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Zheng B, Chen H, Xia W, Jiang Y, Zhang J. Secondary infections of COVID-19 in schools and the effectiveness of school-based interventions: a systematic review and meta-analysis. Public Health 2024; 229:42-49. [PMID: 38394706 DOI: 10.1016/j.puhe.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/17/2023] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES This meta-analysis explored secondary infections of SARS-CoV-2 and the effectiveness of non-pharmaceutical interventions (NPIs) in school settings, with the aim of providing a reference to formulate scientific prevention and response strategies for similar major public health emergencies in specific settings. STUDY DESIGN This was a systematic review and meta-analysis. METHODS Systematic searches were conducted in PubMed, Web of Science and the Cochrane Library through to 1 August 2022 using the following key search terms: COVID-19, SARS-CoV-2, secondary attack rate, school, transmission, etc. The IVhet model was used for the meta-analysis, and the I2 index and Cochran's Q-test were used to assess heterogeneity. Publication bias was examined using Doi plot, Galbraith plots and Luis Furuya-Kanamori index. Prevalence Critical Appraisal Tool was used to assess the quality of the included articles, while Grading of Recommendations Assessment, Development, and Evaluation was used to rate the quality of the evidence. Subgroup analyses were conducted to explore the potential source of heterogeneity. RESULTS Thirty-four studies involving 226,727 school contacts and 2216 secondary cases were included in this study. The pooled secondary attack rates (SARs) of close contacts, staff contacts and student contacts were 0.67% (95% confidence interval [CI]: 0.11, 1.56), 0.79% (95% CI: 0.00, 6.72) and 0.50% (95% CI: 0.00, 4.48), respectively. Subgroup analysis suggested that multiple or specific combinations (e.g. the combination of contact restriction and hygiene action) of NPIs appeared to be associated with lower SARs. CONCLUSIONS The SAR of SARS-CoV-2 was low in schools. Multiple or specific combinations of prevention strategies appear to mitigate SARS-CoV-2 transmission in school settings. These findings provide a basis for continuous improvement of response strategies to major public health emergencies in the school environment.
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Affiliation(s)
- B Zheng
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Key Laboratory of Environment & Health (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China.
| | - H Chen
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Key Laboratory of Environment & Health (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China.
| | - W Xia
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Key Laboratory of Environment & Health (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China.
| | - Y Jiang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Key Laboratory of Environment & Health (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China.
| | - J Zhang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Key Laboratory of Environment & Health (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China.
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Sandlund J, Duriseti R, Ladhani SN, Stuart K, Noble J, Høeg TB. Child mask mandates for COVID-19: a systematic review. Arch Dis Child 2024; 109:e2. [PMID: 38050026 PMCID: PMC10894839 DOI: 10.1136/archdischild-2023-326215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Mask mandates for children during the COVID-19 pandemic varied in different locations. A risk-benefit analysis of this intervention has not yet been performed. In this study, we performed a systematic review to assess research on the effectiveness of mask wearing in children. METHODS We performed database searches up to February 2023. The studies were screened by title and abstract, and included studies were further screened as full-text references. A risk-of-bias analysis was performed by two independent reviewers and adjudicated by a third reviewer. RESULTS We screened 597 studies and included 22 in the final analysis. There were no randomised controlled trials in children assessing the benefits of mask wearing to reduce SARS-CoV-2 infection or transmission. The six observational studies reporting an association between child masking and lower infection rate or antibody seropositivity had critical (n=5) or serious (n=1) risk of bias; all six were potentially confounded by important differences between masked and unmasked groups and two were shown to have non-significant results when reanalysed. Sixteen other observational studies found no association between mask wearing and infection or transmission. CONCLUSIONS Real-world effectiveness of child mask mandates against SARS-CoV-2 transmission or infection has not been demonstrated with high-quality evidence. The current body of scientific data does not support masking children for protection against COVID-19.
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Affiliation(s)
- Johanna Sandlund
- Board-Certified Clinical Microbiologist and Independent Scholar, Alameda, California, USA
| | - Ram Duriseti
- Stanford University School of Medicine, Stanford, California, USA
| | - Shamez N Ladhani
- Immunisation Department, UK Health Security Agency, London, UK
- Centre for Neonatal and Paediatric Infection, St. George's University of London, London, UK
| | - Kelly Stuart
- SmallTalk Pediatric Therapy, San Diego, California, USA
| | - Jeanne Noble
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Tracy Beth Høeg
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Clinical Research, University of Southern Denmark, Odense, Denmark
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Severo M, Meireles P, Ribeiro AI, Morais V, Barros H. Measuring the clustering effect of the SARS-CoV-2 transmission in a school population: a cross-sectional study in a high incidence region. Sci Rep 2023; 13:16300. [PMID: 37770455 PMCID: PMC10539502 DOI: 10.1038/s41598-023-42470-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
Since the beginning of the pandemic, there has been a great deal of controversy regarding the role of schools in the spread of SARS-CoV-2 infection, and the relative contribution of students, teachers, and others. To quantify the clustering effect of SARS-CoV-2 infection within classes and schools considering the seroprevalence of specific antibodies among students and school staff (teachers and non-teachers) evaluated in schools located in the Northern region of Portugal. 1517 individuals (1307 students and 210 school staff) from 4 public and 2 private schools, comprising daycare to secondary levels, were evaluated. A rapid point-of-care test for SARS-CoV-2 specific IgM and IgG antibodies was performed and a questionnaire was completed providing sociodemographic and clinical information. We calculated the seroprevalence of IgM and IgG antibodies and estimated the Median Odds Ratio (OR) and 95% confidence interval (CI) to assess the clustering effect, using a multilevel (school and class) logistic regression. SARS-CoV-2 seroprevalence (IgM or IgG) was 21.8% and 23.8% (p = 0.575) in students and school staff, respectively. A total of 84 (8.6%) students and 35 (16.7%) school staff reported a previous molecular diagnosis. Among students, those who reported high-risk contacts only at school (OR = 1.13; 95% CI 0.72-1.78) had a seroprevalence similar to those without high-risk contacts; however, seroprevalence was significantly higher among those who only reported a high-risk contact outside the school (OR = 6.56; 95% CI 3.68-11.72), or in both places (OR = 7.83; 95% CI 5.14-11.93). Similar associations were found for school staff. The median OR was 1.00 (95% CI 1.00, 1.38) at the school-level and 1.78 (95% CI 1.40, 2.06) at the class-level. SARS-CoV-2 seroprevalence was similar between students and staff, without a clustering effect observed at the school level, and only a moderate clustering effect documented within classes. These results indicate that the mitigation measures in the school environment can prevent the spread of class outbreaks to the remaining school community.
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Affiliation(s)
- Milton Severo
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, nº 135, 4050-600, Porto, Portugal.
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal.
- Instituto de Ciências Biomédicas- Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal.
| | - Paula Meireles
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, nº 135, 4050-600, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal
| | - Ana Isabel Ribeiro
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, nº 135, 4050-600, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Vítor Morais
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, nº 135, 4050-600, Porto, Portugal
| | - Henrique Barros
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, nº 135, 4050-600, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
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Stein-Zamir C, Sinai-Zaken O, Zvulun E, Najajra G, Pinto R, Koren S, Shoob H, Abramson N. SARS-CoV-2 infection characteristics among students and staff in a large high school COVID-19 outbreak and secondary transmission in households. INFECTIOUS MEDICINE 2023; 2:36-43. [PMID: 38013775 PMCID: PMC9977694 DOI: 10.1016/j.imj.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
Background SARS-CoV-2 clinical presentation is associated with the patients' age group. Overall, young individuals present higher proportions of asymptomatic or mild COVID-19 infection, compared to adults. Data on secondary COVID-19 transmission in households, according to the cases' age group, are accumulating. Methods We performed a follow-up cohort study including all COVID-19 real-time polymerase chain reaction (RT-PCR)-confirmed cases (adolescent students and school staff) diagnosed in an epidemiological investigation of a large high school outbreak. We compared the adolescent and adult groups regarding clinical symptoms, time to negative COVID-19 RT-PCR tests, and infection transmission in households. Results The study population included 817 persons. The confirmed COVID-19 RT-PCR outbreak cases (n = 178) were followed (students aged 12-19 years, median age 14 years, n = 153, school staff aged 24-67 years, median age 39 years, n = 25) and the cases' household close contacts (n = 639) were tested. The adolescents had lower symptomatic infection rates, shorter time to negative COVID-19 RT-PCR tests, and lower transmission rates to household members, compared to the adults. The general transmission rate among household contacts was 13.5%, (86/639) ranging from 8.6% in asymptomatic students' contacts to 27.3% in symptomatic staff contacts. COVID-19 transmission rates were significantly higher in contacts of symptomatic cases compared to asymptomatic cases (odds ratio: 2.06, 95% CI 1.26-3.4) and higher in adults compared to adolescents (odds ratio: 2.69, 95% CI 1.43-4.89). Conclusions Adolescents and adults diagnosed in an outbreak investigation differ as to COVID-19 clinical presentation and transmission. As adolescents may show mild or no symptoms, COVID-19 prevention in school settings is challenging. Implementing nonpharmaceutical measures and promoting vaccination programs in eligible staff and students should be considered.
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Affiliation(s)
- Chen Stein-Zamir
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, The Hebrew University and Hadassah Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Ora Sinai-Zaken
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Eti Zvulun
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Ghada Najajra
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Rinat Pinto
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Shahar Koren
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, The Hebrew University and Hadassah Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Hanna Shoob
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Nitza Abramson
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
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Cuschieri L, Deguara M, Bartolo D, Calleja N, Gauci C. A descriptive study of COVID-19 cases in primary and secondary schools in the Maltese islands: a nationwide experience. Eur J Public Health 2023; 33:209-214. [PMID: 36773316 PMCID: PMC10066482 DOI: 10.1093/eurpub/ckad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND As part of the measures to contain the initial cases of Coronavirus Disease (COVID-19) in 2020, all educational facilities were closed in March 2020 and remained so for the remainder of that scholastic year. When they reopened in October 2020, most educational facilities on the Maltese islands did so with various mitigation measures in place. METHODS A Schools Contact Tracing Team (SCTT) dedicated to the management of COVID-19 cases within schools was set up and networks established between the Ministries responsible for Health and Education to facilitate timely communication and, consequently, effective contact tracing. All cases pertaining to educational facilities, be they students, teaching or non-teaching staff were assessed and managed by this Team. RESULTS Between October 2020 and June 2021, the SCTT assessed 2603 COVID-19 cases within educational facilities in Malta. The highest rate of cases overall was observed in teaching staff (56.53/1000). In 72.45% of cases, no contacts were identified as high risk and thus nobody was placed in quarantine. In 3.07% of school cases >21 high-risk contacts were placed in mandatory quarantine together with their household members. Only 11% of the cases were epi-linked to another positive case within school. CONCLUSIONS The strong collaboration between the health and education authorities combined with strict measures observed in schools ensured that schools remained open throughout most of this pandemic. This study describes the processes by which contact tracing for COVID-19 cases in Maltese schools was carried out and analyses the data collected throughout the scholastic year 2020-21.
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Affiliation(s)
- Liliana Cuschieri
- Infectious Disease Prevention and Control Unit, Health Promotion and Disease Prevention Directorate, Pietà, Malta
| | - Michelle Deguara
- Health Promotion Unit, Health Promotion and Disease Prevention Directorate, Pietà, Malta
| | - Dale Bartolo
- Public Health Laboratory, Environmental Health Directorate, Valletta, Malta
| | - Neville Calleja
- Directorate for Health Information and Research, Pietà, Malta
| | - Charmaine Gauci
- Superintendence of Public Health, St. Luke's Hospital, Pietà, Malta
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Rotevatn TA, Nygård K, Espenhain L, Legarth R, Møller KL, Sarvikivi E, Helve O, Aspelund G, Ersson A, Nordahl M, Greve-Isdahl M, Astrup E, Johansen TB. When schools were open for in-person teaching during the COVID-19 pandemic - the nordic experience on control measures and transmission in schools during the delta wave. BMC Public Health 2023; 23:62. [PMID: 36624496 PMCID: PMC9828373 DOI: 10.1186/s12889-022-14906-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Extensive measures to control spread of SARS-CoV-2 have led to limited access to education for millions of children and adolescents during the COVID-19 pandemic. Education and access to schools is vital for children and adolescents' learning, health, and wellbeing. Based on high vaccine uptake and low incidence levels, the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) decided to start the academic year 2021/22 with schools open for in-person teaching and moderate mitigation measures. We describe trends in SARS-CoV-2 infections and vaccination coverage among students during the first 12 weeks of the fall semester. METHODS In this multinational, retrospective, observational study, we have used surveillance and registry data from each of the Nordic countries to describe vaccine uptake (≥12 years), infection incidence (whole population) and transmission of SARS-CoV-2 among students. The study period, week 30 to 41 (Jul 26th - Oct 17th), represents the autumn semester from immediately before school started until fall break. In addition, we collected information on mitigation measures applied by the respective countries. RESULTS There were slight variations between the countries regarding existing infection prevention and control (IPC) measures, testing strategies and vaccination start-up among adolescents. All countries had high vaccine uptake in the adult population, while uptake varied more in the younger age groups. Incidence in the school-aged population differed between countries and seemed to be influenced by both vaccine uptake and test activity. Infection clusters among school-aged children were described for Denmark and Norway, and the number of clusters per week reflected the incidence trend of the country. Most events consisted of only 1-2 cases. Larger clusters appeared more frequently in the higher grades in Norway and in lower grades in Denmark. CONCLUSION Data from the Nordic countries indicate that vaccination of adults and adolescents, in addition to mitigation measures, enabled full in-person learning. As SARS-CoV-2 infection does not represent a severe medical risk for most children as previously thought, measures targeting this group should be carefully adjusted and kept at a minimum. Our data add to the evidence on incidence and transmission of SARS-CoV-2 among students in schools open for in-person teaching, and may be valuable for decision makers worldwide.
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Affiliation(s)
| | - Karin Nygård
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Oslo, Norway
| | - Laura Espenhain
- grid.6203.70000 0004 0417 4147Statens Serum Institut, Copenhagen, Denmark
| | - Rebecca Legarth
- grid.6203.70000 0004 0417 4147Statens Serum Institut, Copenhagen, Denmark
| | | | - Emmi Sarvikivi
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Otto Helve
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Guðrún Aspelund
- grid.494099.90000 0004 0643 5363The Directorate of Health, Reykjavik, Iceland
| | - Annika Ersson
- grid.419734.c0000 0000 9580 3113The Public Health Agency of Sweden, Stockholm, Sweden
| | - Marie Nordahl
- grid.419734.c0000 0000 9580 3113The Public Health Agency of Sweden, Stockholm, Sweden
| | | | - Elisabeth Astrup
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Oslo, Norway
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Dunay GA, Barroso M, Woidy M, Danecka MK, Engels G, Hermann K, Neumann FS, Paul K, Beime J, Escherich G, Fehse K, Grinstein L, Haniel F, Haupt LJ, Hecher L, Kehl T, Kemen C, Kemper MJ, Kobbe R, Kohl A, Klokow T, Nörz D, Olfe J, Schlenker F, Schmiesing J, Schrum J, Sibbertsen F, Stock P, Tiede S, Vettorazzi E, Zazara DE, Zapf A, Lütgehetmann M, Oh J, Mir TS, Muntau AC, Gersting SW. Long-Term Antibody Response to SARS-CoV-2 in Children. J Clin Immunol 2023; 43:46-56. [PMID: 36121535 PMCID: PMC9483535 DOI: 10.1007/s10875-022-01355-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/18/2022] [Indexed: 01/21/2023]
Abstract
Almost 2 years into the pandemic and with vaccination of children significantly lagging behind adults, long-term pediatric humoral immune responses to SARS-CoV-2 are understudied. The C19.CHILD Hamburg (COVID-19 Child Health Investigation of Latent Disease) Study is a prospective cohort study designed to identify and follow up children and their household contacts infected in the early 2020 first wave of SARS-CoV-2. We screened 6113 children < 18 years by nasopharyngeal swab-PCR in a low-incidence setting after general lockdown, from May 11 to June 30, 2020. A total of 4657 participants underwent antibody testing. Positive tests were followed up by repeated PCR and serological testing of all household contacts over 6 months. In total, the study identified 67 seropositive children (1.44%); the median time after infection at first presentation was 83 days post-symptom onset (PSO). Follow-up of household contacts showed less than 100% seroprevalence in most families, with higher seroprevalence in families with adult index cases compared to pediatric index cases (OR 1.79, P = 0.047). Most importantly, children showed sustained seroconversion up to 9 months PSO, and serum antibody concentrations persistently surpassed adult levels (ratio serum IgG spike children vs. adults 90 days PSO 1.75, P < 0.001; 180 days 1.38, P = 0.01; 270 days 1.54, P = 0.001). In a low-incidence setting, SARS-CoV-2 infection and humoral immune response present distinct patterns in children including higher antibody levels, and lower seroprevalence in families with pediatric index cases. Children show long-term SARS-CoV-2 antibody responses. These findings are relevant to novel variants with increased disease burden in children, as well as for the planning of age-appropriate vaccination strategies.
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Affiliation(s)
- Gabor A. Dunay
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Madalena Barroso
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Mathias Woidy
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Marta K. Danecka
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Geraldine Engels
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Katharina Hermann
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Friederike S. Neumann
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Kevin Paul
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Jan Beime
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Gabriele Escherich
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Kristin Fehse
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Lev Grinstein
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Franziska Haniel
- Department of Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Luka J. Haupt
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Laura Hecher
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Torben Kehl
- Department of Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Christoph Kemen
- Wilhelmstift Children’s Hospital, Liliencronstraße 130, 22149 Hamburg, Germany
| | - Markus J. Kemper
- Asklepios Klinik Nord – Heidberg, Tangstedter Landstraße 400, 22417 Hamburg, Germany
| | - Robin Kobbe
- Institute for Infection Research and Vaccine Development (IIRVD), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Aloisa Kohl
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Thomas Klokow
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Dominik Nörz
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Jakob Olfe
- Department of Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Friderike Schlenker
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Jessica Schmiesing
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Johanna Schrum
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Freya Sibbertsen
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Philippe Stock
- Altona Children’s Hospital, Bleickenallee 38, 22763 Hamburg, Germany
| | - Stephan Tiede
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Dimitra E. Zazara
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany ,Department of Obstetrics and Prenatal Medicine, Division for Experimental Feto-Maternal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Jun Oh
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Thomas S. Mir
- Department of Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Ania C. Muntau
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Søren W. Gersting
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
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Sieber J, Schmidthaler K, Kopanja S, Weseslindtner L, Stiasny K, Götzinger F, Graf A, Krotka P, Hoz J, Schoof A, Dwivedi V, Frischer T, Szépfalusi Z. Limited role of children in transmission of SARS-CoV-2 virus in households-Immunological analysis of 26 familial clusters. Pediatr Allergy Immunol 2023; 34:e13913. [PMID: 36705043 PMCID: PMC10107319 DOI: 10.1111/pai.13913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/23/2022] [Accepted: 01/03/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND The impact of children on the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains uncertain. This study provides an insight into distinct patterns of SARS-CoV-2 household transmission in case of pediatric and adult index cases as well as age-dependent susceptibility to SARS-CoV-2 infection. METHODS Immune analysis, medical interviewing, and contact tracing of 26 families with confirmed SARS-CoV-2 infection cases have been conducted. Blood samples were analyzed serologically with the use of a SARS-CoV-2-specific IgG assay and virus neutralization test (VNT). Uni- and multivariable linear regression and mixed effect logistic regression models were used to describe potential risk factors for higher contagiousness and susceptibility to SARS-CoV-2 infection. RESULTS SARS-CoV-2 infection could be confirmed in 67 of 124 family members. Fourteen children and 11 adults could be defined as index cases in their households. Forty of 82 exposed family members were defined as secondarily infected. The mean secondary attack rate in households was 0.48 and was significantly higher in households with adult than with pediatric index cases (0.85 vs 0.19; p < 0.0001). The age (grouped into child and adult) of index case, severity of disease, and occurrence of lower respiratory symptoms in index cases were significantly associated with secondary transmission rates in households. Children seem to be equally susceptible to acquire a SARS-CoV-2 infection as adults, but they suffer milder courses of the disease or remain asymptomatic. CONCLUSION SARS-CoV-2 transmission from infected children to other household members occurred rarely in the first wave of the pandemic, despite close physical contact and the lack of hygienic measures.
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Affiliation(s)
- Justyna Sieber
- Division of Paediatric Pulmonology, Allergy and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre of Paediatrics, Medical University of Vienna, Vienna, Austria.,Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
| | - Klara Schmidthaler
- Division of Paediatric Pulmonology, Allergy and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Sonja Kopanja
- Division of Paediatric Pulmonology, Allergy and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre of Paediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Karin Stiasny
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Florian Götzinger
- Department of Paediatrics and Adolescent Medicine, Klinik Ottakring, Vienna, Austria
| | - Alexandra Graf
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria
| | - Pavla Krotka
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria
| | - Jakub Hoz
- Division of Paediatric Pulmonology, Allergy and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Anja Schoof
- Division of Paediatric Pulmonology, Allergy and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Varsha Dwivedi
- Division of Paediatric Pulmonology, Allergy and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre of Paediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Zsolt Szépfalusi
- Division of Paediatric Pulmonology, Allergy and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre of Paediatrics, Medical University of Vienna, Vienna, Austria
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9
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Methi F, Madslien EH. Lower transmissibility of SARS-CoV-2 among asymptomatic cases: evidence from contact tracing data in Oslo, Norway. BMC Med 2022; 20:427. [PMID: 36348327 PMCID: PMC9641677 DOI: 10.1186/s12916-022-02642-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Asymptomatic COVID-19 cases have complicated the surveillance and tracking of the pandemic. Previous studies have estimated that 15-25% of all infectees remain asymptomatic. METHODS Based on contact tracing data from Oslo, Norway, we estimated transmission and susceptibility dynamics among symptomatic and asymptomatic cases and their contacts as identified by manual contact tracing between September 1, 2020, and September 1, 2021. RESULTS Among 27,473 indexes and 164,153 registered contacts, the secondary attack rate (SAR-14) was estimated to be 28% lower through asymptomatic exposure (13%) compared to symptomatic exposure (18%). Furthermore, those infected by asymptomatic cases were almost three times more likely to be asymptomatic compared to those infected by symptomatic cases. CONCLUSIONS Symptomatic cases spread the virus to a greater extent than asymptomatic, and infectees are more likely to be asymptomatic if their assumed infector was asymptomatic.
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Affiliation(s)
- Fredrik Methi
- Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway.
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10
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Transmission of SARS-CoV-2 by children to contacts in schools and households: a prospective cohort and environmental sampling study in London. THE LANCET. MICROBE 2022; 3:e814-e823. [PMID: 36029775 PMCID: PMC9401977 DOI: 10.1016/s2666-5247(22)00124-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/20/2022] [Accepted: 04/29/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Assessing transmission of SARS-CoV-2 by children in schools is of crucial importance to inform public health action. We assessed frequency of acquisition of SARS-CoV-2 by contacts of pupils with COVID-19 in schools and households, and quantified SARS-CoV-2 shedding into air and onto fomites in both settings. METHODS We did a prospective cohort and environmental sampling study in London, UK in eight schools. Schools reporting new cases of SARS-CoV-2 infection to local health protection teams were invited to take part if a child index case had been attending school in the 48 h before a positive SARS-CoV-2 PCR test. At the time of the study, PCR testing was available to symptomatic individuals only. Children aged 2-14 years (extended to <18 years in November, 2020) with a new nose or throat swab SARS-CoV-2 positive PCR from an accredited laboratory were included. Incidents involving exposure to at least one index pupil with COVID-19 were identified (the prevailing variants were original, α, and δ). Weekly PCR testing for SARS-CoV-2 was done on immediate classroom contacts (the so-called bubble), non-bubble school contacts, and household contacts of index pupils. Testing was supported by genome sequencing and on-surface and air samples from school and home environments. FINDINGS Between October, 2020, and July, 2021 from the eight schools included, secondary transmission of SARS-CoV-2 was not detected in 28 bubble contacts, representing ten bubble classes (participation rate 8·8% [IQR 4·6-15·3]). Across eight non-bubble classes, 3 (2%) of 62 pupils tested positive, but these were unrelated to the original index case (participation rate 22·5% [9·7-32·3]). All three were asymptomatic and tested positive in one setting on the same day. In contrast, secondary transmission to previously negative household contacts from infected index pupils was found in six (17%) of 35 household contacts rising to 13 (28%) of 47 household contacts when considering all potential infections in household contacts. Environmental contamination with SARS-CoV-2 was rare in schools: fomite SARS-CoV-2 was identified in four (2%) of 189 samples in bubble classrooms, two (2%) of 127 samples in non-bubble classrooms, and five (4%) of 130 samples in washrooms. This contrasted with fomites in households, where SARS-CoV-2 was identified in 60 (24%) of 248 bedroom samples, 66 (27%) of 241 communal room samples, and 21 (11%) 188 bathroom samples. Air sampling identified SARS-CoV-2 RNA in just one (2%) of 68 of school air samples, compared with 21 (25%) of 85 air samples taken in homes. INTERPRETATION There was no evidence of large-scale SARS-CoV-2 transmission in schools with precautions in place. Low levels of environmental contamination in schools are consistent with low transmission frequency and suggest adequate cleaning and ventilation in schools during the period of study. The high frequency of secondary transmission in households associated with evident viral shedding throughout the home suggests a need to improve advice to households with infection in children to prevent onward community spread. The data suggest that SARS-CoV-2 transmission from children in any setting is very likely to occur when precautions are reduced. FUNDING UK Research and Innovation and UK Department of Health and Social Care, National Institute for Health and Care Research.
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11
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Hargreaves JR, Langan SM, Oswald WE, Halliday KE, Sturgess J, Phelan J, Nguipdop-Djomo P, Ford B, Allen E, Sundaram N, Ireland G, Poh J, Ijaz S, Diamond I, Rourke E, Dawe F, Judd A, Warren-Gash C, Clark TG, Glynn JR, Edmunds WJ, Bonell C, Mangtani P, Ladhani SN. Epidemiology of SARS-CoV-2 infection among staff and students in a cohort of English primary and secondary schools during 2020-2021. THE LANCET REGIONAL HEALTH. EUROPE 2022; 21:100471. [PMID: 36035630 PMCID: PMC9398464 DOI: 10.1016/j.lanepe.2022.100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background There remains uncertainty about the epidemiology of SARS-CoV-2 among school students and staff and the extent to which non-pharmaceutical-interventions reduce the risk of school settings. Methods We conducted an open cohort study in a sample of 59 primary and 97 secondary schools in 15 English local authority areas that were implementing government guidance to schools open during the pandemic. We estimated SARS-CoV-2 infection prevalence among those attending school, antibody prevalence, and antibody negative to positive conversion rates in staff and students over the school year (November 2020-July 2021). Findings 22,585 staff and students participated. SARS-CoV-2 infection prevalence among those attending school was highest during the first two rounds of testing in the autumn term, ranging from 0.7% (95% CI 0.2, 1.2) among primary staff in November 2020 to 1.6% (95% CI 0.9, 2.3) among secondary staff in December 2020. Antibody conversion rates were highest in the autumn term. Infection patterns were similar between staff and students, and between primary and secondary schools. The prevalence of nucleoprotein antibodies increased over the year and was lower among students than staff. SARS-CoV-2 infection prevalence in the North-West region was lower among secondary students attending school on normal school days than the regional estimate for secondary school-age children. Interpretation SARS-CoV-2 infection prevalence in staff and students attending school varied with local community infection rates. Non-pharmaceutical interventions intended to prevent infected individuals attending school may have partially reduced the prevalence of infection among those on the school site. Funding UK Department of Health and Social Care.
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Affiliation(s)
- James R. Hargreaves
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sinéad M. Langan
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - William E. Oswald
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Katherine E. Halliday
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Joanna Sturgess
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jody Phelan
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Patrick Nguipdop-Djomo
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Benjamin Ford
- Office for National Statistics, Government Buildings, Newport, UK
| | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Neisha Sundaram
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Georgina Ireland
- National Infection Service, UK Health Security Agency, London, UK
| | - John Poh
- National Infection Service, UK Health Security Agency, London, UK
| | - Samreen Ijaz
- National Infection Service, UK Health Security Agency, London, UK
| | - Ian Diamond
- Office for National Statistics, Government Buildings, Newport, UK
| | - Emma Rourke
- Office for National Statistics, Government Buildings, Newport, UK
| | - Fiona Dawe
- Office for National Statistics, Government Buildings, Newport, UK
| | - Alison Judd
- Office for National Statistics, Government Buildings, Newport, UK
| | - Charlotte Warren-Gash
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Taane G. Clark
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Judith R. Glynn
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - W. John Edmunds
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Punam Mangtani
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Shamez N. Ladhani
- National Infection Service, UK Health Security Agency, London, UK
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
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12
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Spread of SARS-CoV-2 Infections in Educational Settings by Level of Education, Taking into Account the Predominant Virus Variant. Processes (Basel) 2022. [DOI: 10.3390/pr10101947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The COVID-19 pandemic has negatively affected educational settings (ES) in Slovenia. To effectively limit the emergence and spread of SARS-CoV-2 infections in ES, it is important to identify the pathways of introduction and transmission of infection. This study aims to analyse the spread of infections in ES according to the level of education, taking into account the predominant variant of the virus in Slovenia in order to advise on public health action. We calculated the incidence rate of infection by age group, according to the level of the ES. Additionally, we analysed data on the reported outbreak criteria in ES. In Slovenia, SARS-CoV-2 infections in children and adolescents (1–18 years) accounted for 16.8% of all confirmed infections. The incidence and leading outbreak criteria differed according to the level of the ES and predominant SARS-CoV-2 variant. The occurrence of cases in ≥3 different “bubbles” was the most common outbreak criteria (59%). A high number of employee-imported outbreaks was observed in pre-school settings (44%). As countries move away from widespread nonpharmaceutical interventions, the focus should be on vaccination promotion among teaching staff in pre-school settings and systemic solutions, such as self-testing and ventilation, to enable safe educational environments.
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13
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Schuit E, Venekamp RP, Hooft L, Veldhuijzen IK, van den Bijllaardt W, Pas SD, Zwart VF, Lodder EB, Hellwich M, Koppelman M, Molenkamp R, Wijers CJH, Vroom IH, Smeets LC, Nagel-Imming CRS, Han WGH, van den Hof S, Kluytmans JAJW, van de Wijgert JHHM, Moons KGM. Diagnostic accuracy of covid-19 rapid antigen tests with unsupervised self-sampling in people with symptoms in the omicron period: cross sectional study. BMJ 2022; 378:e071215. [PMID: 36104069 PMCID: PMC9471225 DOI: 10.1136/bmj-2022-071215] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the performance of rapid antigen tests with unsupervised nasal and combined oropharyngeal and nasal self-sampling during the omicron period. DESIGN Prospective cross sectional diagnostic test accuracy study. SETTING Three public health service covid-19 test sites in the Netherlands, 21 December 2021 to 10 February 2022. PARTICIPANTS 6497 people with covid-19 symptoms aged ≥16 years presenting for testing. INTERVENTIONS Participants had a swab sample taken for reverse transcription polymerase chain reaction (RT-PCR, reference test) and received one rapid antigen test to perform unsupervised using either nasal self-sampling (during the emergence of omicron, and when omicron accounted for >90% of infections, phase 1) or with combined oropharyngeal and nasal self-sampling in a subsequent (phase 2; when omicron accounted for >99% of infections). The evaluated tests were Flowflex (Acon Laboratories; phase 1 only), MPBio (MP Biomedicals), and Clinitest (Siemens-Healthineers). MAIN OUTCOME MEASURES The main outcomes were sensitivity, specificity, and positive and negative predictive values of each self-test, with RT-PCR testing as the reference standard. RESULTS During phase 1, 45.0% (n=279) of participants in the Flowflex group, 29.1% (n=239) in the MPBio group, and 35.4% ((n=257) in the Clinitest group were confirmatory testers (previously tested positive by a self-test at own initiative). Overall sensitivities with nasal self-sampling were 79.0% (95% confidence interval 74.7% to 82.8%) for Flowflex, 69.9% (65.1% to 74.4%) for MPBio, and 70.2% (65.6% to 74.5%) for Clinitest. Sensitivities were substantially higher in confirmatory testers (93.6%, 83.6%, and 85.7%, respectively) than in those who tested for other reasons (52.4%, 51.5%, and 49.5%, respectively). Sensitivities decreased from 87.0% to 80.9% (P=0.16 by χ2 test), 80.0% to 73.0% (P=0.60), and 83.1% to 70.3% (P=0.03), respectively, when transitioning from omicron accounting for 29% of infections to >95% of infections. During phase 2, 53.0% (n=288) of participants in the MPBio group and 44.4% (n=290) in the Clinitest group were confirmatory testers. Overall sensitivities with combined oropharyngeal and nasal self-sampling were 83.0% (78.8% to 86.7%) for MPBio and 77.3% (72.9% to 81.2%) for Clinitest. When combined oropharyngeal and nasal self-sampling was compared with nasal self-sampling, sensitivities were found to be slightly higher in confirmatory testers (87.4% and 86.1%, respectively) and substantially higher in those testing for other reasons (69.3% and 59.9%, respectively). CONCLUSIONS Sensitivities of three rapid antigen tests with nasal self-sampling decreased during the emergence of omicron but was only statistically significant for Clinitest. Sensitivities appeared to be substantially influenced by the proportion of confirmatory testers. Sensitivities of MPBio and Clinitest improved after the addition of oropharyngeal to nasal self-sampling. A positive self-test result justifies prompt self-isolation without the need for confirmatory testing. Individuals with a negative self-test result should adhere to general preventive measures because a false negative result cannot be ruled out. Manufacturers of MPBio and Clinitest may consider extending their instructions for use to include combined oropharyngeal and nasal self-sampling, and other manufacturers of rapid antigen tests should consider evaluating this as well.
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Affiliation(s)
- Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, 3584 CG Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Netherlands
| | - Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, 3584 CG Utrecht, Netherlands
| | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, 3584 CG Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Netherlands
| | - Irene K Veldhuijzen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Wouter van den Bijllaardt
- Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, Netherlands
- Department of Infection Control, Amphia Hospital, Breda, Netherlands
| | - Suzan D Pas
- Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, Netherlands
- Microvida Laboratory for Medical Microbiology, Bravis Hospital, Roosendaal, Netherlands
| | - Vivian F Zwart
- Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, Netherlands
| | | | | | - Marco Koppelman
- National Screening laboratory of Sanquin, Sanquin Blood Supply foundation, Amsterdam, Netherlands
| | | | | | - Irene H Vroom
- Public Health Service Rotterdam-Rijnmond, Rotterdam, Netherlands
| | | | - Carla R S Nagel-Imming
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, 3584 CG Utrecht, Netherlands
| | - Wanda G H Han
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Susan van den Hof
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Jan A J W Kluytmans
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, 3584 CG Utrecht, Netherlands
| | - Janneke H H M van de Wijgert
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, 3584 CG Utrecht, Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, 3584 CG Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Netherlands
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14
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Nenna R, Zeric H, Petrarca L, Mancino E, Midulla F. Weighing policymaking: A narrative review of school closures as COVID-19 pandemic-mitigation strategies. Pediatr Pulmonol 2022; 57:1982-1989. [PMID: 34894111 DOI: 10.1002/ppul.25787] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION In the era of data-driven decision-making, unacceptable haziness, and inconsistency surrounds the yearlong scientific and public debate on the school closure policy in the coronavirus disease-2019 (COVID-19) pandemic mitigation efforts. AIM The present literature review stems out of the need for a clear scaffold collecting in one place all current evidence, as well as helping to organize incoming future evidence, concerning both the role of schools in driving the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) community spread and the cost-effectiveness of school closure in containing such spread. METHODS References for this review were initially identified through searches of PubMed, Scopus, and Cochrane Library for articles published from March 2020 to March 2021 by the use of key terms "Schools," "COVID-19," "pandemic," "clusters," "outbreak," and "seroprevalence," selecting all articles from 2020 to 2021 with full-text availability. A further search was undertaken by screening citations of articles found in the original search and through Google Scholar and ResearchGate. RESULTS Overall, evidence shows that opening schools and keeping them open in the context of the SARS-CoV-2 pandemic is possible, although behaviorally challenging and unfeasible if educational facilities or testing services are inadequate. Contrary to other respiratory viruses, children are not chief targets of SARS-CoV-2 infection, transmission, and disease. It also appears that the second wave of the SARS-CoV-2 virus spread in the WHO European region has been unrelated to school re-opening. CONCLUSIONS A fact-based understanding of what is currently known on such a consequential policy is required to provide a basis of evidence for advocacy of either school closure or school opening at times of high-intensity community transmission of SARS-CoV-2.
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Affiliation(s)
- Raffaella Nenna
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Hana Zeric
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Laura Petrarca
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Enrica Mancino
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Fabio Midulla
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
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15
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Lorthe E, Bellon M, Michielin G, Berthelot J, Zaballa ME, Pennacchio F, Bekliz M, Laubscher F, Arefi F, Perez-Saez J, Azman AS, L’Huillier AG, Posfay-Barbe KM, Kaiser L, Guessous I, Maerkl SJ, Eckerle I, Stringhini S. Epidemiological, virological and serological investigation of a SARS-CoV-2 outbreak (Alpha variant) in a primary school: A prospective longitudinal study. PLoS One 2022; 17:e0272663. [PMID: 35976947 PMCID: PMC9385020 DOI: 10.1371/journal.pone.0272663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/24/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives To report a prospective epidemiological, virological and serological investigation of a SARS-CoV-2 outbreak in a primary school. Methods As part of a longitudinal, prospective, school-based surveillance study, this investigation involved repeated testing of 73 pupils, 9 teachers, 13 non-teaching staff and 26 household members of participants who tested positive, with rapid antigen tests and/or RT-PCR (Day 0–2 and Day 5–7), serologies on dried capillary blood samples (Day 0–2 and Day 30), contact tracing interviews and SARS-CoV-2 whole genome sequencing. Results We identified 20 children (aged 4 to 6 years from 4 school classes), 2 teachers and a total of 4 household members who were infected by the Alpha variant during this outbreak. Infection attack rates were between 11.8 and 62.0% among pupils from the 4 school classes, 22.2% among teachers and 0% among non-teaching staff. Secondary attack rate among household members was 15.4%. Symptoms were reported by 63% of infected children, 100% of teachers and 50% of household members. All analysed sequences but one showed 100% identity. Serological tests detected 8 seroconversions unidentified by SARS-CoV-2 virological tests. Conclusions This study confirmed child-to-child and child-to-adult SARS-CoV-2 transmission and introduction into households. Effective measures to limit transmission in schools have the potential to reduce the overall community circulation.
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Affiliation(s)
- Elsa Lorthe
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- * E-mail:
| | - Mathilde Bellon
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Center for Emerging Viral Diseases, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Grégoire Michielin
- Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Julie Berthelot
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - María-Eugenia Zaballa
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Francesco Pennacchio
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Meriem Bekliz
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Florian Laubscher
- Laboratory of Virology, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
| | - Fatemeh Arefi
- Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Javier Perez-Saez
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Andrew S. Azman
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Arnaud G. L’Huillier
- Laboratory of Virology, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
- Department of Pediatrics, Gynecology & Obstetrics, Pediatric Infectious Disease Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Klara M. Posfay-Barbe
- Department of Pediatrics, Gynecology & Obstetrics, Pediatric Infectious Disease Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laurent Kaiser
- Center for Emerging Viral Diseases, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sebastian J. Maerkl
- Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Isabella Eckerle
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Center for Emerging Viral Diseases, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Laboratory of Virology, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
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16
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Af Geijerstam A, Mehlig K, Hunsberger M, Åberg M, Lissner L. Children in the household and risk of severe COVID-19 during the first three waves of the pandemic: a prospective registry-based cohort study of 1.5 million Swedish men. BMJ Open 2022; 12:e063640. [PMID: 35953248 PMCID: PMC9378946 DOI: 10.1136/bmjopen-2022-063640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate whether Swedish men living with children had elevated risk for severe COVID-19 or infection with SARS-CoV-2 during the first three waves of the pandemic. DESIGN Prospective registry-based cohort study. PARTICIPANTS 1 557 061 Swedish men undergoing military conscription between 1968 and 2005 at a mean age of 18.3 (SD 0.73) years. MAIN OUTCOME MEASURES Infection with SARS-CoV-2 and hospitalisation due to COVID-19 from March 2020 to September 2021. RESULTS There was a protective association between preschool children at home and hospitalisation due to COVID-19 during the first and third waves compared with only older or no children at all, with ORs (95% CIs) 0.63 (0.46 to 0.88) and 0.75 (0.68 to 0.94) respectively. No association was observed for living with children 6-12 years old, but for 13-17 years old, the risk increased. Age in 2020 did not explain these associations. Further adjustment for socioeconomic and health factors did not attenuate the results. Exposure to preschool children also had a protective association with testing positive with SARS-CoV-2, with or without hospitalisation, OR=0.91 (95% CI 0.89 to 0.93), while living with children of other ages was associated with increased odds of infection. CONCLUSIONS Cohabiting with preschool children was associated with reduced risk for severe COVID-19. Living with school-age children between 6 and 12 years had no association with severe COVID-19, but sharing the household with teenagers and young adults was associated with elevated risk. Our results are of special interest since preschools and compulsory schools (age 6-15 years) in Sweden did not close in 2020.
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Affiliation(s)
- Agnes Af Geijerstam
- School of Public Health and Community Medicine, University of Gothenburg Institute of Medicine, Goteborg, Sweden
| | - Kirsten Mehlig
- School of Public Health and Community Medicine, University of Gothenburg Institute of Medicine, Goteborg, Sweden
| | - Monica Hunsberger
- School of Public Health and Community Medicine, University of Gothenburg Institute of Medicine, Goteborg, Sweden
| | - Maria Åberg
- School of Public Health and Community Medicine, University of Gothenburg Institute of Medicine, Goteborg, Sweden
- Regionhälsan, Region Västra Götaland, Gothenburg, Sweden
| | - Lauren Lissner
- School of Public Health and Community Medicine, University of Gothenburg Institute of Medicine, Goteborg, Sweden
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17
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Symptomatic and Asymptomatic Transmission of SARS-CoV-2 in K-12 Schools, British Columbia, Canada April to June 2021. Microbiol Spectr 2022; 10:e0062222. [PMID: 35862938 PMCID: PMC9430687 DOI: 10.1128/spectrum.00622-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There is concern that schools may be a setting where asymptomatic infections might result in significant “silent” transmission of SARS-CoV-2, particularly after the emergence of more transmissible variants of concern. After the programmatic implementation of a strategy of asymptomatic testing of close COVID-19 contacts as part of contact tracing in the school setting, the majority of the secondary cases were still found to have occurred in home or social contacts.
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18
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Keeling MJ, Moore SE. An assessment of the vaccination of school-aged children in England against SARS-CoV-2. BMC Med 2022; 20:196. [PMID: 35581585 PMCID: PMC9113775 DOI: 10.1186/s12916-022-02379-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/20/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Children and young persons are known to have a high number of close interactions, often within the school environment, which can facilitate rapid spread of infection; yet for SARS-CoV-2, it is the elderly and vulnerable that suffer the greatest health burden. Vaccination, initially targeting the elderly and vulnerable before later expanding to the entire adult population, has been transformative in the control of SARS-CoV-2 in England. However, early concerns over adverse events and the lower risk associated with infection in younger individuals means that the expansion of the vaccine programme to those under 18 years of age needs to be rigorously and quantitatively assessed. METHODS Here, using a bespoke mathematical model matched to case and hospital data for England, we consider the potential impact of vaccinating 12-17 and 5-11-year-olds. This analysis is reported from an early model (generated in June 2021) that formed part of the evidence base for the decisions in England, and a later model (from November 2021) that benefits from a richer understanding of vaccine efficacy, greater knowledge of the Delta variant wave and uses data on the rate of vaccine administration. For both models, we consider the population wide impact of childhood vaccination as well as the specific impact on the age groups targeted for vaccination. RESULTS Projections from June suggested that an expansion of the vaccine programme to those 12-17 years old could generate substantial reductions in infection, hospital admission and deaths in the entire population, depending on population behaviour following the relaxation of control measures. The benefits within the 12-17-year-old cohort were less marked, saving between 660 and 1100 (95% PI (prediction interval) 280-2300) hospital admissions and between 22 and 38 (95% PI 9-91) deaths depending on assumed population behaviour. For the more recent model, the benefits within this age group are reduced, saving on average 630 (95% PI 300-1300) hospital admissions and 11 (95% PI 5-28) deaths for 80% vaccine uptake, while the benefits to the wider population represent a reduction of 8-10% in hospital admissions and deaths. The vaccination of 5-11-year-olds is projected to have a far smaller impact, in part due to the later roll-out of vaccines to this age group. CONCLUSIONS Vaccination of 12-170-year-olds and 5-11-year-olds is projected to generate a reduction in infection, hospital admission and deaths for both the age groups involved and the population in general. For any decision involving childhood vaccination, these benefits needs to be balanced against potential adverse events from the vaccine, the operational constraints on delivery and the potential for diverting resources from other public health campaigns.
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Affiliation(s)
- Matt J Keeling
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, CV4 7AL, UK.
| | - Sam E Moore
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, CV4 7AL, UK
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19
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Schechter-Perkins EM, Doron S, Johnston R, Hay J, Berlin D, Ciaranello A, Nelson SB, Gormley JM, Smole SC, Brown CM, Madoff LC, Branch-Elliman W. A Test-to-Stay Modified Quarantine Program for COVID-19 in Schools. Pediatrics 2022; 149:184750. [PMID: 35132435 DOI: 10.1542/peds.2021-055727] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Mandatory quarantine upon exposure to coronavirus disease 2019 (COVID-19) results in a substantial number of lost days of school. We hypothesized that implementation of a state-wide test-to-stay (TTS) program would allow more students to participate in in-person learning, and not cause additional clusters of COVID-19 cases due to in-school transmission. METHODS For the 2020-2021 academic year, Massachusetts implemented an opt-in TTS program, in which students exposed to COVID-19 in school are tested each school day with a rapid antigen test. If negative, students may participate in school-related activities that day. Testing occurs daily for a duration of 7 calendar days after exposure. Here, we report the results from the first 13 weeks of the program. RESULTS A total of 2298 schools signed up for TTS, and 504 167 individuals out of a total population of 860 457 consented. During the first 13 weeks with complete data, 1959 schools activated the program at least once for 102 373 individual, exposed students. Out of 328 271 tests performed, 2943 positive cases were identified (per person positivity rate, 2.9%, 95% confidence interval, 2.8-3.0). A minimum of 325 328 and a maximum of 497 150 days of in-person school were saved through participation in the program. CONCLUSIONS Daily, rapid on-site antigen testing is a safe and feasible alternative to mandatory quarantine and can be used to maximize safe in-person learning time during the pandemic.
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Affiliation(s)
- Elissa M Schechter-Perkins
- Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | | | - Russell Johnston
- Massachusetts Department of Elementary and Secondary Education, Malden, Massachusetts
| | - Jeremiah Hay
- Massachusetts Executive Office of Health and Human Services, Boston, Massachusetts
| | | | - Andrea Ciaranello
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts
| | - Sandra B Nelson
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts
| | - Jenny M Gormley
- Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Sandra C Smole
- Massachusetts Department of Public Health, Boston, Massachusetts
| | | | | | - Westyn Branch-Elliman
- Department of Medicine, Section of Infectious Disease, VA Boston Healthcare System and Harvard Medical School, Boston
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20
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SARS-CoV-2 Circulation in the School Setting: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095384. [PMID: 35564779 PMCID: PMC9099553 DOI: 10.3390/ijerph19095384] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 02/01/2023]
Abstract
The contribution of children to viral spread in schools is still debated. We conducted a systematic review and meta-analysis of studies to investigate SARS-CoV-2 transmission in the school setting. Literature searches on 15 May 2021 yielded a total of 1088 publications, including screening, contact tracing, and seroprevalence studies. MOOSE guidelines were followed, and data were analyzed using random-effects models. From screening studies involving more than 120,000 subjects, we estimated 0.31% (95% confidence interval (CI) 0.05–0.81) SARS-CoV-2 point prevalence in schools. Contact tracing studies, involving a total of 112,622 contacts of children and adults, showed that onward viral transmission was limited (2.54%, 95% CI 0.76–5.31). Young index cases were found to be 74% significantly less likely than adults to favor viral spread (odds ratio (OR) 0.26, 95% CI 0.11–0.63) and less susceptible to infection (OR 0.60; 95% CI 0.25–1.47). Lastly, from seroprevalence studies, with a total of 17,879 subjects involved, we estimated that children were 43% significantly less likely than adults to test positive for antibodies (OR 0.57, 95% CI 0.49–0.68). These findings may not applied to the Omicron phase, we further planned a randomized controlled trial to verify these results.
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21
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Kirsten C, Kahre E, Blankenburg J, Schumm L, Haag L, Galow L, Unrath M, Czyborra P, Schneider J, Lück C, Dalpke AH, Berner R, Armann J. Seroprevalence of SARS-CoV-2 in German secondary schools from October 2020 to July 2021: a longitudinal study. Infection 2022; 50:1483-1490. [PMID: 35460495 PMCID: PMC9034260 DOI: 10.1007/s15010-022-01824-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/31/2022] [Indexed: 12/23/2022]
Abstract
Purpose To quantify the number of SARS-CoV-2 infections in students and teachers in 14 Secondary schools in eastern Saxony, Germany. Seroprevalence of SARS-CoV-2 antibodies in study population. Number of undetected cases.
Methods Serial seroprevalence study. Results The role of educational settings in the SARS-CoV-2 Pandemic is still controversial. Seroprevalence increases from 0.8 to 5.9% from October to December when schools remained open and to 12.2% in March/April during a strict lockdown with closed schools. The ratio of undetected to detected cases decreased from 0.76 to 0.44 during the study period.
Conclusion During the second and third wave of the pandemic in Germany, students and teachers are not overrepresented in SARS-CoV-2 infections. The percentage of undetected cases is moderate and decreases over time. The risk of contracting SARS-CoV-2 within the household is higher than contracting it in educational settings making school closures rather ineffective in terms of pandemic control measures or individual risk reduction in children and adolescents. Trial registration DRKS00022455 (July 23rd, 2020). Supplementary Information The online version contains supplementary material available at 10.1007/s15010-022-01824-9.
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Affiliation(s)
- Carolin Kirsten
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. .,University Children's Hospital, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Elisabeth Kahre
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Judith Blankenburg
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Leonie Schumm
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Luise Haag
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Lukas Galow
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Manja Unrath
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Paula Czyborra
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Josephine Schneider
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Lück
- Medical Faculty Carl Gustav Carus, Institute for Virology and Institute for Medical Microbiology and Hygiene, Technische Universität Dresden, Dresden, Germany
| | - Alexander H Dalpke
- Medical Faculty Carl Gustav Carus, Institute for Virology and Institute for Medical Microbiology and Hygiene, Technische Universität Dresden, Dresden, Germany
| | - Reinhard Berner
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jakob Armann
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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22
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Goldfarb DM, Mâsse LC, Watts AW, Hutchison SM, Muttucomaroe L, Bosman ES, Barakauskas VE, Choi A, Dhillon N, Irvine MA, Reicherz F, O'Reilly C, Sediqi S, Xu RY, Razzaghian HR, Sadarangani M, Coombs D, O'Brien SF, Lavoie PM. SARS-CoV-2 seroprevalence among Vancouver public school staff in British Columbia, Canada: a cross-sectional study. BMJ Open 2022; 12:e057846. [PMID: 35383082 PMCID: PMC8983418 DOI: 10.1136/bmjopen-2021-057846] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Few studies reported COVID-19 cases in schools during the 2020/21 academic year in a setting of uninterrupted in-person schooling. The main objective was to determine the SARS-CoV-2 seroprevalence among school staff in Vancouver public schools. DESIGN Cumulative incident COVID-19 cases among all students and school staff based on public health data, with an embedded cross-sectional serosurvey among a school staff sample that was compared to period, age, sex and geographical location-weighted data from blood donors. SETTING Vancouver School District (British Columbia, Canada) from kindergarten to grade 12. PARTICIPANTS Active school staff enrolled from 3 February to 23 April 2021 with serology testing from 10 February to 15 May 2021. MAIN OUTCOME MEASURES SARS-CoV-2 seroprevalence among school staff, based on spike (S)-based (unvaccinated staff) or N-based serology testing (vaccinated staff). RESULTS Public health data showed the cumulative incidence of COVID-19 among students attending in-person was 9.8 per 1000 students (n=47 280), and 13 per 1000 among school staff (n=7071). In a representative sample of 1689 school staff, 78.2% had classroom responsibilities, and spent a median of 17.6 hours in class per week (IQR: 5.0-25 hours). Although 21.5% (363/1686) of surveyed staff self-reported close contact with a COVID-19 case outside of their household (16.5% contacts were school-based), 5 cases likely acquired the infection at school based on viral testing. Sensitivity/Specificity-adjusted seroprevalence in 1556/1689 staff (92.1%) was 2.3% (95% CI: 1.6% to 3.2%), comparable to a sex, age, date and residency area-weighted seroprevalence of 2.6% (95% CI: 2.2% to 3.1%) among 5417 blood donors. CONCLUSION Seroprevalence among staff was comparable to a reference group of blood donors from the same community. These data show that in-person schooling could be safely maintained during the 2020/21 school year with mitigation measures, in a large school district in Vancouver, Canada.
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Affiliation(s)
- David M Goldfarb
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Louise C Mâsse
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allison W Watts
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah M Hutchison
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren Muttucomaroe
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Else S Bosman
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vilte E Barakauskas
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Alexandra Choi
- Office of the Medical Health Officer, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Nalin Dhillon
- Office of the Medical Health Officer, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Michael A Irvine
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Frederic Reicherz
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sadaf Sediqi
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Rui Yang Xu
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hamid R Razzaghian
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Daniel Coombs
- Department of Mathematics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheila F O'Brien
- Epidemiology & Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Pascal M Lavoie
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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23
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Vardavas C, Nikitara K, Mathioudakis AG, Hilton Boon M, Phalkey R, Leonardi-Bee J, Pharris A, Deogan C, Suk JE. Transmission of SARS-CoV-2 in educational settings in 2020: a review. BMJ Open 2022; 12:e058308. [PMID: 35383084 PMCID: PMC8983413 DOI: 10.1136/bmjopen-2021-058308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES School closures have been used as a core non-pharmaceutical intervention (NPI) during the COVID-19 pandemic. This review aims at identifying SARS-CoV-2 transmission in educational settings during the first waves of the pandemic. METHODS This literature review assessed studies published between December 2019 and 1 April 2021 in Medline and Embase, which included studies that assessed educational settings from approximately January 2020 to January 2021. The inclusion criteria were based on the PCC framework (P-Population, C-Concept, C-Context). The study Population was restricted to people 1-17 years old (excluding neonatal transmission), the Concept was to assess child-to-child and child-to-adult transmission, while the Context was to assess specifically educational setting transmission. RESULTS Fifteen studies met inclusion criteria, ranging from daycare centres to high schools and summer camps, while eight studies assessed the re-opening of schools in the 2020-2021 school year. In principle, although there is sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in school settings, the SAR remain relatively low-when NPI measures are implemented in parallel. Moreover, although the evidence was limited, there was an indication that younger children may have a lower SAR than adolescents. CONCLUSIONS Transmission in educational settings in 2020 was minimal-when NPI measures were implemented in parallel. However, with an upsurge of cases related to variants of concern, continuous surveillance and assessment of the evidence is warranted to ensure the maximum protection of the health of students and the educational workforce, while also minimising the numerous negative impacts that school closures may have on children.
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Affiliation(s)
- Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | | | - Alexander G Mathioudakis
- Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Michele Hilton Boon
- WISE Centre for Economic Justice, Glasgow Caledonian University, Glasgow, UK
| | - Revati Phalkey
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Anastasia Pharris
- Epidemic Prone Diseases, Coronavirus and Influenza, Disease Programmes Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Charlotte Deogan
- Epidemic Prone Diseases, Coronavirus and Influenza, Disease Programmes Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E Suk
- Emergency Preparedness and Response Support, Public Health Functions Unit, European Centre for Disease Prevention and Control, Solna, Sweden
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24
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Silverberg SL, Zhang BY, Li SNJ, Burgert C, Shulha HP, Kitchin V, Sauvé L, Sadarangani M. Child transmission of SARS-CoV-2: a systematic review and meta-analysis. BMC Pediatr 2022; 22:172. [PMID: 35365104 PMCID: PMC8975734 DOI: 10.1186/s12887-022-03175-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background Understanding of the role of children in COVID-19 transmission has significant implications for school and childcare policies, as well as appropriate targeting of vaccine campaigns. The objective of this systematic review was to identify the role of children in SARS-CoV-2 transmission to other children and adults. Methods MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Web of Science were electronically searched for articles published before March 31, 2021. Studies of child-to-child and child-to-adult transmission and quantified the incidence of index and resulting secondary attack rates of children and adults in schools, households, and other congregate pediatric settings were identified. All articles describing confirmed transmission of SARS-CoV-2 from a child were included. PRISMA guidelines for data abstraction were followed, with each step conducted by two reviewers. Results 40 of 6110 articles identified met inclusion criteria. Overall, there were 0.8 secondary cases per primary index case, with a secondary attack rate of 8.4% among known contacts. The secondary attack rate was 26.4% among adult contacts versus 5.7% amongst child contacts. The pooled estimate of a contact of a pediatric index case being infected as secondary case was 0.10 (95% CI 0.03-0.25). Conclusions Children transmit COVID-19 at a lower rate to children than to adults. Household adults are at highest risk of transmission from an infected child, more so than adults or children in other settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03175-8.
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Affiliation(s)
- Sarah L Silverberg
- Department of Pediatrics, BC Children's Hospital, 4500 Oak Street, V6H 3N1, Vancouver, BC, Canada.
| | - Bei Yuan Zhang
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Conrad Burgert
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Hennady P Shulha
- Department of Pediatrics, BC Children's Hospital, 4500 Oak Street, V6H 3N1, Vancouver, BC, Canada.,Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada.,BC Centre for Disease Control, Vancouver, Canada
| | | | - Laura Sauvé
- Department of Pediatrics, BC Children's Hospital, 4500 Oak Street, V6H 3N1, Vancouver, BC, Canada.,Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada
| | - Manish Sadarangani
- Department of Pediatrics, BC Children's Hospital, 4500 Oak Street, V6H 3N1, Vancouver, BC, Canada.,Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada
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25
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Størdal K, Ruiz PLD, Greve-Isdahl M, Surén P, Knudsen PK, Gulseth HL, Tapia G. Risk factors for SARS-CoV-2 infection and hospitalisation in children and adolescents in Norway: a nationwide population-based study. BMJ Open 2022; 12:e056549. [PMID: 35277409 PMCID: PMC8919132 DOI: 10.1136/bmjopen-2021-056549] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To determine risk factors for SARS-CoV-2 infection and hospitalisation among children and adolescents. DESIGN Nationwide, population-based cohort study. SETTING Norway from 1 March 2020 to 30 November 2021. PARTICIPANTS All Norwegian residents<18 years of age. MAIN OUTCOME MEASURES Population-based healthcare and population registries were used to study risk factors for SARS-CoV-2 infection, including socioeconomic factors, country of origin and pre-existing chronic comorbidities. All residents were followed until age 18 years, emigration, death or end of follow-up. HRs estimated by Cox regression models were adjusted for testing frequency. Further, risk factors for admission to the hospital among the infected were investigated. RESULTS Of 1 219 184 residents, 82 734 (6.7%) tested positive by PCR or lateral flow tests, of whom 241 (0.29%) were admitted to a hospital. Low family income (adjusted HR (aHR) 1.26, 95% CI 1.23 to 1.30), crowded housing (1.27, 1.24 to 1.30), household size, age, non-Nordic country of origin (1.63, 1.60 to 1.66) and area of living were independent risk factors for infection. Chronic comorbidity was associated with a slightly lower risk of infection (aHR 0.90, 95% CI 0.88 to 0.93). Chronic comorbidity was associated with hospitalisation (aHR 3.46, 95% CI 2.50 to 4.80), in addition to age, whereas socioeconomic status and country of origin did not predict hospitalisation among those infected. CONCLUSIONS Socioeconomic factors, country of origin and area of living were associated with the risk of SARS-CoV-2 infection. However, these factors did not predict hospitalisation among those infected. Chronic comorbidity was associated with higher risk of admission but slightly lower overall risk of acquiring SARS-CoV-2.
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Affiliation(s)
- Ketil Størdal
- Department of Pediatric Research, Faculty of Medicine, University of Oslo, Oslo, Norway
- Childrens Center, Oslo University Hospital, Oslo, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Paz Lopez-Doriga Ruiz
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Margrethe Greve-Isdahl
- Vaccine and Infectious Disease Prevention, Norwegian Institute of Public Health, Oslo, Norway
| | - Pål Surén
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Hanne Løvdal Gulseth
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - German Tapia
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
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See KC, Tan LP, Ong LT, Lee PY. Clinical and epidemiological characteristics of children with COVID-19 in Selangor, Malaysia. IJID REGIONS 2022; 2:63-69. [PMID: 35721419 PMCID: PMC8645283 DOI: 10.1016/j.ijregi.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
COVID-19 was a mild disease in the children of Selangor, Malaysia in 2020. Most children did not require any treatment and all children were discharged well from the hospital. A lower white blood cell count, absolute lymphocyte count, and absolute neutrophil count, as well as raised C-reactive protein and aspartate aminotransferase were more frequent in symptomatic children than in asymptomatic children. Few adult caretakers were infected during their children's hospital quarantine.
Objective To describe the clinical and epidemiological characteristics of children diagnosed with coronavirus disease 2019 (COVID-19) at Hospital Sungai Buloh, Selangor, Malaysia. Methods A retrospective observational study was performed on children aged <12 years diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between January 25 and December 31, 2020. A comparative analysis was undertaken between asymptomatic and symptomatic children, as well as a sub-analysis of their caretakers’ COVID-19 status. Results A total of 1498 children were included, 48.7% female and 51.3% male. Their mean age was 5.6 years (standard deviation 3.5 years). Overall, 82.3% were detected through contact tracing of positive family members or from the same household. Fifty-seven percent were asymptomatic. The most common symptoms reported were fever, nasal congestion/rhinorrhoea, and cough. Compared to asymptomatic children, those who were symptomatic had higher reported comorbidities, lower total white blood cell (WBC), absolute lymphocyte, and absolute neutrophil counts, raised C-reactive protein (CRP), and raised aspartate transaminase (P < 0.05). The median duration of illness was 10 days (interquartile range 3 days). Overall outcomes were good. Only 19 (8.2%) negative caretakers seroconverted prior to discharge. Conclusions The majority of the children in the State of Selangor experienced mild COVID-19 illness in 2020, and they did not appear to be key drivers in the transmission of the disease.
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Schechter-Perkins EM, van den Berg P, Branch-Elliman W. The Science Behind Safe School Re-opening: Leveraging the Pillars of Infection Control to Support Safe Elementary and Secondary Education During the COVID-19 Pandemic. Open Forum Infect Dis 2022; 9:ofab134. [PMID: 35141343 PMCID: PMC7989186 DOI: 10.1093/ofid/ofab134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/16/2021] [Indexed: 12/23/2022] Open
Abstract
There are limited tools for adapting coronavirus disease 2019 (COVID-19) infection control plans to school settings. We present an infection prevention model for optimizing safe re-opening for elementary and secondary schools during the global COVID-19 pandemic and review the current evidence behind various infection prevention interventions in school settings. The model is adapted from the Centers for Disease Control and Prevention fundamental pillars for infection prevention and includes 4 categories of intervention: epidemiologic controls (town prevalence metrics, diagnostic testing, quarantine strategies), administrative controls (state vaccination policies, alternative school models, symptom screens, quarantine breaks), engineering/environmental controls (distancing, outdoor space, ventilation), and personal protective equipment (PPE)/hand hygiene (face coverings, hand sanitizing). The adapted infection control pillars model utilizes implementation science–informed considerations to maximize pragmatism and adherence by leveraging evidence-based strategies. It highlights the necessity of redundant infection prevention interventions, acknowledges the importance of community buy-in to achieve real-world effectiveness, and addresses tactics to overcome implementation barriers. Recommendations are grounded in the Dynamic Sustainability Framework and include suggestions to maintain infection prevention effectiveness over time to ensure ongoing safety.
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Affiliation(s)
- Elissa M Schechter-Perkins
- Department of Emergency Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Polly van den Berg
- Beth Israel Deaconess Medical Center, Department of Medicine, Section of Infectious Diseases, Boston, Massachusetts, USA
| | - Westyn Branch-Elliman
- Section of Infectious Diseases, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,VA Boston Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, USA
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Cabiedes-Miragaya L, Galende-Domínguez I. COVID-19 vaccines: a look at the ethics of the clinical research involving children. JOURNAL OF MEDICAL ETHICS 2022; 48:medethics-2021-107941. [PMID: 35144979 PMCID: PMC8844969 DOI: 10.1136/medethics-2021-107941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
Currently, millions of minors are being inoculated against SARS-CoV-2 in many countries in the world. Ethical concerns about clinical research involving children have barely been addressed in the literature, despite the fact that the paediatric population is particularly vulnerable within this context. Children should be included in the research plans for COVID-19 vaccines. Nevertheless, it is necessary to critically assess to what extent clinical trials are being conducted according to methodological and ethical criteria that allow us to conclude that the results are valid and, in consequence, how far the vaccination plans for children are scientifically justified.The principal aim of this article is to analyse critically the process of clinical research on COVID-19 vaccines involving children, highlighting the ethical concerns that arise, including the need to stratify the results from older adolescents separately for analysis before proceeding, if further research is warranted, in descending age order. The development of COVID-19 vaccines is examined, with a special look at the participation of children throughout their clinical development, including a review of the clinical trials registered in three international databases. We also offer some additional considerations about the inclusion of minors in vaccination plans. Finally, we conclude with some recommendations, with particular emphasis on the following ethical duties: research in children should be carried out only once the relevant research in adults has previously been conducted; issues that concern children's needs and rights should be specifically addressed; and, therefore, the highest standards of ethical and scientific quality should be met.
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Affiliation(s)
| | - Inés Galende-Domínguez
- Community of Madrid Ministry of Health, Directorate General for Research, Education and Documentation, Madrid, Spain
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Yuan H, Reynolds C, Ng S, Yang W. Factors affecting the transmission of SARS-CoV-2 in school settings. Influenza Other Respir Viruses 2022; 16:643-652. [PMID: 35146922 PMCID: PMC9111692 DOI: 10.1111/irv.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 11/29/2022] Open
Abstract
Background Several studies have reported SARS‐CoV‐2 outbreaks in schools, with a wide range of secondary attack rate (SAR; range: 0–100%). We aimed to examine key risk factors to better understand SARS‐CoV‐2 transmission in schools. Methods We collected records of 35 SARS‐CoV‐2 school outbreaks globally published from January 2020 to July 2021 and compiled information on hypothesized risk factors. We utilized the directed acyclic graph (DAG) to conceptualize risk mechanisms, used logistic regression to examine each risk‐factor group, and further built multirisk models. Results The best‐fit model showed that the intensity of community transmission (adjusted odds ratio [aOR]: 1.11, 95% CI: 1.06–1.16, for each increase of 1 case per 10 000 persons per week) and individualism (aOR: 2.72, 95% CI: 1.50–4.95, above vs. below the mean) was associated higher risk, whereas preventive measures (aOR: 0.25, 95% CI: 0.19–0.32, distancing and masking vs. none) and higher population immunity (aOR: 0.57, 95% CI: 0.46–0.71) were associated with lower risk of SARS‐CoV‐2 transmission in schools. Compared with students in high schools, the aOR was 0.47 (95% CI: 0.23–0.95) for students in preschools and 0.90 (95% CI: 0.76–1.08) for students in primary schools. Conclusions Preventive measures in schools (e.g., social distancing and mask wearing) and communal efforts to lower transmission and increase vaccination uptake (i.e., vaccine‐induced population immunity) in the community should be taken to collectively reduce transmission and protect children in schools.
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Affiliation(s)
- Haokun Yuan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Connor Reynolds
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sydney Ng
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Wan Yang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Bordas A, Soriano-Arandes A, Subirana M, Malagrida R, Reyes-Urueña JM, Folch C, Soler-Palacin P, Gascón M, Sunyer J, Anton A, Blanco I, Fernández-Morales J, Colom-Cadena A, Sentís A, Pumarola T, Basora J, Casabona J. Study protocol for monitoring SARS-CoV-2 infection and its determinants in Catalonia (Spain): an observational and participatory research approach in a Sentinel Network of Schools. BMJ Open 2022; 12:e055649. [PMID: 35078847 PMCID: PMC8795925 DOI: 10.1136/bmjopen-2021-055649] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Since the SARS-CoV-2 became of concern in January 2020, many preventive measures have been adopted in educational settings to ensure the control of COVID-19 pandemic among children and staff in schools. This study aims to set up a school sentinel surveillance network with the purpose of monitoring SARS-CoV-2 infection, seroprevalence as well as to analyse the impact of preventive interventions of SARS-CoV-2 in school settings. Additionally, we will assess diverse screening strategies in a cohort of students and school staff to monitor the screening acceptance and its potential impact. Altogether, we hope this study will enable the design of more effective strategies for the prevention of COVID-19 spread. METHODS AND ANALYSIS The sentinel schools' study is a cross-sectional, school-based project including 26 participating sentinel schools in Catalonia (Spain). Children, adolescents and staff at the schools will be invited to participate. This project will be carried out from January 2021 to June 2022 as follows: (1) twice yearly serological testing and molecular SARS-CoV-2 detection and questionnaires covering SARS-CoV-2 symptoms, tests, health, knowledge, attitudes and behaviours; (2) an environmental evaluation carried out in different classrooms; (3) SARS-CoV-2 transmission dynamics and the impact of different variants among confirmed cases and classmates; (4) a participatory process by which the participants are invited to act as coinvestigators to evaluate prevention strategies and provide recommendations to improve COVID-19 prevention in schools. Descriptive analysis will be performed for the main variables collected. The incidence and seroprevalence will be calculated and the association with sociodemographic factors and school characteristics will be determined using multivariate logistic regression. ETHICS AND DISSEMINATION Ethical approval was obtained from the IDIAPJGol and the Hospital Universitari Vall d'Hebron ethics committees. A report will be generated quarterly. Findings will be disseminated at national and international conferences and published in peer-reviewed journals.
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Affiliation(s)
- Anna Bordas
- Centre for Epidemiological Studies of HIV/SIDA and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Catalunya, Spain
- Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Catalunya, Spain
| | - Maria Subirana
- Barcelona Institut for Global Health, IMIM-Parc Salut Mar, Barcelona, Catalunya, Spain
- Universitat Pompeu Fabra, Barcelona, Catalunya, Spain
| | - Rosina Malagrida
- Living Lab for Health, IrsiCaixa AIDS Research Institute, Badalona, Catalunya, Spain
| | - Juliana Maria Reyes-Urueña
- Centre for Epidemiological Studies of HIV/SIDA and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Catalunya, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain
| | - Cinta Folch
- Centre for Epidemiological Studies of HIV/SIDA and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Catalunya, Spain
- Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Catalunya, Spain
| | - Mireia Gascón
- Universitat Pompeu Fabra, Barcelona, Catalunya, Spain
- Centre for International Health Research (CRESIB), ISGlobal, Barcelona, Catalunya, Spain
| | - Jordi Sunyer
- Universitat Pompeu Fabra, Barcelona, Catalunya, Spain
- IMIM-Parc Salut Mar, ISGlobal, Barcelona, Catalunya, Spain
| | - Andres Anton
- Microbiology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut Català de la Salut, Barcelona, Catalunya, Spain
| | - Ignacio Blanco
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut D'Investigació en Ciències de La Salut Germans Trias I Pujol (IGTP), Institut Català de la Salut, Barcelona, Catalunya, Spain
| | | | - Andreu Colom-Cadena
- Centre for Epidemiological Studies of HIV/SIDA and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Catalunya, Spain
- Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Alexis Sentís
- Centre for Epidemiological Studies of HIV/SIDA and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Catalunya, Spain
- Epiconcept SAS, Paris, Île-de-France, France
| | - Tomas Pumarola
- Microbiology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut Català de la Salut, Barcelona, Catalunya, Spain
| | - Josep Basora
- Foundation University Institute for Research in Primary Health Care Jordi Gol i Gurina (IDIAP Jordi Gol), Barcelona, Catalunya, Spain
| | - Jordi Casabona
- Centre for Epidemiological Studies of HIV/SIDA and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Catalunya, Spain
- Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain
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Godøy A, Grøtting MW, Hart RK. Reopening schools in a context of low COVID-19 contagion: consequences for teachers, students and their parents. JOURNAL OF POPULATION ECONOMICS 2022; 35:935-961. [PMID: 35125667 PMCID: PMC8807960 DOI: 10.1007/s00148-021-00882-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 12/17/2021] [Indexed: 05/15/2023]
Abstract
Knowing how school reopenings affect the spread of COVID-19 is crucial when balancing children's right to schooling with contagion management. This paper considers the effects on COVID-19 testing prevalence and the positive test rate of reopening Norwegian schools after a 6-week closure aimed at reducing contagion. We estimate the effects of school reopening on teachers, parents and students using an event study/difference-in-differences design that incorporates comparison groups with minimal exposure to in-person schooling. We find no evidence that COVID-19 incidence increased following reopening among students, parents or teachers pooled across grade levels. We find some suggestive evidence that infection rates among upper secondary school teachers increased; however, the effects are small and transitory. At low levels of contagion, schools can safely be reopened when other social distancing policies remain in place.
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Affiliation(s)
- Anna Godøy
- Norwegian Institute of Public Health and Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Maja Weemes Grøtting
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Rannveig Kaldager Hart
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
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Bouillon K, Baricault B, Botton J, Jabagi MJ, Bertrand M, Semenzato L, Le Vu S, Drouin J, Dray-Spira R, Weill A, Zureik M. Effectiveness of BNT162b2, mRNA-1273, and ChAdOx1-S vaccines against severe covid-19 outcomes in a nationwide mass vaccination setting: cohort study. BMJ MEDICINE 2022; 1:e000104. [PMID: 36936561 PMCID: PMC9978755 DOI: 10.1136/bmjmed-2021-000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/11/2022] [Indexed: 11/07/2022]
Abstract
Objective To estimate the effectiveness of the three covid-19 vaccines by Pfizer-BioNTech (BNT162b2), Moderna (mRNA-1273), and Oxford-AstraZeneca (ChAdOx1-S) in people after receiving two doses. Design Cohort study. Setting Nationwide, population based data in France, from the French National Health Data System (Système National des Données de Santé), between 27 December 2020 and 30 April 2021. Participants Adults aged ≥50 years receiving a first dose of BNT162b2, mRNA-1273, or ChAdOx1-S were randomly selected (1:1) and matched on the date of vaccination with one unvaccinated control. Individuals were matched on year of birth, sex, region of residence, and residence in a nursing home (for individuals aged ≥75 years). All individuals were followed up until 20 August 2021. Main outcome measures Primary outcome measure was vaccine effectiveness estimated at least 14 days after the second dose against covid-19 related hospital admission using Cox proportional hazards models adjusted for baseline characteristics and comorbidities. Vaccine effectiveness against covid-19 related death in hospital was also investigated. Results 11 256 832 vaccinated individuals were included in the study (63.6% (n=7 161 658) with the BNT162b2 vaccine, 7.6% (n=856 599) with the mRNA-1273 vaccine, and 28.8% (n=3 238 575) with the ChAdOx1-S vaccine), along with 11 256 832 matched unvaccinated controls. During follow-up (up to 20 August 2021), 43 158 covid-19 related hospital admissions and 7957 covid-19 related deaths in hospital were registered. Compared with unvaccinated controls, vaccine effectiveness of two doses against covid-19 related hospital admission was 91% (95% confidence interval 91% to 92%), 95% (93% to 96%), and 91% (89% to 94%) for the BNT162b2, mRNA-1273, and ChAdOx1-S vaccines, respectively. Similar results were observed for vaccine effectiveness of two doses against covid-19 related deaths in hospital (BNT162b2, 91% (90% to 93%); mRNA-1273, 96% (92% to 98%); and ChAdOx1 nCoV-19, 88% (68% to 95%)). At 5-6 months after receiving the second dose of vaccine, effectiveness remained high at 94% (92% to 95%) for the BNT162b2 vaccine and 98% (93% to 100%) for the mRNA-1273 vaccine. Vaccine effectiveness of ChAdOx1-S estimated at 3-4 months was 90% (63% to 97%). All three vaccines remained effective at the time of circulation of the delta variant of SARS-CoV-2 between 1 July and 20 August 2021 (effectiveness between 89% and 95%). Conclusions These findings provide evidence indicating that two doses of ChAdOx1-S is as effective as two doses of mRNA vaccines in France against the alpha and delta variants of SARS-CoV-2. The effectiveness of ChAdOx1-S should be further examined with a longer follow-up and in the light of the circulation of new SARS-CoV-2 variants of concern.
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Affiliation(s)
- Kim Bouillon
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Bérangère Baricault
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
- Faculty of Pharmacy, Paris-Saclay University, Châtenay-Malabry, France
| | - Marie-Joëlle Jabagi
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Marion Bertrand
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Laura Semenzato
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Stéphane Le Vu
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Jérôme Drouin
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
- CESP-Inserm, Anti-infective evasion and pharmacoepidemiology, Paris-Saclay University, UVSQ, Montigny le Bretonneux, France
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Viner R, Waddington C, Mytton O, Booy R, Cruz J, Ward J, Ladhani S, Panovska-Griffiths J, Bonell C, Melendez-Torres GJ. Transmission of SARS-CoV-2 by children and young people in households and schools: a meta-analysis of population-based and contact-tracing studies. J Infect 2021; 84:361-382. [PMID: 34953911 PMCID: PMC8694793 DOI: 10.1016/j.jinf.2021.12.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 12/23/2022]
Abstract
Background The role of children and young people (CYP) in transmission of SARS-CoV-2 in household and educational settings remains unclear. We undertook a systematic review and meta-analysis of contact-tracing and population-based studies at low risk of bias. Methods We searched 4 electronic databases on 28 July 2021 for contact-tracing studies and population-based studies informative about transmission of SARS-CoV-2 from 0-19 year olds in household or educational settings. We excluded studies at high risk of bias, including from under-ascertainment of asymptomatic infections. We undertook multilevel random effects meta-analyses of secondary attack rates (SAR: contact-tracing studies) and school infection prevalence, and used meta-regression to examine the impact of community SARS-CoV-2 incidence on school infection prevalence. Findings 4529 abstracts were reviewed, resulting in 37 included studies (16 contact-tracing; 19 population studies; 2 mixed studies). The pooled relative transmissibility of CYP compared with adults was 0.92 (0.68, 1.26) in adjusted household studies. The pooled SAR from CYP was lower (p=0.002) in school studies 0.7% (0.2, 2.7) than household studies (7.6% (3.6, 15.9) . There was no difference in SAR from CYP to child or adult contacts. School population studies showed some evidence of clustering in classes within schools. School infection prevalence was associated with contemporary community 14-day incidence (OR 1.003 (1.001, 1.004), p<0.001). Interpretation We found no difference in transmission of SARS-CoV-2 from CYP compared with adults within household settings. SAR were markedly lower in school compared with household settings, suggesting that household transmission is more important than school transmission in this pandemic. School infection prevalence was associated with community infection incidence, supporting hypotheses that school infections broadly reflect community infections. These findings are important for guiding policy decisions on shielding, vaccination school and operations during the pandemic.
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Affiliation(s)
- Russell Viner
- Population, Policy and Practice, UCL Great Ormond St. Institute of Child Health, London.
| | | | | | | | - Joana Cruz
- Population, Policy and Practice, UCL Great Ormond St. Institute of Child Health, London
| | - Joseph Ward
- Population, Policy and Practice, UCL Great Ormond St. Institute of Child Health, London
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Sombetzki M, Lücker P, Ehmke M, Bock S, Littmann M, Reisinger EC, Hoffmann W, Kästner A. Impact of Changes in Infection Control Measures on the Dynamics of COVID-19 Infections in Schools and Pre-schools. Front Public Health 2021; 9:780039. [PMID: 34988054 PMCID: PMC8720754 DOI: 10.3389/fpubh.2021.780039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/23/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: With the increased emergence of SARS-CoV-2 variants, the impact on schools and preschools remains a matter of debate. To ensure that schools and preschools are kept open safely, the identification of factors influencing the extent of outbreaks is of importance. Aim: To monitor dynamics of COVID-19 infections in schools and preschools and identify factors influencing the extent of outbreaks. Methods: In this prospective observational study we analyzed routine surveillance data of Mecklenburg-Western Pomerania, Germany, from calendar week (CW) 32, 2020 to CW19, 2021 regarding SARS-CoV-2 infection events in schools and preschools considering changes in infection control measures over time. A multivariate linear regression model was fitted to evaluate factors influencing the number of students, teachers and staff tested positive following index cases in schools and preschools. Due to an existing multicollinearity in the common multivariate regression model between the variables "face mask obligation for children" and "face mask obligation for adults", two further separate regression models were set up (Multivariate Model Adults and Multivariate Model Children). Results: We observed a significant increase in secondary cases in preschools in the first quarter of 2021 (CW8 to CW15, 2021), and simultaneously a decrease in secondary cases in schools. In multivariate regression analysis, the strongest predictor of the extent of the outbreaks was the teacher/ caregiver mask obligation (B = -1.9; 95% CI: -2.9 to -1.0; p < 0.001). Furthermore, adult index cases (adult only or child+adult combinations) increased the likelihood of secondary cases (B = 1.3; 95% CI: 0.9 to 1.8; p < 0.001). The face mask obligation for children also showed a significant reduction in the number of secondary cases (B = -0.6; 95% CI: -0.9 to -0.2; p = 0.004. Conclusion: The present study indicates that outbreak events at schools and preschools are effectively contained by an obligation for adults and children to wear face masks.
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Affiliation(s)
- Martina Sombetzki
- Department of Tropical Medicine and Infectious Diseases, University Medical Center Rostock, Rostock, Germany
| | - Petra Lücker
- Department for Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Manja Ehmke
- Department of Tropical Medicine and Infectious Diseases, University Medical Center Rostock, Rostock, Germany
| | - Sabrina Bock
- Landesamt für Gesundheit und Soziales Mecklenburg-Vorpommern State Office for Health and Social Affairs, Rostock, Germany
| | - Martina Littmann
- Landesamt für Gesundheit und Soziales Mecklenburg-Vorpommern State Office for Health and Social Affairs, Rostock, Germany
| | - Emil C. Reisinger
- Department of Tropical Medicine and Infectious Diseases, University Medical Center Rostock, Rostock, Germany
| | - Wolfgang Hoffmann
- Department for Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Anika Kästner
- Department for Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Lordan R, Prior S, Hennessy E, Naik A, Ghosh S, Paschos GK, Skarke C, Barekat K, Hollingsworth T, Juska S, Mazaleuskaya LL, Teegarden S, Glascock AL, Anderson S, Meng H, Tang SY, Weljie A, Bottalico L, Ricciotti E, Cherfane P, Mrcela A, Grant G, Poole K, Mayer N, Waring M, Adang L, Becker J, Fries S, FitzGerald GA, Grosser T. Considerations for the Safe Operation of Schools During the Coronavirus Pandemic. Front Public Health 2021; 9:751451. [PMID: 34976917 PMCID: PMC8716382 DOI: 10.3389/fpubh.2021.751451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/18/2021] [Indexed: 12/25/2022] Open
Abstract
During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, providing safe in-person schooling has been a dynamic process balancing evolving community disease burden, scientific information, and local regulatory requirements with the mandate for education. Considerations include the health risks of SARS-CoV-2 infection and its post-acute sequelae, the impact of remote learning or periods of quarantine on education and well-being of children, and the contribution of schools to viral circulation in the community. The risk for infections that may occur within schools is related to the incidence of SARS-CoV-2 infections within the local community. Thus, persistent suppression of viral circulation in the community through effective public health measures including vaccination is critical to in-person schooling. Evidence suggests that the likelihood of transmission of SARS-CoV-2 within schools can be minimized if mitigation strategies are rationally combined. This article reviews evidence-based approaches and practices for the continual operation of in-person schooling.
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Affiliation(s)
- Ronan Lordan
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Samantha Prior
- Faculty of Science & Engineering, University of Limerick, Limerick, Ireland
| | - Elizabeth Hennessy
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Amruta Naik
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Soumita Ghosh
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Georgios K. Paschos
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Carsten Skarke
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Kayla Barekat
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Taylor Hollingsworth
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sydney Juska
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Liudmila L. Mazaleuskaya
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sarah Teegarden
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Abigail L. Glascock
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sean Anderson
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Hu Meng
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Soon-Yew Tang
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Aalim Weljie
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Lisa Bottalico
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Emanuela Ricciotti
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Perla Cherfane
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Antonijo Mrcela
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Gregory Grant
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Kristen Poole
- Department of English, University of Delaware, Newark, DE, United States
| | - Natalie Mayer
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael Waring
- Department of Civil, Architectural and Environmental Engineering, Drexel University, Philadelphia, PA, United States
| | - Laura Adang
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Julie Becker
- Division of Public Health, University of the Sciences, Philadelphia, PA, United States
| | - Susanne Fries
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Garret A. FitzGerald
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Tilo Grosser
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Winje BA, Ofitserova TS, Brynildsrud OB, Greve-Isdahl M, Bragstad K, Rykkvin R, Hungnes O, Lund HM, Nygård K, Meijerink H, Brandal LT. Comprehensive Contact Tracing, Testing and Sequencing Show Limited Transmission of SARS-CoV-2 between Children in Schools in Norway, August 2020 to May 2021. Microorganisms 2021; 9:2587. [PMID: 34946187 PMCID: PMC8705768 DOI: 10.3390/microorganisms9122587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/03/2021] [Accepted: 12/12/2021] [Indexed: 12/23/2022] Open
Abstract
The role of children in the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in schools has been a topic of controversy. In this study among school contacts of SARS-CoV-2 positive children in 43 contact-investigations, we investigated SARS-CoV-2 transmission in Norway, August 2020-May 2021. All participants were tested twice within seven to ten days, using SARS-CoV-2 PCR on home-sampled saliva. Positive samples were whole genome sequenced. Among the 559 child contacts, eight tested positive (1.4%, 95% CI 0.62-2.80), with no significant difference between primary (1.0%, 95% CI 0.27-2.53) and secondary schools (2.6%, 95% CI 0.70-6.39), p = 0.229, nor by viral strain, non-Alpha (1.4%, 95% CI 0.50-2.94) and Alpha variant (B.1.1.7) (1.7%, 95% CI 0.21-5.99), p = 0.665. One adult contact (1/100) tested positive. In 34 index cases, we detected 13 different SARS-CoV-2 Pango lineage variants, with B.1.1.7 being most frequent. In the eight contact-investigations with SARS-CoV-2 positive contacts, four had the same sequence identity as the index, one had no relation, and three were inconclusive. With mitigation measures in place, the spread of SARS-CoV-2 from children in schools is limited. By excluding contact-investigations with adult cases known at the time of enrolment, our data provide a valid estimate on the role of children in the transmission of SARS-CoV-2 in schools.
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Affiliation(s)
- Brita Askeland Winje
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, 0213 Oslo, Norway; (T.S.O.); (M.G.-I.); (H.M.)
- Faculty of Health Sciences, Oslo Metropolitan University, 0167 Oslo, Norway
| | - Trine Skogset Ofitserova
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, 0213 Oslo, Norway; (T.S.O.); (M.G.-I.); (H.M.)
| | - Ola Brønstad Brynildsrud
- Department of Method Development and Analytics, Norwegian Institute of Public Health, 0213 Oslo, Norway;
| | - Margrethe Greve-Isdahl
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, 0213 Oslo, Norway; (T.S.O.); (M.G.-I.); (H.M.)
| | - Karoline Bragstad
- Department of Virology, Norwegian Institute of Public Health, 0213 Oslo, Norway; (K.B.); (R.R.); (O.H.)
| | - Rikard Rykkvin
- Department of Virology, Norwegian Institute of Public Health, 0213 Oslo, Norway; (K.B.); (R.R.); (O.H.)
| | - Olav Hungnes
- Department of Virology, Norwegian Institute of Public Health, 0213 Oslo, Norway; (K.B.); (R.R.); (O.H.)
| | - Hilde Marie Lund
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, 0213 Oslo, Norway; (H.M.L.); (K.N.); (L.T.B.)
| | - Karin Nygård
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, 0213 Oslo, Norway; (H.M.L.); (K.N.); (L.T.B.)
| | - Hinta Meijerink
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, 0213 Oslo, Norway; (T.S.O.); (M.G.-I.); (H.M.)
| | - Lin Thorstensen Brandal
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, 0213 Oslo, Norway; (H.M.L.); (K.N.); (L.T.B.)
- European Program for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control, (ECDC), 169 73 Solna, Sweden
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Heudorf U, Gottschalk R, Walczok A, Tinnemann P, Steul K. [Children in the COVID-19 pandemic and the public health service (ÖGD) : Data and reflections from Frankfurt am Main, Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1559-1569. [PMID: 34705052 PMCID: PMC8548699 DOI: 10.1007/s00103-021-03445-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/30/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND The measures taken to combat the COVID-19 pandemic have severely restricted the opportunities for the development of children. This paper will discuss the reporting data of children and the public health department's activities against the background of the restrictions of school and leisure time offers as well as sports and club activities. MATERIALS AND METHODS Reporting data from Frankfurt am Main, Hesse, were obtained using a SURVStat query for the calendar weeks 10/2020-28/2021 and from SURVNet (until 30 June 2021). Contact persons (CP) of SARS-CoV‑2 positive persons from schools and daycare centers were screened for SARS-CoV‑2 by PCR test. These results and those of rapid antigen testing, which has been mandatory for schoolchildren since April 2021, are presented. RESULTS Until Easter break, the age-related seven-day incidence values per 100,000 for children 14 years of age and younger were lower than the overall incidence; it was only higher after rapid antigen-testing was mandatory for schoolchildren. Most children with SARS-CoV‑2 had no or mild symptoms; hospitalization was rarely required and no deaths occurred. Contact tracing in schools and daycare centers found no positive contacts in most cases and rarely more than two. Larger outbreaks did not occur. CONCLUSION SARS-CoV‑2 infections in children appear to be less frequent and much less severe than in adults. Hygiene rules and contact management have proven themselves effective during times with high incidences in the local population without mandatory rapid antigen testing - and even with a high proportion of variants of concern (alpha and delta variants) in Germany. Against this background, further restriction of school and daycare operations appears neither necessary nor appropriate.
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Affiliation(s)
- Ursel Heudorf
- Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt, Deutschland
| | - René Gottschalk
- Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt, Deutschland
| | - Antoni Walczok
- Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt, Deutschland
| | - Peter Tinnemann
- Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt, Deutschland
| | - Katrin Steul
- Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt, Deutschland.
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38
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Lopes-Júnior LC, Siqueira PC, Maciel ELN. School reopening and risks accelerating the COVID-19 pandemic: A systematic review and meta-analysis protocol. PLoS One 2021; 16:e0260189. [PMID: 34788344 PMCID: PMC8598030 DOI: 10.1371/journal.pone.0260189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/02/2021] [Indexed: 12/24/2022] Open
Abstract
Background One of the most recent concerns of this pandemic regards the role of schools reopening in disease transmission, as well as the impact of keeping schools closed. While school reopening seems critical for the education and mental health of children, adolescents, and adults, so far the literature has not systematically reached a consensus whether to recommend the return to schools in a way that would be safe for students and staff. Objective To synthesize and critically evaluate the scientific evidence on the potential risk of accelerating the Coronavirus Disease 2019 (COVID-19) pandemic among children, adolescents, young adults, and adults with school reopening. Methods This systematic review and meta-analysis protocol was elaborated following the PRISMA-P. We will include all observational study designs, which report on the potential risk of accelerating the COVID-2019 pandemic with school reopening. Electronic databases included were MEDLINE/PubMed, Cochrane Library, EMBASE, Web of Science, SCOPUS and CNKI. Additional sources will be also retrieved, including Clinical trials.gov-NIH, The British Library, Pro Quest Dissertations Database, Public Health Gray Literature Sources and Health Evidence, Google Scholar, and pre-prints [medRXiv]. No restriction to language or date will be used as search strategy. In an independently manner, two investigators will select studies, perform data extraction, as well as perform a critical appraisal of the risk of bias and overall quality of the selected observational studies, based on their designs. The heterogeneity among the studies will be assessed using the I2 statistic test. According to the results of this test, we will verify whether a meta-analysis is feasible. If feasibility is confirmed, a random-effect model analysis will be carried out. For data analysis, the calculation of the pooled effect estimates will consider a 95% CI and alpha will be set in 0.05 using the R statistical software, v.4.0.4. In addition, we will rate the certainty of evidence based on Cochrane methods and in accordance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Expected results This systematic review and meta-analysis will provide better insights into safety in the return to school in the context of the COVID-2019 pandemic, at a time when vaccination advances unevenly in several countries around the world. Hence, consistent data and robust evidence will be provided to help decision-makers and stakeholders in the current pandemic scenario. PROSPERO registration number CRD42021265283; https://clinicaltrials.gov.
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Affiliation(s)
- Luís Carlos Lopes-Júnior
- Health Sciences Center at the Federal University of Espírito Santo (UFES), Vitoria, Espírito Santo, Brazil
- * E-mail:
| | | | - Ethel Leonor Noia Maciel
- Health Sciences Center at the Federal University of Espírito Santo (UFES), Vitoria, Espírito Santo, Brazil
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Aizawa Y, Shobugawa Y, Tomiyama N, Nakayama H, Takahashi M, Yanagiya J, Kaji N, Ikuse T, Izumita R, Yamanaka T, Hasegawa S, Tamura T, Saito R, Saitoh A. Coronavirus Disease 2019 Cluster Originating in a Primary School Teachers' Room in Japan. Pediatr Infect Dis J 2021; 40:e418-e423. [PMID: 34561385 PMCID: PMC8505149 DOI: 10.1097/inf.0000000000003292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND School closures are a subject of debate during the present coronavirus disease 2019 (COVID-19) pandemic. Because children are not the main driver of COVID-19 transmission in the community, school education must be prioritized in conjunction with appropriate infection prevention and control measures, as determined by local COVID-19 incidence. METHODS We investigated the causes and transmission routes of a primary school cluster of COVID-19 that occurred during November and December 2020 in Niigata, Japan. RESULTS In the cluster, the virus spread among teachers, then from teachers to students, and then to their family members. This primary school cluster comprised 26 infected patients and included teachers (13/33, 39%), students (9/211, 4%), and family members (4/65, 6%). The secondary attack rate from the 3 index teachers to the remaining 30 teachers was 33%; however, the rate to students was only 4%. Factors contributing to cluster formation include the fact that 2 of the index teachers continued working while symptomatic and that the environment and infection prevention measures in the teachers' room were inadequate. CONCLUSIONS To open schools safely and without interruption, adequate measures to prevent COVID-19 infection in schools should be emphasized not only for children but also for teachers and their environment.
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Affiliation(s)
- Yuta Aizawa
- From the Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yugo Shobugawa
- Department of Active Aging, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Nobuko Tomiyama
- Department of Health and Welfare, Niigata Prefectural Office, Niigata, Japan
| | - Hitoshi Nakayama
- Department of Health and Welfare, Niigata Prefectural Office, Niigata, Japan
| | - Masako Takahashi
- Department of Health and Welfare, Niigata Prefectural Office, Niigata, Japan
| | - Junko Yanagiya
- Department of Health and Welfare, Niigata Prefectural Office, Niigata, Japan
| | - Noriko Kaji
- Kashiwazaki Health Care Center, Niigata, Japan
| | - Tatsuki Ikuse
- From the Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ryohei Izumita
- From the Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Department of Pediatrics, Niigata City General Hospital, Niigata, Japan
| | - Takayuki Yamanaka
- Department of Pediatrics, Niigata City General Hospital, Niigata, Japan
| | - Satoshi Hasegawa
- Pediatric liaison, Niigata Prefectural Patient Control Center, Niigata, Japan
| | - Tsutomu Tamura
- Department of Virology, Niigata Prefectural Institute of Public Health and Environmental Science, Niigata, Japan
| | - Reiko Saito
- Department of International Health (Public Health), Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akihiko Saitoh
- From the Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Chernozhukov V, Kasahara H, Schrimpf P. The association of opening K-12 schools with the spread of COVID-19 in the United States: County-level panel data analysis. Proc Natl Acad Sci U S A 2021; 118:e2103420118. [PMID: 34642247 PMCID: PMC8545468 DOI: 10.1073/pnas.2103420118] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 12/23/2022] Open
Abstract
This paper empirically examines how the opening of K-12 schools is associated with the spread of COVID-19 using county-level panel data in the United States. As preliminary evidence, our event-study analysis indicates that cases and deaths in counties with in-person or hybrid opening relative to those with remote opening substantially increased after the school opening date, especially for counties without any mask mandate for staff. Our main analysis uses a dynamic panel data model for case and death growth rates, where we control for dynamically evolving mitigation policies, past infection levels, and additive county-level and state-week "fixed" effects. This analysis shows that an increase in visits to both K-12 schools and colleges is associated with a subsequent increase in case and death growth rates. The estimates indicate that fully opening K-12 schools with in-person learning is associated with a 5 (SE = 2) percentage points increase in the growth rate of cases. We also find that the association of K-12 school visits or in-person school openings with case growth is stronger for counties that do not require staff to wear masks at schools. These findings support policies that promote masking and other precautionary measures at schools and giving vaccine priority to education workers.
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Affiliation(s)
- Victor Chernozhukov
- Department of Economics, Massachusetts Institute of Technology, Cambridge, MA 02142
- Center for Statistics and Data Science, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Hiroyuki Kasahara
- Vancouver School of Economics, University of British Columbia, Vancouver, BC V6T1L4, Canada
| | - Paul Schrimpf
- Vancouver School of Economics, University of British Columbia, Vancouver, BC V6T1L4, Canada
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41
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Haag L, Blankenburg J, Unrath M, Grabietz J, Kahre E, Galow L, Schneider J, Dalpke AH, Lück C, Büttner L, Berner R, Armann JP. Prevalence and Transmission of Severe Acute Respiratory Syndrome Coronavirus Type 2 in Childcare Facilities: A Longitudinal Study. J Pediatr 2021; 237:136-142. [PMID: 34324882 PMCID: PMC8313816 DOI: 10.1016/j.jpeds.2021.07.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the role of childcare facilities in the transmission of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) in a longitudinal study to gain further knowledge of SARS-CoV-2 prevalence, transmission, and spread among preschool children, their parents, and their caregivers. STUDY DESIGN Children aged 1-6 years, their parents, and their caregivers in 14 childcare facilities in Dresden, Saxony/Germany were invited to participate in the KiTaCoviDD19-study between July 2020 and January 2021. Seroprevalence of SARS-CoV-2 antibodies was assessed up to 4 times during the study period in all participating adults, and demographic characteristics, as well as epidemiologic information on personal SARS-CoV-2 history were obtained. Samples for stool virus shedding of SARS-CoV-2 were analyzed by polymerase chain reaction every 2-4 weeks in all participating children. RESULTS In total, 318 children, 299 parents and 233 childcare workers were enrolled. By January 2021, 11% of the participating adults were found to be seropositive, whereas the percentage of children shedding SARS-CoV-2 was 6.8%. Overall, we detected 17 children with SARS-CoV-2 virus shedding in 8 different childcare facilities. In 4 facilities, there were a maximum of 3 connected cases in children. Approximately 50% of SARS-CoV-2 infections in the children could not be connected to a secondary case in our study population. CONCLUSIONS This study does not provide evidence of relevant asymptomatic ("silent") spread of SARS-CoV-2 in childcare facilities in both low- and high-prevalence settings. Our findings add to the evidence that childcare and educational settings do not have a crucial role in driving the SARS-CoV-2 pandemic.
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Affiliation(s)
- Luise Haag
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Judith Blankenburg
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Manja Unrath
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Johanna Grabietz
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Elisabeth Kahre
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Lukas Galow
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Josephine Schneider
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Alexander H. Dalpke
- Institute for Medical Microbiology and Virology, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Lück
- Institute for Medical Microbiology and Virology, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Leo Büttner
- Institute for Medical Microbiology and Virology, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Reinhard Berner
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jakob P. Armann
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Katz SE, McHenry R, Mauer LG, Chappell JD, Stewart LS, Schmitz JE, Halasa N, Edwards KM, Banerjee R. Low In-School COVID-19 Transmission and Asymptomatic Infection Despite High Community Prevalence. J Pediatr 2021; 237:302-306.e1. [PMID: 34144028 PMCID: PMC8271352 DOI: 10.1016/j.jpeds.2021.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 12/25/2022]
Abstract
There is concern that in-person schooling during the coronavirus disease 2019 (COVID-19) pandemic will facilitate disease transmission. Through asymptomatic surveillance and contact tracing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we found low rates of asymptomatic SARS-CoV-2 infection and little in-school transmission of COVID-19 when physical distancing and masking strategies were enforced despite a high community prevalence of COVID-19.
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Affiliation(s)
- Sophie E. Katz
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN,Reprint requests: Sophie E. Katz, MD, MPH, Vanderbilt University Medical Center, 1161 21st Avenue South, D-7235 Medical Center North, Nashville, TN 37232-2581
| | - Rendie McHenry
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN
| | | | - James D. Chappell
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN
| | - Laura S. Stewart
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN
| | - Jonathan E. Schmitz
- Division of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Natasha Halasa
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN
| | - Kathryn M. Edwards
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN
| | - Ritu Banerjee
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN
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Sweeney-Reed CM, Wolff D, Hörnschemeyer S, Faßhauer H, Haase A, Schomburg D, Niggel J, Kabesch M, Apfelbacher C. Feasibility of a surveillance programme based on gargle samples and pool testing to prevent SARS-CoV-2 outbreaks in schools. Sci Rep 2021; 11:19521. [PMID: 34593887 PMCID: PMC8484445 DOI: 10.1038/s41598-021-98849-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/15/2021] [Indexed: 01/12/2023] Open
Abstract
School closures have a negative impact on physical and mental well-being, and education, of children and adolescents. A surveillance programme to detect asymptomatic SARS-CoV-2 infection could allow schools to remain open, while protecting the vulnerable. We assessed the feasibility of a programme employing gargle samples and pool testing of individually extracted RNA using rRT-qPCR in a primary and a secondary school in Germany, based on programme logistics and acceptance. Twice a week, five participants per class were selected to provide samples, using an algorithm weighted by a risk-based priority score to increase likelihood of case detection. The positive response rate was 54.8% (550 of 1003 pupils). Logistics evaluation revealed the rate-limiting steps: completing the regular pre-test questionnaire and handing in the samples. Acceptance questionnaire responses indicated strong support for research into developing a surveillance programme and a positive evaluation of gargle tests. Participation was voluntary. As not all pupils participated, individual reminders could lead to participant identification. School-wide implementation of the programme for infection monitoring purposes would enable reminders to be given to all school pupils to address these steps, without compromising participant anonymity. Such a programme would provide a feasible means to monitor asymptomatic respiratory tract infection in schools.
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Affiliation(s)
- Catherine M Sweeney-Reed
- Neurocybernetics and Rehabilitation, Dept. of Neurology, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Germany.
- Center for Behavioral Brain Sciences, Otto von Guericke University Magdeburg, Magdeburg, Germany.
| | - Doreen Wolff
- Institute of Social Medicine and Health System Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Sarah Hörnschemeyer
- Institute of Social Medicine and Health System Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Henriette Faßhauer
- Institute of Social Medicine and Health System Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Antonia Haase
- Institute of Social Medicine and Health System Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Dirk Schomburg
- Institute of Biometry und Medical Informatics (IBMI), Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Jakob Niggel
- University of Regensburg, Regensburg, Germany
- MaganaMed GmbH, Regensburg, Germany
| | - Michael Kabesch
- University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
- Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John and University of Regensburg, Regensburg, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health System Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
- Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John and University of Regensburg, Regensburg, Germany
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44
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McGee RS, Homburger JR, Williams HE, Bergstrom CT, Zhou AY. Model-driven mitigation measures for reopening schools during the COVID-19 pandemic. Proc Natl Acad Sci U S A 2021; 118:e2108909118. [PMID: 34518375 PMCID: PMC8488607 DOI: 10.1073/pnas.2108909118] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 01/02/2023] Open
Abstract
Reopening schools is an urgent priority as the COVID-19 pandemic drags on. To explore the risks associated with returning to in-person learning and the value of mitigation measures, we developed stochastic, network-based models of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in primary and secondary schools. We find that a number of mitigation measures, alone or in concert, may reduce risk to acceptable levels. Student cohorting, in which students are divided into two separate populations that attend in-person classes on alternating schedules, can reduce both the likelihood and the size of outbreaks. Proactive testing of teachers and staff can help catch introductions early, before they spread widely through the school. In secondary schools, where the students are more susceptible to infection and have different patterns of social interaction, control is more difficult. Especially in these settings, planners should also consider testing students once or twice weekly. Vaccinating teachers and staff protects these individuals and may have a protective effect on students as well. Other mitigations, including mask wearing, social distancing, and increased ventilation, remain a crucial component of any reopening plan.
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Affiliation(s)
| | | | | | - Carl T Bergstrom
- Department of Biology, University of Washington, Seattle, WA 98195
| | - Alicia Y Zhou
- Scientific Affairs, Color Health, Burlingame, CA 94010
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Yuan H, Reynolds C, Ng S, Yang W. Factors affecting the transmission of SARS-CoV-2 in school settings. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.06.18.21259156. [PMID: 34189533 PMCID: PMC8240688 DOI: 10.1101/2021.06.18.21259156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Several studies have reported SARS-CoV-2 outbreaks in schools, with a wide range of secondary attack rate (SAR; range: 0-100%). We aimed to examine key risk factors to better understand SARS-CoV-2 transmission in schools. METHODS We collected records of 39 SARS-CoV-2 school outbreaks globally published through July 2021 and compiled information on hypothesized risk factors. We utilized the directed acyclic graph (DAG) to conceptualize risk mechanisms, used logistic regression to examine each risk-factor group, and further built multi-risk models. RESULTS The best-fit model showed that the intensity of concurrent community transmission (adjusted odds ratio [aOR]: 1.2, 95% CI: 1.17 - 1.24, for each increase of 1 case per 10,000 persons per week), individualism (aOR: 1.72, 95% CI: 1.19 - 2.5, above vs. below the median) were associated higher risk, whereas preventive measures (aOR: 0.22, 95% CI: 0.17 - 0.29, distancing and masking vs. none) and higher population immunity (aOR: 0.28, 95% CI: 0.22 - 0.35) were associated with lower risk of SARS-CoV-2 transmission in schools. Compared to students in pre-schools, the aOR was 0.35 (95% CI: 0.23 - 0.54) for students in primary schools and 1.3 (95% CI: 0.9 - 1.88) for students in high schools. CONCLUSIONS Preventive measures in schools (e.g. social distancing and mask-wearing) and communal efforts to lower transmission and increase vaccination uptake (i.e. vaccine-induced population immunity) in the community should be taken to collectively reduce transmission and protect children in schools. Flexible reopening policies may be considered for different levels of schools given their risk differences.
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Koirala A, Goldfeld S, Bowen AC, Choong C, Ryan K, Wood N, Winkler N, Danchin M, Macartney K, Russell FM. Lessons learnt during the COVID-19 pandemic: Why Australian schools should be prioritised to stay open. J Paediatr Child Health 2021; 57:1362-1369. [PMID: 34101922 PMCID: PMC8242752 DOI: 10.1111/jpc.15588] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Abstract
In 2020, school and early childhood educational centre (ECEC) closures affected over 1.5 billion school-aged children globally as part of the COVID-19 pandemic response. Attendance at school and access to ECEC is critical to a child's learning, well-being and health. School closures increase inequities by disproportionately affecting vulnerable children. Here, we summarise the role of children and adolescents in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission and that of schools and ECECs in community transmission and describe the Australian experience. In Australia, most SARS-CoV-2 cases in schools were solitary (77% in NSW and 67% in Victoria); of those that did progress to an outbreak, >90% involved fewer than 10 cases. Australian and global experience has demonstrated that SARS-CoV-2 is predominantly introduced into schools and ECECs during periods of heightened community transmission. Implementation of public health mitigation strategies, including effective testing, tracing and isolation of contacts, means schools and ECECs can be safe, not drivers of transmission. Schools and ECEC are essential services and so they should be prioritised to stay open for face-to-face learning. This is particularly critical as we continue to manage the next phase of the COVID-19 pandemic.
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Affiliation(s)
- Archana Koirala
- National Centre for Immunisation Research and Surveillance Kids Research, Sydney Children's Hospitals NetworkWestmeadNew South WalesAustralia,School of Child and Adolescent HealthUniversity of SydneySydneyNew South WalesAustralia,Department of Infectious Diseases, Nepean HospitalKingswoodNew South WalesAustralia
| | - Sharon Goldfeld
- Centre for Community Child Health, Royal Children's HospitalParkvilleVictoriaAustralia,Population Health, Murdoch Children's Research InstituteParkvilleVictoriaAustralia,Department of PaediatricsThe University of MelbourneParkvilleVictoriaAustralia
| | - Asha C Bowen
- Department of Infectious DiseasesPerth Children's HospitalNedlandsWestern AustraliaAustralia,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids InstituteNedlandsWestern AustraliaAustralia,School of Medicine, The University of Western AustraliaPerthWestern AustraliaAustralia,Centre for Child Health ResearchThe University of Western AustraliaPerthWestern AustraliaAustralia,Menzies School of Health ResearchCharles Darwin UniversityDarwinNorthern TerritoryAustralia,Institute for Health ResearchThe University of Notre Dame AustraliaFremantleWestern AustraliaAustralia
| | - Catherine Choong
- School of Medicine, The University of Western AustraliaPerthWestern AustraliaAustralia,Menzies School of Health ResearchCharles Darwin UniversityDarwinNorthern TerritoryAustralia,Department of Endocrinology, Perth Children's HospitalNedlandsWestern AustraliaAustralia
| | - Kathleen Ryan
- Population Health, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance Kids Research, Sydney Children's Hospitals NetworkWestmeadNew South WalesAustralia,School of Child and Adolescent HealthUniversity of SydneySydneyNew South WalesAustralia,Department of Paediatrics, The Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Noni Winkler
- National Centre for Immunisation Research and Surveillance Kids Research, Sydney Children's Hospitals NetworkWestmeadNew South WalesAustralia,National Centre for Epidemiology and Population Health, Research School of Population HealthAustralian National UniversityCanberraAustralian Capitol TerritoryAustralia
| | - Margie Danchin
- Department of PaediatricsThe University of MelbourneParkvilleVictoriaAustralia,Department of General Medicine, Royal Children's HospitalParkvilleVictoriaAustralia,Infection and Immunity, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance Kids Research, Sydney Children's Hospitals NetworkWestmeadNew South WalesAustralia,School of Child and Adolescent HealthUniversity of SydneySydneyNew South WalesAustralia,Department of Infectious Diseases, The Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Fiona M Russell
- Department of PaediatricsThe University of MelbourneParkvilleVictoriaAustralia,Infection and Immunity, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
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47
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Rowland LC, Hahn JB, Jelderks TL, Welch NM, Ramirez DWE. SARS-CoV-2 Incidence and Transmission in 48 K-12 Virginia Public Schools During Community Surge. J Pediatric Infect Dis Soc 2021:piab075. [PMID: 34437703 PMCID: PMC8499807 DOI: 10.1093/jpids/piab075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022]
Abstract
Among 20 681 students and 4282 staff, the in-school transmission of SARS-CoV-2 appeared low during highest community spread and at 3- to 6-foot distancing. Nine of 820 school cases (1.1%) resulted in spread, with only one student-to-staff transmission. A school epidemiologist and mitigation audit teams were useful.
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Affiliation(s)
- Leah C Rowland
- Department of Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, Virginia, USA
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Jennifer B Hahn
- Office of Epidemiology, Chesapeake Health Department, Chesapeake, Virginia, USA
| | | | - Nancy M Welch
- Director, Chesapeake Health Department, Chesapeake, Virginia, USA
| | - Dana W E Ramirez
- Department of Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, Virginia, USA
- Eastern Virginia Medical School, Norfolk, Virginia, USA
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48
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Irfan O, Li J, Tang K, Wang Z, Bhutta ZA. Risk of infection and transmission of SARS-CoV-2 among children and adolescents in households, communities and educational settings: A systematic review and meta-analysis. J Glob Health 2021; 11:05013. [PMID: 34326997 PMCID: PMC8285769 DOI: 10.7189/jogh.11.05013] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There is uncertainty with respect to SARS-CoV-2 transmission in children (0-19 years) with controversy on effectiveness of school-closures in controlling the pandemic. It is of equal importance to evaluate the risk of transmission in children who are often asymptomatic or mildly symptomatic carriers that may incidentally transmit SARS-CoV-2 in different settings. We conducted this review to assess transmission and risks for SARS-CoV-2 in children (by age-groups or grades) in community and educational-settings compared to adults. METHODS Data for the review were retrieved from PubMed, EMBASE, Cochrane Library, WHO COVID-19 Database, China National Knowledge Infrastructure (CNKI) Database, WanFang Database, Latin American and Caribbean Health Sciences Literature (LILACS), Google Scholar, and preprints from medRixv and bioRixv) covering a timeline from December 1, 2019 to April 1, 2021. Population-screening, contact-tracing and cohort studies reporting prevalence and transmission of SARS-CoV-2 in children were included. Data were extracted according to PRISMA guidelines. Meta-analyses were performed using Review Manager 5.3. RESULTS Ninety studies were included. Compared to adults, children showed comparable national (risk ratio (RR) = 0.87, 95% confidence interval (CI) = 0.71-1.060 and subnational (RR = 0.81, 95% CI = 0.66-1.01) prevalence in population-screening studies, and lower odds of infection in community/household contact-tracing studies (odds ratio (OR) = 0.62, 95% CI = 0.46-0.84). On disaggregation, adolescents observed comparable risk (OR = 1.22, 95% CI = 0.74-2.04) with adults. In educational-settings, children attending daycare/preschools (OR = 0.53, 95% CI = 0.38-0.72) were observed to be at lower-risk when compared to adults, with odds of infection among primary (OR = 0.85, 95% CI = 0.55-1.31) and high-schoolers (OR = 1.30, 95% CI = 0.71-2.38) comparable to adults. Overall, children and adolescents had lower odds of infection in educational-settings compared to community and household clusters. CONCLUSIONS Children (<10 years) showed lower susceptibility to COVID-19 compared to adults, whereas adolescents in communities and high-schoolers had comparable risk. Risks of infection among children in educational-settings was lower than in communities. Evidence from school-based studies demonstrate it is largely safe for children (<10 years) to be at schools, however older children (10-19 years) might facilitate transmission. Despite this evidence, studies focusing on the effectiveness of mitigation measures in educational settings are urgently needed to support both public health and educational policy-making for school reopening.
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Affiliation(s)
- Omar Irfan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Jiang Li
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Kun Tang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zhicheng Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Institute for Global Health & Development, the Aga Khan University, Karachi, Pakistan
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50
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Bark D, Dhillon N, St-Jean M, Kinniburgh B, McKee G, Choi A. SARS-CoV-2 transmission in kindergarten to grade 12 schools in the Vancouver Coastal Health region: a descriptive epidemiologic study. CMAJ Open 2021; 9:E810-E817. [PMID: 34429325 DOI: 10.1101/2021.05.15.21257271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND There is an urgent need to assess the role of schools in the spread of SARS-CoV-2 in Canada to inform public health measures. We describe the epidemiology of SARS-CoV-2 infection among students and staff in the Vancouver Coastal Health (VCH) region in the first 3 months of the 2020/2021 academic year, and examine the extent of transmission in schools. METHODS This descriptive epidemiologic study using contact tracing data included individuals aged 5 years and older with SARS-CoV-2 infection, reported between Sept. 10 and Dec. 18, 2020, who worked in or attended kindergarten to grade 12 (K-12) schools in person in the VCH region. We described case and cluster characteristics and reported the number of school-based transmissions. RESULTS During the study period, 699 cases of SARS-CoV-2 infection were reported (55 cases per 10 000 VCH school population). Among cases in VCH resident staff and students, 52.5% (354/674) were linked to a household case or cluster; less than 1.5% (< 10) of infected individuals were hospitalized and none died. Out of 699 cases present at school, 26 clusters with school-based transmission resulted in 55 secondary cases. Staff members accounted for 53.8% of index cases (14/26) while making up 14.3% of the school population (17 742/123 647). Among clusters, 88.5% (23) had fewer than 4 secondary cases. INTERPRETATION In our population during the study period, there were no deaths and severe disease was rare; furthermore, school-based SARS-CoV-2 transmissions were uncommon and clusters were small. Our results, which relate primarily to symptomatic disease, support the growing body of evidence that schools likely did not play a major role in SARS-CoV-2 spread in 2020.
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Affiliation(s)
- Diana Bark
- School of Population and Public Health (Bark, McKee), University of British Columbia; Population Health Surveillance Unit (Dhillon, St-Jean, Kinniburgh), Vancouver Coastal Health; Population and Public Health (McKee), BC Centre for Disease Control; Office of the Chief Medical Health Officer (Choi), Vancouver Coastal Health, Vancouver, BC
| | - Nalin Dhillon
- School of Population and Public Health (Bark, McKee), University of British Columbia; Population Health Surveillance Unit (Dhillon, St-Jean, Kinniburgh), Vancouver Coastal Health; Population and Public Health (McKee), BC Centre for Disease Control; Office of the Chief Medical Health Officer (Choi), Vancouver Coastal Health, Vancouver, BC
| | - Martin St-Jean
- School of Population and Public Health (Bark, McKee), University of British Columbia; Population Health Surveillance Unit (Dhillon, St-Jean, Kinniburgh), Vancouver Coastal Health; Population and Public Health (McKee), BC Centre for Disease Control; Office of the Chief Medical Health Officer (Choi), Vancouver Coastal Health, Vancouver, BC
| | - Brooke Kinniburgh
- School of Population and Public Health (Bark, McKee), University of British Columbia; Population Health Surveillance Unit (Dhillon, St-Jean, Kinniburgh), Vancouver Coastal Health; Population and Public Health (McKee), BC Centre for Disease Control; Office of the Chief Medical Health Officer (Choi), Vancouver Coastal Health, Vancouver, BC
| | - Geoff McKee
- School of Population and Public Health (Bark, McKee), University of British Columbia; Population Health Surveillance Unit (Dhillon, St-Jean, Kinniburgh), Vancouver Coastal Health; Population and Public Health (McKee), BC Centre for Disease Control; Office of the Chief Medical Health Officer (Choi), Vancouver Coastal Health, Vancouver, BC
| | - Alexandra Choi
- School of Population and Public Health (Bark, McKee), University of British Columbia; Population Health Surveillance Unit (Dhillon, St-Jean, Kinniburgh), Vancouver Coastal Health; Population and Public Health (McKee), BC Centre for Disease Control; Office of the Chief Medical Health Officer (Choi), Vancouver Coastal Health, Vancouver, BC
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