PONE-D-21-25774SARS-CoV-2 Seroepidemiology in ChildrenPLOS ONE

Dear Dr. Hourigan,

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Academic Editor

PLOS ONE

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“The Virginia Department of Health provided funding for this study. The Virginia Department of Health, in conjunction with the authors of this manuscript, were involved in study design, the writing of the report and the decision to submit the paper for publication. The Virginia Department of Health were not involved in collection, analysis or interpretation of the data.  Research reported in this publication was also supported in part by the National Institute of Child Health and Human Development under Award Number K23HD099240 (Hourigan). Research reported in this publication was also supported in part via a subcontract from the parent award by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR003015 (Hunter, Sun, Bruce). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health”

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“The Virginia Department of Health provided funding for this study. The Virginia Department of Health, in conjunction with the authors of this manuscript, were involved in study design, the writing of the report and the decision to submit the paper for publication. The Virginia Department of Health were not involved in collection, analysis or interpretation of the data.  Research reported in this publication was also supported in part by the National Institute of Child Health and Human Development under Award Number K23HD099240 (Hourigan). Research reported in this publication was also supported in part via a subcontract from the parent award by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR003015 (Hunter, Sun, Bruce). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: The authors performed seroepidemiologic evaluation of SARS-CoV-2 in children in a major metropolitan region of the US. Three FDA approved serology tests were used to assess seroprevalence, Vitros as a primary assay, followed by Orthogonal testing with Siemens and Architect. The observed seroprevalence was higher than what is reported in the literature, I have questions in this regard:

1- Vitros (ortho clinical assay) measures the total antibody to the full spike protein, do you think that the use of Vitros as a primary assay for screening overestimated the seroprevalence in children? as you mentioned in the discussion line 291 “these lower titers levels may represent cross-reactivity to conserved epitopes in benign seasonal human coronavirus” which I agree with. I suggest you cite this paper to support your findings (JCI Insight. 2021;6(4):e144499. https://doi.org/10.1172/jci. insight.144499.).

Reviewer #2: The manuscript by Suchitra K Hourigan and colleagues, titled “SARS-CoV-2 Seroepidemiology in Children"presents a study and test performance data from SARS-CoV-2 spike protein levels in children and adolescents ≤19 years. The work was well-researched, and the authors mined good techniques to evaluate the performance of the assays in detecting SARS-CoV-2 antibodies. There are minor comment:

1#Since the samples were taken in the period July-Octobar 2020. It would be good to plot this months to see which month was most effected to link this date to occasion holidays or schools.

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Reviewer #1: No

Reviewer #2: No

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A cross-sectional investigation of SARS-CoV-2 seroprevalence and associated risk factors in children and adolescents in the United States

PONE-D-21-25774R1

Dear Dr. Suchitra K Hourigan

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Gheyath K. Nasrallah

Academic Editor

PLOS ONE

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