ArticlePLOS global public health2026
Development of seropositivity to SARS-CoV-2 over the course of the COVID-19 pandemic in adolescents in a longitudinal cohort study in Cebu, Philippines.
Article in PLOS global public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
COVID-19 was first reported in the Philippines in January 2020 and the country experienced several COVID-19 waves. Little is known on the seroprevalence of SARS-CoV-2 among adolescents in a developing country such as the Philippines. In this study, we incorporated testing for acute COVID-19 and SARS-CoV-2 seropositivity in an ongoing dengue study of 9- to 14-year-old participants enrolled in 2017. Acute febrile episodes were detected through active surveillance and a nasopharyngeal swab was obtained for SARS-CoV-2 RT-PCR. Before COVID-19 vaccination was offered, we tested a subset of sera obtained in 2021 for SARS-CoV-2 receptor binding domain (RBD) antibodies. Development of SARS-CoV-2 seropositivity acquired through natural infection and vaccination was conducted by measuring antibodies pre- (2018-2019), early- (2019-2020), and late-pandemic (2022-2023) in those with matched samples. From July 2021-October 2022, we recorded 29 acute febrile illness episodes in the cohort and 17.0% were SARS-CoV-2 RT-PCR positive. In the subset of 499 samples tested for SARS-CoV-2 RBD antibodies in 2021, 30.3% were seropositive. Among these, 4.0% were seropositive in 2018-2019, and 11.0% had seroconverted by 2020. Interestingly, 74.0% experienced antibody waning between 2020 and 2021 sampling. By 2022, 345/499 children received full COVID-19 vaccination and 13/499 was partially vaccinated, with 96.6% SARS-CoV-2 seropositive by late-pandemic sample in 2022-2023. Vaccination and site were predictors of SARS-CoV-2 RBD antibodies. These findings suggest both variation in local transmission over time as well as association of vaccination with the development of SARS-CoV-2 immunity in adolescents in the Philippines.
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