Dear Professor Wellmann,

We are delighted to inform you that your manuscript, 'Postnatal SARS-CoV-2 Infection and Immunological Reaction: A Prospective Family Cohort Study' (PAI-20-L-0250.R2), has been accepted for publication in Pediatric Allergy and Immunology.

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Kindest regards

Professor Ömer Kalaycı
Associate Editor
Pediatric Allergy and Immunology

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Decision letter by

Ömer Kalaycı

Cite this decision letter

COMMENTS FOR THE AUTHOR:
There are only two minor corrections:
Insert "immune response" after " humoral" in the sentence "Furthermore, the role
of the humoral [immune response] in fending off SARS-CoV-2 requires additional discussions which may have far-reaching implications for gauging the value of newly developed vaccines.

Also, insert "immune" after "humoral" in the sentence "Finally, additional studies are
needed to better understand the humoral [immune] response against SARS-CoV-2."

RESPONSE:
Thank you very much for these corrections. Both have been done as recommended in the manuscript and are highlighted in “Main Document (changes marked)”.

Many thanks for the very speedy and uncomplicated revision process.
Yours sincerely,
Sven Wellmann

Author response by

Pressler, Julia

Fill Malfertheiner, Sara

Kabesch, Michael

Buntrock-Doepke, Heike

Haeusler, Sebastian

Ambrosch, Andreas

Wellmann, Sven

Dear Professor Wellmann,

We recognise that the impact of the COVID-19 pandemic may affect your ability to return your revised manuscript to us within the requested timeframe. If this is the case, please let us know.

02-Jun-2020

Your manuscript, PAI-20-L-0250.R1, has been reviewed.

The reviewers feel that certain specific issues must be addressed before the manuscript can be accepted. Please see the comments below. Any revision you may choose to submit must incorporate changes. You must thoroughly and satisfactorily address all comments made by the reviewers in a point-by-point reply:

1) Copy each “comment to the author” made by the reviewer
2) Put your reply directly underneath each comment

Then you may upload the point-by-point reply and two versions of the revised manuscript, as follows:

• a 'clean' version of the manuscript, using the file designation 'Main Document';
• a version of the manuscript with changes marked by using the “Track changes” tool on Word. Save the file as 'Main Document (changes marked)'.

To adapt your manuscript to our new standards please visit the Author Guidelines at the following link:

http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1399-3038/homepage/ForAuthors.html

The deadline for submission of the revised version is 31-Aug-2020

Kindest regards,

Professor Ömer Kalaycı
Associate Editor
Pediatric Allergy and Immunology

Reviewer: 1

COMMENTS FOR THE AUTHOR:
There are only two minor corrections:
Insert "immune response" after " humoral" in the sentence "Furthermore, the role
of the humoral [immune response] in fending off SARS-CoV-2 requires additional discussions which may have far-reaching implications for gauging the value of newly developed vaccines.

Also, insert "immune" after "humoral" in the sentence "Finally, additional studies are
needed to better understand the humoral [immune] response against SARS-CoV-2."

Decision letter by

Ömer Kalaycı

Cite this decision letter

COMMENTS FOR THE AUTHOR:
In this prospective study triggered by a nosocomial outbreak of COVID19 in an obstetric department, there were 7 patients from 3 families who became PCR positive for SARS-CoV-2 within one week of exposure. These patients also had symptoms suggestive of COVID19. In all cases, symptoms were mild and resolved spontanenously, none of the 7 patients required invasive mechanical ventilation. When these 7 patients were tested again one month later for the presence of IgA and IgG antibodies directed against SARS-CoV-2,, only 2 of them had both IgA and IgG (Father #1, Mother #7), while 3 of them had neither IgA nor IgG antibodies detected (Mother #1, Father #3, Father #7). One case each had IgA but not IgG (Infant #7), or IgG but no IgA (Mother #3). These findings have implications that merit further discussion. Either the antibody assays employed failed to detect all antibodies, or the patients overcame COVID19 without mounting an antibody response. If these data are corroborated by further investigations, there is little value in determining antibodies against SARS-CoV-2. Furthermore, a humoral may not be necessary to fend off SARS-CoV-2 which has far-reaching implications for gauging the value of newly developed vaccines.

RESPONSE:
Thank you very much for this valuable comment addressing important issues.
- We added to the result section the following sentence (paragraph 4): In addition, three parents of the three families tested positive for SARS-CoV-2 by RT-PCR within the first week after infection (mother ID1, father ID3 and father ID7) had symptoms but remained negative in both antibody tests performed, EUROIMMUN and Roche Diagnostics.
- We added to the discussion section (second last paragraph): Our finding that not all RT-PCR positive family members produced antibodies against SARS-CoV-2 is in line with previous reports from us and others, describing a match rate of only 70-80% between RT-PCR and antibody results in COVID-19 patients.5,9 These findings may indicate that an relevant amount of COVID-19 patients, including neonates, does not develop a humoral response to SARS-CoV-2. If these data are corroborated by further investigations, there is limited value in determining antibodies against SARS-CoV-2. Furthermore, the role of the humoral in fending off SARS-CoV-2 requires additional discussions which may have far-reaching implications for gauging the value of newly developed vaccines.
- We added to the final paragraph: Finally, additional studies are needed to better understand the humoral response against SARS-CoV-2.
In addition, we added reference 9 to the literature supporting the mismatch of RT-PCR and antibody results.

Author response by

Pressler, Julia

Fill Malfertheiner, Sara

Kabesch, Michael

Buntrock-Doepke, Heike

Haeusler, Sebastian

Ambrosch, Andreas

Wellmann, Sven

Dear Professor Wellmann,

We recognise that the impact of the COVID-19 pandemic may affect your ability to return your revised manuscript to us within the requested timeframe. If this is the case, please let us know.

27-May-2020

Your manuscript, PAI-20-L-0250, has been reviewed.

The reviewers feel that certain specific issues must be addressed before the manuscript can be accepted. Please see the comments below. Any revision you may choose to submit must incorporate changes. You must thoroughly and satisfactorily address all comments made by the reviewers in a point-by-point reply:

1) Copy each “comment to the author” made by the reviewer
2) Put your reply directly underneath each comment

Then you may upload the point-by-point reply and two versions of the revised manuscript, as follows:

• a 'clean' version of the manuscript, using the file designation 'Main Document';
• a version of the manuscript with changes marked by using the “Track changes” tool on Word. Save the file as 'Main Document (changes marked)'.

Author Contribution Indication
The contributions of each author to this work must now be indicated when you submit your revised manuscript. To add Author Contributions using CRediT taxonomy (https://casrai.org/credit/), simply click the “Provide CRediT Contribution” link for each author in the ‘Authors & Institutions’ step of the submission process. From there, you will be able to check applicable Author/Contributor Roles and, if available, specify the Degree of Contribution. You MUST provide this information as part of the revision process. Author Contributions will be published with the accepted article and cannot be edited after article acceptance. Therefore you must ensure the Author Contribution information you provide is accurate prior to final acceptance.

To adapt your manuscript to our new standards please visit the Author Guidelines at the following link:

http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1399-3038/homepage/ForAuthors.html

The deadline for submission of the revised version is 25-Aug-2020

Kindest regards,

Professor Ömer Kalaycı
Associate Editor
Pediatric Allergy and Immunology

Reviewer: 1

COMMENTS FOR THE AUTHOR:
In this prospective study triggered by a nosocomial outbreak of COVID19 in an obstetric department, there were 7 patients from 3 families who became PCR positive for SARS-CoV-2 within one week of exposure. These patients also had symptoms suggestive of COVID19. In all cases, symptoms were mild and resolved spontanenously, none of the 7 patients required invasive mechanical ventilation. When these 7 patients were tested again one month later for the presence of IgA and IgG antibodies directed against SARS-CoV-2,, only 2 of them had both IgA and IgG (Father #1, Mother #7), while 3 of them had neither IgA nor IgG antibodies detected (Mother #1, Father #3, Father #7). One case each had IgA but not IgG (Infant #7), or IgG but no IgA (Mother #3). These findings have implications that merit further discussion. Either the antibody assays employed failed to detect all antibodies, or the patients overcame COVID19 without mounting an antibody response. If these data are corroborated by further investigations, there is little value in determining antibodies against SARS-CoV-2. Furthermore, a humoral may not be necessary to fend off SARS-CoV-2 which has far-reaching implications for gauging the value of newly developed vaccines.

Decision letter by

Ömer Kalaycı

Cite this decision letter