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) appears milder in children but little is known about neonates and about the chains of infections after delivery.(1‐3) When in early March 2020 a midwife in our large maternity and perinatal center returned from vacation in Ischgl, Austria, she triggered a COVID‐19 outbreak affecting 36 midwives, nurses and doctors. We reported previously on the successful containment of this outbreak and characterized the clinical symptoms and immunoglobulin development in staff members exposed to SARS‐CoV‐2.(4‐5)

uses a recombinant protein representing the nucleocapsid antigen for determination of all kind of antibodies against SARS-CoV-2 following the manufacturer's instructions (Elecsys anti-SARS-CoV-2, Roche Diagnostics, Penzberg, Germany). According to the manufacturer's recommendations for both antibody assays from EUROIMMUN and Roche Diagnostics, a cutoff index of < 1.0 was considered non-reactive (negative for anti-SARS-CoV-2 antibodies) and a value ≥ 1.0 reactive (positive).

One or both parents from 16 families reported symptoms suggestive of a SARS-CoV-2 infection within 2 weeks postpartum ( Table 1 ). Three of their infants (all spontaneous births) displayed nonspecific signs of infection similar to late-onset sepsis, including fever, dyspnea and compromised circulation leading to admission to our neonatal intensive care unit, at day of life 5 (ID 3), 10 (ID 7) and 26 (ID 1), resolving within few days (Figure) . Blood cultures and tests for non SARS-CoV-2 viruses remained negative. Although families with symptoms did not differ in baseline characteristics from those without (n=45), risk category I families tended to be at higher symptom risk ( Table 1) . 

This article is protected by copyright. All rights reserved including screening of all pregnant women admitted to the maternity hospital and isolation until SARS-CoV-2 test is negative, surgical face masks for all personnel and patients, proper personal protective equipment when working with patients under investigation for SARS-CoV-2 or for confirmed cases as explained in detail elsewhere. 8 The outbreak coincided with the seasonal flu peak ultimately responsible for most recorded symptoms. Indeed the coincidence blurred initial pandemic awareness, with some staff and parents already wearing surgical face masks for seasonal flu protection.

Our finding that not all RT-PCR positive family members produced antibodies against SARS-CoV-2 is in line with previous reports from us and others, describing a match rate of only 70-80% between RT-PCR and antibody results in COVID-19 patients. 5 

Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China. JAMA Pediatr

Novel Coronavirus Infection in Newborn Babies Under 28 Days in China

A case report of neonatal COVID-19 infection in China

Successful containment of COVID-19 outbreak in a large maternity and perinatal center while continuing clinical service

Symptoms and immunoglobulin development in hospital staff exposed to a SARS-CoV-2 outbreak

Working Committee on Perinatal and Neonatal Management for the Prevention and Control of the 2019 Novel Coronavirus Infection

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