SARS-CoV-2 specific T cell responses are lower in children and increase with age and time after infection

Cohen, Carolyn A; Li, Athena PY; Hachim, Asmaa; Hui, David SC; Kwan, Mike YW; Tsang, Owen TY; Chiu, Susan S; Chan, Wai Hung; Yau, Yat Sun; Kavian, Niloufar; Ma, Fionn NL; Lau, Eric HY; Cheng, Samuel MS; Poon, Leo LM; Peiris, JS Malik; Valkenburg, Sophie A

SARS-CoV-2 infection of children leads to a mild illness and the immunological differences with adults remains unclear. We quantified the SARS-CoV-2 specific T cell responses in adults and children (<13 years of age) with RT-PCR confirmed asymptomatic and symptomatic infection for long-term memory, phenotype and polyfunctional cytokines. Acute and memory CD4(+) T cell responses to structural SARS-CoV-2 proteins significantly increased with age, whilst CD8(+) T cell responses increased with time post infection. Infected children had significantly lower CD4(+) and CD8(+) T cell responses to SARS-CoV-2 structural and ORF1ab proteins compared to infected adults. SARS-CoV-2-specific CD8(+) T cell responses were comparable in magnitude to uninfected negative adult controls. In infected adults CD4(+) T cell specificity was skewed towards structural peptides, whilst children had increased contribution of ORF1ab responses. This may reflect differing T cell compartmentalisation for antigen processing during antigen exposure or lower recruitment of memory populations. T cell polyfunctional cytokine production was comparable between children and adults, but children had a lower proportion of SARS-CoV-2 CD4(+) T cell effector memory. Compared to adults, children had significantly lower levels of antibodies to β-coronaviruses, indicating differing baseline immunity. Total T follicular helper responses was increased in children during acute infection indicating rapid co-ordination of the T and B cell responses. However total monocyte responses were reduced in children which may be reflective of differing levels of inflammation between children and adults. Therefore, reduced prior β-coronavirus immunity and reduced activation and recruitment of de novo responses in children may drive milder COVID-19 pathogenesis.