# SARS-CoV-2 Anti-S an Anti-N IgG Seropositivity in Children and Young People (1-24 Years) According to HIV Status in Lome (Togo) in 2022

Yao Rodion Konu, Florence Damond, I Wone Oumarou Adama, Valentine

Marie Ferre, Alassane Ouro-Medeli, Ounoo Elom Takassi, Nina Dapam, Magnoulelen N'Zonou, Ridwane Bawa-Kawte, Martin Kouame Tchankoni, et al.

► To cite this version:

Yao Rodion Konu, Florence Damond, I Wone Oumarou Adama, Valentine Marie Ferre, Alassane Ouro-Medeli, et al. SARS-CoV-2 Anti-S an Anti-N IgG Seropositivity in Children and Young People (1-24 Years) According to HIV Status in Lome (Togo) in 2022. Influenza and Other Respiratory Viruses, 2025, 19 (4), pp.e70112. 10.1111/irv.70112. hal-05086803

HAL Id: hal-05086803

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Submitted on 27 May 2025

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# SARS-CoV-2 Anti-S an Anti-N IgG Seropositivity in Children and Young People (1–24 Years) According to HIV Status in Lomé (Togo) in 2022

Yao Rodion Konu<fnref n="1" />,² ID | Florence Damond³ | I. Wone Oumarou Adama² | Valentine Marie Ferré³ | Alassane Ouro-médéli⁴ | Ounoo Elom Takassi⁵ | Nina Dapam⁶ | Magnoulélén N'zonou⁷ | Ridwane Bawa-Kawte⁸ | Martin Kouame Tchankoni<fnref n="1" /> | Arnold Junior Sadio<fnref n="1" />,² | Fatoumata Binta Tidiane Diallo⁹ | Claver Anoumou Dagnra⁴ | Charlotte Charpentier³ ID | Didier Koumavi Ekouevi<fnref n="1" />,²

**Correspondence:** Yao Rodion Konu (rodionko@yahoo.fr)

**Received:** 1 August 2024 | **Revised:** 10 April 2025 | **Accepted:** 13 April 2025

**Funding:** This project received funding from the World Health Organization Country Office of Togo (WHO Reference 2022/1307691-0). Dr. Rodion KONU was supported by the “Agence Nationale de Recherche sur le sida et les hépatites virales (ANRS)” in France for his PhD training in Epidemiology at the University of Bordeaux through a doctoral scholarship. This work is solely the responsibility of the authors and does not necessarily represent the official views of any of the institutions mentioned above.

**Keywords:** HIV | SARS-CoV-2 | seropositivity | young people

## ABSTRACT

We aimed to estimate SARS-CoV-2 seropositivity among children and young people in Lomé, Togo, according to HIV status. A multicenter comparative cross-sectional study was conducted, and 636 participants were included (41.8% living with HIV). Anti-S (88.7% vs. 89.1%) and anti-N (41.6% vs. 39.5%) IgG seropositivity were comparable in both groups. These data suggest no increased COVID-19 susceptibility in children and young people with HIV.

## 1 | Background

Since the onset of the COVID-19 pandemic, questions have been raised as to who are at greater risk of COVID-19 infection and worse outcomes [1]. People living with human immunodeficiency virus (PLWH) were initially suspected, but it remains unclear whether they have an increased susceptibility to SARS-CoV-2 infection and severe COVID-19 manifestations due to HIV-related immunosuppression [2]. Conversely, it has been suggested that PLWH may be protected against severe

manifestations of COVID-19 because of the initiation of antiretroviral therapy [2].

Understanding whether or not HIV infection could affect susceptibility to SARS-CoV-2 infection, its severity, and lower antibody production against SARS-CoV-2 is essential both for PLWH and for the healthcare system so as to inform policies and response to future epidemics in which PLWH populations will likely to face [3]. Data on SARS-CoV-2 infection and COVID-19 outcomes in PLWH in Africa is however scarce in general [2].

<footnote n="1">¹Centre de Formation et de Recherche en Santé Publique, Département de Santé Publique, Faculté des Science de la Santé, Université de Lomé, Lomé, Togo | ²GHiGS Team, University of Bordeaux, Inserm (UMR 1219), IRD (EMR 279), Bordeaux Population Health Centre, Bordeaux, France | ³Service de Virologie, Université Paris Cité, INSERM, IAME, UMR 1137, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France | ⁴Centre national de recherche sur le VIH, Programme National de Lutte contre le VIH et les hépatites virales, Lomé, Togo | ⁵Service de pédiatrie, CHU Sylvanus Olympio, Lomé, Togo | ⁶Centre Médicosocial Lucia, ONG Espoir Vie Togo, Lomé, Togo | ⁷Service de pédiatrie, Hopital de Bè, Lomé, Togo | ⁸Centre médicosocial de l'ONG Action Communautaire pour la Santé, Lomé, Togo | ⁹World Health Organization Country Office (WCO), Lomé, Togo</footnote>

<footnote>This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.</footnote>

<footnote>© 2025 The Author(s). *Influenza and Other Respiratory Viruses* published by John Wiley & Sons Ltd.</footnote>
In particular, little is known about vulnerability faced by chil-
dren, adolescents, and youths living with HIV to SARS-CoV-2
infection.

In sub-Saharan Africa (SSA) where 66% of PLWH lived in 2023,
adolescents and youths aged 10 to 24years bears the heaviest bur-
den of HIV [4]. The majority (85%) of 1.65 million adolescents liv-
ing with HIV in the world are found in SSA. Studies have reported
poorer HIV care outcomes in adolescents compared to adults in-
cluding lower viral suppression [5], which could increase the risk
of immunosuppression and vulnerability to a range of illnesses,
including severe symptoms or death as a result of COVID-19 [5].

In Togo, seroprevalence of SARS-CoV-2 ranged from 50 to 70%
in 5- to 29-year-olds in the general population in 2021 [6]. In this
study, we aimed to estimate SARS-CoV-2 anti-S and anti-N IgG
seropositivity among children and young people living with HIV
(CYWH) and without HIV (CYWoH) in Lomé (Togo) in 2022.

## 2 | Methods

## 2.1 | Study Design, Study Sample, and Data Collection

A comparative cross-sectional study was conducted in four
health facilities in Lomé between August and November 2022.
The pediatric wards of two tertiary-level hospitals (Sylvanus
Olympio teaching hospital and Bè hosptial) and two care cen-
ters for people living with HIV (Centre Médico-social Lucia
and ONG Action Communautaire pour la Santé) were selected
for the study for having a large patient volume. Ethical ap-
proval was obtained from the Bioethics Committee for Health
Research of the Togo Ministry of Health (N°002/2021/CBRS).
Participants meeting the following criteria were included by
convenience sampling: i) being 18 months of age or older, ii)
seen in consultation or hospitalized during the study period,
and iii) given informed consent (and assent for those under
18 years old).

To allow comparison of two proportions, the double population
proportion formula was used to estimate a minimum sample
size in each group. Assuming an alpha risk of 5%, a beta risk of
20%, a 67.0% seroprevalence in CYWH [6] and 80% seropreva-
lence in adolescents living with HIV, a minimum of 177 partici-
pants per group was thought to be necessary.

A structured questionnaire was administered to child's parent/
guardian or participant him/herself (if ≥18 years old) to collect
information on sociodemographic characteristics, self-declared
COVID-19-related history, and antiretroviral treatment
characteristics.

## 2.2 | Biological Sample and Analysis

We collected a 5mL blood sample from each participant. Aliquots
of plasma were stored to the laboratory of molecular biology and
immunology (BIOLIM, University of Lomé, Togo) and transported
frozen to the virology laboratory of the Hôpital Bichat-Claude
Bernard (Paris, France), for the search for anti-SARS-CoV-2

antibodies. SARS-CoV-2 anti-S and anti-N IgG were measured
using the Abbott SARS-CoV-2 IgG kits (Alinity i SARS-CoV-2 IgG
II Quant, and SARS-CoV-2 IgG, Abbott, Illinois, United States)
with the Alinity i platform according to the manufacturer's in-
structions (sensitivity > 99% and specificity > 99%) [7].

HIV serology, performed at BIOLIM, was ensured by rapid test
(SD Bioline HIV/Syphilis Duo, Abott, Santa Clara, California,
United States), and each positive result was confirmed with
the First Response® HIV 1-2-O Card Test (Premier Medical
Corporation Pvt. Ltd., Maharashtra, India). In case of discor-
dant results, samples were tested with the INNO-LIA® HIV I/
II Score (20 T) (Fujirebio, Göteborg, Sweden) line immunoassay
according to the national guidelines in Togo.

## 2.3 | Statistical Analysis

Categorical and quantitative variables were described as propor-
tions and median (with interquartile range [IQR]), respectively.
Antibody seroprevalence was estimated with a 95% confidence
interval (CI). A linear regression model adjusted for age and sex
was fitted to compare anti-S antibody titer by HIV status in par-
ticipants positive to SARS-CoV-2 anti-S IgG.

Analyses were carried out using R software version 4.3.2. The
predicted means were estimated using the *emmeans* (version
1.11.0) package. The significance level was set at 5%.

## 3 | Results

### 3.1 | Sociodemographic and HIV-Related Characteristics

A total of 636 adolescents were included, of which 266 (41.8%)
were CYWH. The median age was 17years (IQR 13–19) in
CYWH versus 9years (IQR 5–14) in CYWoH. Of CYWH, 61.3%
were virologically suppressed (viral load <50 copies/mL). The
majority (72.6%) has been on antiretroviral therapy for at least
5years, and 85.7% (n=228/266) were on a dolutegravir-based reg-
imen (Table 1).

## 3.2 | COVID-19 Related History

Of 266 CYWH, 20.1% (n=53) reported having had at least one
symptom of COVID-19 in the 15 days prior to inclusion, and 10.2%
(n=27) reported having been vaccinated against COVID-19.
These proportions were respectively 63.8% (n=236/370) and
14.6% (n=54/370) among CYWoH (Table 1).

## 3.3 | SARS-CoV-2 IgG Seropositivity

Overall, seropositivity of SARS-CoV-2 anti-S IgG was 89.0%
(566/636). Among CYWH, seropositivity was 88.7% (95%CI
84.1–92.1), compared with 89.1% (95%CI 85.5–92.1) CYWoH
(Table 1). Among participants who reported not having been
vaccinated against COVID-19, seropositivity was 87.3% among
CYWH versus 87.6% CYWoH (Supplementary Table S1).
<table><caption>TABLE 1 | Seroprevalence of SARS-CoV-2 anti-S IgG according to sociodemographic and HIV-related characteristics (N=636).</caption><thead><tr><th rowspan="2">Characteristic</th><th colspan="3">HIV negative</th><th colspan="3">HIV positive</th></tr><tr><th>Overall<sup>a</sup>, N=370<sup>d</sup></th><th>Anti-S positive<sup>b</sup>, N=330<sup>d</sup></th><th>Anti-S negative<sup>b</sup>, N=40<sup>d</sup></th><th>p value<sup>e</sup></th><th>Overall<sup>a</sup>, N=266<sup>d</sup></th><th>Anti-S positive<sup>b</sup>, N=236<sup>d</sup></th><th>Anti-S negative<sup>b</sup>, N=30<sup>d</sup></th><th>p value<sup>e</sup></th></tr></thead><tbody><tr><td><strong>Age (years), median (IQR)</strong></td><td>9 (5-14)</td><td>9 (5-15)</td><td>6 (3-8)</td><td><strong>&lt;0.001</strong></td><td>17 (13-19)</td><td>17 (14-20)</td><td>12 (9-15)</td><td><strong>&lt;0.001</strong></td></tr><tr><td><strong>Age (years)</strong></td><td></td><td></td><td></td><td><strong>0.006</strong></td><td></td><td></td><td></td><td><strong>&lt;0.001</strong></td></tr><tr><td>&lt;5</td><td>96 (25.9)</td><td>79 (82.3)</td><td>17 (17.7)</td><td></td><td>2 (0.8)</td><td>2 (100.0)</td><td>0 (0.0)</td><td></td></tr><tr><td>[5-10]</td><td>105 (28.4)</td><td>91 (86.7)</td><td>14 (13.3)</td><td></td><td>35 (13.2)</td><td>22 (62.9)</td><td>13 (37.1)</td><td></td></tr><tr><td>[10-15]</td><td>83 (22.4)</td><td>76 (91.6)</td><td>7 (8.4)</td><td></td><td>62 (23.1)</td><td>54 (87.1)</td><td>8 (12.9)</td><td></td></tr><tr><td>[15-20]</td><td>42 (11.4)</td><td>40 (95.2)</td><td>2 (4.8)</td><td></td><td>109 (41.0)</td><td>102 (93.6)</td><td>7 (6.4)</td><td></td></tr><tr><td>≥20</td><td>44 (11.9)</td><td>44 (100.0)</td><td>0 (0.0)</td><td></td><td>58 (21.8)</td><td>56 (96.6)</td><td>2 (3.4)</td><td></td></tr><tr><td><strong>Gender</strong></td><td></td><td></td><td></td><td><strong>0.008</strong></td><td></td><td></td><td></td><td>0.070</td></tr><tr><td>Female</td><td>165 (44.7)</td><td>155 (93.9)</td><td>10 (6.1)</td><td></td><td>139 (52.3)</td><td>128 (92.1)</td><td>11 (7.9)</td><td></td></tr><tr><td>Male</td><td>204 (55.3)</td><td>174 (85.3)</td><td>30 (14.7)</td><td></td><td>127 (47.7)</td><td>108 (85.0)</td><td>19 (15.0)</td><td></td></tr><tr><td>Missing data</td><td>1</td><td>1</td><td>0</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td><strong>Education level</strong></td><td></td><td></td><td></td><td><strong>0.053</strong></td><td></td><td></td><td></td><td><strong>0.004</strong></td></tr><tr><td>No education</td><td>81 (22.0)</td><td>69 (85.2)</td><td>12 (14.8)</td><td></td><td>34 (13.2)</td><td>33 (97.1)</td><td>1 (2.9)</td><td></td></tr><tr><td>Primary</td><td>161 (43.8)</td><td>139 (86.3)</td><td>22 (13.7)</td><td></td><td>74 (28.7)</td><td>57 (77.0)</td><td>17 (23.0)</td><td></td></tr><tr><td>Secondary</td><td>66 (17.9)</td><td>62 (93.9)</td><td>4 (6.1)</td><td></td><td>118 (45.7)</td><td>109 (92.4)</td><td>9 (7.6)</td><td></td></tr><tr><td>University</td><td>60 (16.3)</td><td>58 (96.7)</td><td>2 (3.3)</td><td></td><td>32 (12.4)</td><td>30 (93.7)</td><td>2 (6.3)</td><td></td></tr><tr><td>Missing data</td><td>2</td><td>2</td><td>0</td><td></td><td>8</td><td>7</td><td>1</td><td></td></tr><tr><td><strong>COVID-19 symptoms in the last 15 days<sup>c</sup></strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td><strong>0.004</strong></td></tr><tr><td>No</td><td>134 (36.2)</td><td>122 (91.0)</td><td>12 (9.0)</td><td></td><td>213 (79.9)</td><td>195 (91.5)</td><td>18 (8.5)</td><td></td></tr><tr><td>Yes</td><td>236 (63.8)</td><td>208 (88.1)</td><td>28 (11.9)</td><td>0.4</td><td>53 (20.1)</td><td>41 (77.4)</td><td>12 (22.6)</td><td></td></tr><tr><td>Missing data</td><td></td><td></td><td></td><td></td><td>2</td><td>2</td><td>0</td><td></td></tr><tr><td><strong>COVID-19 vaccination</strong></td><td></td><td></td><td></td><td><strong>0.016</strong></td><td></td><td></td><td></td><td>0.13</td></tr><tr><td>Do not know</td><td>26 (7.1)</td><td>25 (96.2)</td><td>1 (3.8)</td><td></td><td>1 (0.4)</td><td>1 (100.0)</td><td>0 (0.0)</td><td></td></tr></tbody></table>

(Continues)
<table><caption>TABLE 1 | (Continued)</caption><thead><tr><th rowspan="2">Characteristic</th><th colspan="3">HIV negative</th><th colspan="3">HIV positive</th></tr><tr><th>Overall<sup>a</sup>, N=370<sup>d</sup></th><th>Anti-S positive<sup>b</sup>, N=330<sup>d</sup></th><th>Anti-S negative<sup>b</sup>, N=40<sup>d</sup></th><th>p value<sup>e</sup></th><th>Overall<sup>a</sup>, N=266<sup>d</sup></th><th>Anti-S positive<sup>b</sup>, N=236<sup>d</sup></th><th>Anti-S negative<sup>b</sup>, N=30<sup>d</sup></th><th>p value<sup>e</sup></th></tr></thead><tbody><tr><td>No</td><td>289 (78.3)</td><td>251 (86.9)</td><td>38 (13.1)</td><td></td><td>236 (89.4)</td><td>206 (87.3)</td><td>30 (12.7)</td><td></td></tr><tr><td>Yes</td><td>54 (14.6)</td><td>53 (98.1)</td><td>1 (1.9)</td><td></td><td>27 (10.2)</td><td>27 (100.0)</td><td>0 (0.0)</td><td></td></tr><tr><td>Missing data</td><td>1</td><td>1</td><td>0</td><td></td><td>2</td><td>2</td><td>0</td><td>0.7</td></tr><tr><td><strong>Antiretroviral regimen</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>DTG-based</td><td></td><td></td><td></td><td></td><td>228 (85.7)</td><td>203 (89.0)</td><td>25 (11.0)</td><td></td></tr><tr><td>NNRT1-based</td><td></td><td></td><td></td><td></td><td>24 (9.0)</td><td>20 (83.3)</td><td>4 (16.7)</td><td></td></tr><tr><td>PI-based</td><td></td><td></td><td></td><td></td><td>14 (5.3)</td><td>13 (92.9)</td><td>1 (7.1)</td><td></td></tr><tr><td><strong>Duration of antiretroviral therapy (years)</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td><strong>0.025</strong></td></tr><tr><td>&lt;5</td><td></td><td></td><td></td><td></td><td>73 (27.4)</td><td>58 (79.5)</td><td>15 (20.5)</td><td></td></tr><tr><td>[5,10]</td><td></td><td></td><td></td><td></td><td>100 (37.6)</td><td>92 (92.0)</td><td>8 (8.0)</td><td></td></tr><tr><td>[10,15]</td><td></td><td></td><td></td><td></td><td>73 (27.4)</td><td>66 (90.4)</td><td>7 (9.6)</td><td></td></tr><tr><td>&gt;15</td><td></td><td></td><td></td><td></td><td>20 (7.5)</td><td>20 (100.0)</td><td>0 (0.0)</td><td></td></tr><tr><td><strong>Duration of DTG based regimen (month)</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td><strong>0.004</strong></td></tr><tr><td>&lt;12</td><td></td><td></td><td></td><td></td><td>47 (22.3)</td><td>37 (78.7)</td><td>10 (21.3)</td><td></td></tr><tr><td>[12,24]</td><td></td><td></td><td></td><td></td><td>92 (43.6)</td><td>82 (89.1)</td><td>10 (10.9)</td><td></td></tr><tr><td>&gt;24</td><td></td><td></td><td></td><td></td><td>72 (34.1)</td><td>70 (97.2)</td><td>2 (2.8)</td><td></td></tr><tr><td>Missing data</td><td></td><td></td><td></td><td></td><td>55</td><td>47</td><td>8</td><td></td></tr><tr><td><strong>HIV viral suppression (&lt;50 c/mL)</strong></td><td></td><td></td><td></td><td></td><td>163 (61.3)</td><td>145 (89.0)</td><td>18 (11.0)</td><td>0.9</td></tr><tr><td><strong>HIV viral load &lt;200 c/mL</strong></td><td></td><td></td><td></td><td></td><td>200 (75.2)</td><td>178 (89.0)</td><td>22 (11.0)</td><td>0.8</td></tr><tr><td><strong>HIV viral load &lt;1000 c/mL</strong></td><td></td><td></td><td></td><td></td><td>218 (81.9)</td><td>195 (89.4)</td><td>23 (10.6)</td><td>0.4</td></tr></tbody></table>

Abbreviations: IQR, interquartile range; DTG, dolutegravir.

<sup>a</sup>Proportions were calculated by dividing the modality number by the column total.

<sup>b</sup>Proportions are calculated by dividing the number of modalities by the total for the line (anti-S positive + anti-S negative).

<sup>c</sup>At least one of the following symptoms: fever, headache, joint/muscle pain, sore throat, rhinorrhea, shortness of breath, ageuria, anosmia, abdominal pain, diarrhea, cough, and unusual fatigue.

<sup>d</sup>Median (25–75%); n (%).

<sup>e</sup>Wilcoxon rank sum test; Fisher's exact test; Pearson's chi-squared test.
In the multiple linear regression model, CYWH had on average 108 BAU/mL fewer anti-S antibody titers ($\beta = -108, 95\%CI -184, -31$) adjusted for age and gender (Supplementary Table S2).

Finally, 40.7% ($n=259/636$) participants where positive to SARS-CoV-2 anti-N IgG. This seropositivity was 41.6% (95%CI 36.6–46.8) among CYWH, compared with 39.5% (95%CI 33.6–45.6) among CYWoH (Supplementary Table S3).

## 4 | Discussion

This study was carried out between August and November 2022, more than 2 years after the first COVID-19 case was detected in Togo. We observed that SARS-CoV-2 anti-S and anti-N seropositivity was comparable between CYWH and CYWoH. In a repeat SARS-CoV-2 seroprevalence survey amongst CALWHIV in Europe ($n=493$) and South Africa (SA, $n=307$), and HIV-negative adolescents in South Africa ($n=100$), in 2020–2022, Jackson et al., questioned the susceptibility of children and adolescents living with HIV to SARS-CoV-2. They reported that SARS-CoV-2 seroprevalence was 55% (50–59%) in participant with HIV in Europe, 67% (61–72%) in SA, and 85% (77–92%) among HIV negative participants in SA [8]. Similarly, in a study of 6 cohorts from 55,349 PLWH to over 3.7 million HIV-free subjects, the proportion of patients testing positive for SARS-CoV-2 was comparable according to HIV status [9]. In Uganda, a lower proportion of anti-S antibodies was reported in PLWH (58.8% vs. 84.9%, $p=0.009$), while anti-N antibodies were comparable (68.2% vs. 60.0%, $p=0.344$) [10]. All this reinforces the idea of a lack of association between HIV infection and susceptibility to SARS-CoV-2 infection in children and young people [8], as well as demonstrated in adult populations [11].

In general, anti-N persists less longer than anti-S [10], which can explain the results observed with a lower proportion of participants with anti-N positivity. Elsewhere, the proportion of anti-S can be modulated by vaccination. Nevertheless, the results observed in our study remain high in a sample in which only 12.8% reported having been vaccinated. We therefore argue that vaccination rates did not influence our results.

Among anti-S positive participants, HIV positive ones had lower anti-S titers than their counterparts. Similar findings were made by Spinelli in adult sample [3]. Several studies reported that accumulation of mutations leading to hypermutated variants of SARS-CoV-2 may appear during these persistent cases of COVID-19 [12]. These observations might suggest that PLWH, especially those with immunosuppression, should be prioritized for COVID-19 risk reduction, including vaccination [12]. This could prevent the emergence of mutations. However, in the absence of an anti-S titer cutoff this should be further investigated.

This study has several limitations. Firstly, the study sample was drawn using a convenience sampling, which increases the risk of selection bias. Secondly, in the absence of computerized individual medical records, data on the history of COVID-19 symptoms and vaccination history were collected on the basis of self-reports. A reporting bias cannot therefore be excluded. Thirdly, anti-S IgG titers among the two groups of participants should be considered with caution, since there was no SARS-CoV-2 PCR

available and no data regarding clinical symptoms older than 15 days.

Taking these limitations into account, the results of this study remain relevant, as to our knowledge, it is one of the few investigations exploring the susceptibility of CYWH to SARS-CoV-2 infection in sub-Saharan Africa in comparison with CYWoH. These initial data suggest no increased COVID-19 susceptibility in CYWH. In the longer term, it would be useful for HIV managing agencies to consider a surveillance strategy for this population in the context of emerging epidemics, in order to identify specific risks and subsequently bring adequate responses.

### Author Contributions

Y.R.K., F.B.T.D., C.C., C.A.D., and D.K.E. conceived, designed, and developed the protocol. I.W.O.A., O.E.T., N.D., M.N., and R.B.K. collected the data. A.O.M., F.D., and V.M.F. performed lab procedures. Y.R.K., M.K.T., and A.J.S. managed and analyzed the data. Y.K.R. and I.W.O.A. drafted the manuscript. All authors reviewed the manuscript.

### Ethics Statement

This study was approved by the Bioethics Committee for Health Research of the Ministry of Health (Number 002/2021/CBRS).

### Consent

Informed consent was provided by parents/caregivers and assent was given by children/adolescents.

### Conflicts of Interest

The authors declare no conflicts of interest.

### Data Availability Statement

Data may be obtained from a third party and are not publicly available. The data are obtainable from the Ministry of Health in Togo.

### Peer Review

The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer-review/10.1111/irv.70112.

### Permission to Reproduce Material From Other Sources

Not applicable.

### References

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**Supporting Information**

Additional supporting information can be found online in the Supporting Information section.