PONE-D-24-24474Seroprevalence of SARS-CoV-2 and risk factors for infection among children in Uganda: a serial cross-sectional studyPLOS ONE

Dear Dr. Briggs,

I would like to sincerely apologise for the delay you have incurred with your submission. It has been exceptionally difficult to secure reviewers to evaluate your study. We have now received three completed reviews; the comments are available below. One of the reviewers feels more positive about your work but the other reviewers have raised significant scientific concerns about the study that need to be addressed in a revision.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is a manuscript on an important subject of COVID 19 and prevalence risk factors and effect on vulnerable population.It is well written but there are several clarifications that needs to be done to make it even better.

-Please clarify who is the Corresponding author is. is it Jessica Briggs or Irene Bagala?

-Since you have not reported testing The SARS COV2 strains, you can only conclude that the seroprevalence --was 'during' the said strain was circulating and not caused 'by' the said strains

-Not clear how the 12 and the 32 communities were picked out of 64 MRC

-Not clear why the consent to use stored samples was waived yet you had access to the population ( what reasons did you give the ETHICS review board?)

-I feel the word “Impact” is too strong, could you replace with another word such as “effect”

-You introduce the use of samples from other studies without giving a short brief on the studies.

-At baseline you do not have results for under 2 years- any reason?

-Please state if an In-house determination of cut of using R package ROCR would affect comparability with other studies?.

Reviewer #2: Bagala et al. describe the results of a cross-sectional survey nested in a cluster-randomized trial conducted in Uganda. This report informs children’s exposure to SARS-CoV-2 across epidemic waves while analyzing knowledge, attitudes, and behavior toward COVID-19 at the household level. Overall, the manuscript is well-written and presents relevant data. However, the following points need to be clarified/improved:

Background

L56. “SARS-CoV-2 acronym already includes virus in it. So, there might be no need to add “virus” after SARS-CoV-2.

Methods

L99-100. “For each cluster for each survey…” Could the authors rephrase to avoid repeating “each”?

L111. Authors might need to rephrase as follows for a better understanding of the sentence: “… prick blood sample was collected from all children aged 2-10 present in the household.”

L116-117. “…along with assent if the child was 8 years old or older…” could be replaced with “…along with assent if the child was at least eight years of age or at least eight years old”.

L160-164. The authors state that four institutions approved the study. Yet, they didn’t provide approval numbers. “LLINEUP2” seems to be the project name, and other details provided in L160 refer to the clinical trial registration of the main study.

L190. Please add the content in parenthesis rather after “study” than after “The parent.”

Results

A general concern is that the authors mention in the abstract and methods that they adjusted the seroprevalence to account for clustering within households and for the test kit performance. Could they provide crude seroprevalence estimates to see whether adjustments significantly changed the figures?

L175, 179, 180. I wonder why Figure 2 appears before Figure 1 while Figure 1 appears for the first time in the Results section.

L188. “…the children were ages…” This is likely a typo, please correct.

L192 vs L193. Are the authors presenting data on attitudes or perceptions? Both seem to be used interchangeably in the next paragraphs.

L175-226. Although data on knowledge, attitudes, behaviors, and vaccination are important to understanding COVID-19, they seem to draw the reader’s attention more than the actual seroprevalence data, which is supposed to be the focus of this study. Presenting seroprevalence data first to address the main research question and then mentioning additional data could be one way forward.

L295-297. Please rephrase the sentence for a better understanding.

Figure 3. Please indicate the north and the scales on the provided maps of RBD seroprevalence at baseline and follow-up

L373-377. Please provide the approval number for the listed ethical approvals

Reviewer #3: This is a straightforward analysis of a substudy conducted within the context of a large, cluster-randomized trial. The statistical analysis is appropriate and well-conducted, although I would like to see an enumeration of the variables included in the multivariate models. The manuscript is clearly written, with cogent discussions of study limitations. I have little to recommend in the way of changes. I might quibble over whether households' omitting fomites as a SARS-CoV-2 transmission truly represents a lack of knowledge (I'm not sure fomites have ever been shown to be even a moderate exposure risk), but this is minor and debatable. The results have modest immediate utility, but assessing "importance" is beyond the scope of review. In any case, as the largest seroprevalence survey of children in Uganda to date, the study is valuable.

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Reviewer #1: Yes: Dr Evans Amukoye

Reviewer #2: No

Reviewer #3: No

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Seroprevalence of SARS-CoV-2 and risk factors for infection among children in Uganda: a serial cross-sectional study

PONE-D-24-24474R1

Dear Dr. Briggs,

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.

Within one week, you’ll receive an e-mail detailing the required amendments. I would especially raise your attention on the declaration of publicly making the data available used in the manuscript. This declaration is currently missing in your submission. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Sk Md Mamunur Rahman Malik

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: (No Response)

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: (No Response)

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: (No Response)

Reviewer #3: (No Response)

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: (No Response)

Reviewer #3: (No Response)

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: You have addressed all my concerns except use of the term 'Impact' which to me means long term effect. Ill treat it as a matter of semantics

Reviewer #2: All comments have been addressed although line numbers with changes were hard to find.

Authors might need to check the following:

L141. “specimens, along with assent if the child “was” at least 8 years of age. “was” is missing.

Reviewer #3: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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