SARS-CoV-2 Infection in Children Does Not Necessitate Establishment of Adaptive SARS- CoV-2-Specific Immunological Memory

Children are at lower risk of developing severe COVID-19, yet the underlying immune mechanisms are understudied. While children’s innate immunity can drive rapid resolution of SARS-CoV-2 infection, the establishment of SARS-CoV-2-specific T-cell and B-cell memory in COVID-19 children remains unexplored. We recruited a household cohort to understand SARS-CoV-2-specific CD4+ and CD8+ T-cell immune responses at one month after mild or asymptomatic SARS-CoV-2 infection in PCR-positive children in comparison to those found in their mothers. We analysed SARS-CoV-2-specific T-cell responses, together with B-cells, directly ex vivo using six HLA class-I tetramers and one class-II tetramer presenting SARS57 CoV-2 T-cell epitopes (A1/ORF1a1637, A2/S269, A3/N361, A24/S1208, B7/N105, B40/N322 and DPB4/S167), and Spike- and Receptor Binding Domain (RBD)-specific B-cell probes. Our in depth profiling of epitope-specific T-cell responses at quantitative, phenotypic and clonal levels found that only children who seroconverted had prominent memory T-cell and B-cell profiles. These children had a high magnitude of SARS-CoV-2-specific T-cells displaying memory phenotypes and prevalent T-cell receptor motifs, which were not observed in PCR+ RBD but IgG-negative children. This suggests that seroconversion but not PCR-positivity defines establishment of adaptive SARS-CoV-2-specific immunological memory in children. Our study suggests that COVID-19 vaccination of children could be a major advantage in terms of establishing T-cell and B-cell immunological memory, especially in children who did not seroconvert after SARS-CoV-2 infection.