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Shiino T, Takeuchi JS, Ohyanagi H, Kimura M, Kazuyama Y, Ikeda M, Sugiura W. Molecular epidemiology of SARS-CoV-2 genome sentinel surveillance in commercial COVID-19 testing sites targeting asymptomatic individuals during Japan's seventh epidemic wave. Sci Rep 2024; 14:20950. [PMID: 39251760 PMCID: PMC11385524 DOI: 10.1038/s41598-024-71953-8] [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: 02/19/2024] [Accepted: 09/02/2024] [Indexed: 09/11/2024] Open
Abstract
Eight peaks of coronavirus disease 2019 (COVID-19) outbreak occurred in Japan, each associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern. The National Epidemiological Surveillance of Infectious Diseases (NESID) analyzed viral genome sequences from symptomatic patients and submitted the results to GISAID. Meanwhile, commercial testing services occasionally sequence samples from asymptomatic individuals. We compared a total of 1248 SARS-CoV-2 full-genome sequences obtained from the SB Coronavirus Inspection Center Corp. (SBCVIC) during Japan's seventh wave, which was dominated by Omicron variants, with 1764 sequences obtained in Japan from GISAID during the same period using chronological phylogenies and molecular transmission networks. The number of SBCVIC sequences was consistent with the number of cases reported by NESID. The SBCVIC detected a shift in the PANGO lineage from BA.2 to BA.5 earlier than that of GISAID. BA.2 lineages from the SBCVIC were distributed at different locations in the transmission network dominated by GISAID entries, whereas BA.5 lineages from SBCVIC and GISAID often formed distinct subclusters. Test-based sentinel surveillance of asymptomatic individuals may be a more manageable approach compared to notifiable disease surveillance; however, it may not necessarily capture all infection populations throughout Japan.
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Affiliation(s)
- Teiichiro Shiino
- Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Junko S Takeuchi
- Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Hajime Ohyanagi
- Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Moto Kimura
- Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | | | - Masato Ikeda
- SB Coronavirus Inspection Center Corp., Tokyo, Japan
| | - Wataru Sugiura
- Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
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2
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Alcantara DMC, Dos Santos CM, Torres JM, Stutz C, Vieira CA, Moreira RMDS, Rodrigues R, Marcon GEB, Ferreira EDC, Mendes FML, Sarti ECFB, de Oliveira TF, Lemos EF, Andrade UV, Lichs GGDC, Demarchi LHF, Zardin MCSU, Gonçalves CCM, Guilhermino JDF, Fernandez ZDC. Long-term surveillance of SARS-CoV-2 in the school community from Campo Grande, Brazil. BMC Public Health 2024; 24:2057. [PMID: 39085807 PMCID: PMC11290088 DOI: 10.1186/s12889-024-19555-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: 02/27/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly impacted education systems worldwide, with Brazil being one of the countries with the longest school closures. Over a million children and teenagers have been affected, leading to increased hunger and nutritional deficiencies. This study aimed to implement long-term surveillance of SARS-CoV-2 infections in public and private schools in Campo Grande, Brazil, after returning to in-person classes. METHODS The study involved testing and genomic surveillance at 23 public and private schools in Campo Grande, Mato Grosso do Sul, Brazil, from October 18, 2021 to November 21, 2022. The participants eligible for enrollment were students aged 6-17 years and staff members from school institutions. At the time of collection, participants were asked if they had symptoms in the last two weeks. Whole-genome sequencing of SARS-CoV-2 was conducted to identify circulating variants and to compare them with those detected in the municipality. The demographic data and clinical history of the participants were described, and a logistic regression model was used to understand how the RT-qPCR results could be related to different characteristics. RESULTS The study included 999 participants, most of whom were women. A total of 85 tests were positive, with an overall positivity rate of 3.2%. The dynamics of case frequency were consistent with those observed in the municipality during the study period. The most common symptoms reported were cough, rhinorrhea, headache, and sore throat. Symptoms were significantly associated with SARS-CoV-2 infection. Eleven lineages were identified in school community samples, with a frequency of occurrence per period similar to that found in the sequences available for the municipality. The most prevalent lineages within the sampling period were BA.2 (59.3%) and BA.5 (29.6%). CONCLUSIONS Our findings demonstrate that schools can play a crucial role in epidemiological surveillance, helping trigger rapid responses to pathogens such as SARS-CoV-2. Long-term surveillance can be used to track outbreaks and assess the role of children and adults in transmission. It can also contribute to pandemic preparedness, enabling a rapid response to emergencies, such as COVID-19.
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Affiliation(s)
| | - Camila Maria Dos Santos
- FIOCRUZ Mato Grosso do Sul, Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil
| | - Jaire Marinho Torres
- FIOCRUZ Mato Grosso do Sul, Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil
| | - Claudia Stutz
- FIOCRUZ Mato Grosso do Sul, Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição (FACFAN), Fundação Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Camila Aoyama Vieira
- FIOCRUZ Mato Grosso do Sul, Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil
| | - Raissa Mariele Dos Santos Moreira
- Instituto Integrado de Saúde (INISA), Fundação Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Rudielle Rodrigues
- FIOCRUZ Mato Grosso do Sul, Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Eduardo de Castro Ferreira
- FIOCRUZ Mato Grosso do Sul, Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil
- Programa de Pós-graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina (FAMED), Fundação Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Flavia Maria Lins Mendes
- FIOCRUZ Mato Grosso do Sul, Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil
| | | | | | - Everton Ferreira Lemos
- Universidade Estadual de Mato Grosso do Sul (UEMS), Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Gislene Garcia de Castro Lichs
- Laboratório Central de Saúde Pública do Estado de Mato Grosso do Sul (LACEN/MS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Luiz Henrique Ferraz Demarchi
- Programa de Pós-graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina (FAMED), Fundação Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
- Laboratório Central de Saúde Pública do Estado de Mato Grosso do Sul (LACEN/MS), Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Crhistinne Cavalheiro Maymone Gonçalves
- Programa de Pós-graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina (FAMED), Fundação Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
- Secretaria de Estado de Saúde de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
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Loidl V, Klinc C, Fusiak J, Crispin A, Hoffmann VS, Nennstiel-Ratzel U, Mansmann U. [Results of PCR Pool Testing In Primary and Special Needs Schools In Bavaria For The School Year 2021/2022: Sentinel Surveillance In Face-To-Face Teaching During The Sars-CoV-2 Pandemic]. DAS GESUNDHEITSWESEN 2024; 86:237-246. [PMID: 38316408 PMCID: PMC11301650 DOI: 10.1055/a-2216-0139] [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] [Indexed: 02/07/2024]
Abstract
In the school years 2019/20 and 2020/21, children were physically, psychologically, and socially stressed by school closures caused by the SARS-CoV-2 pandemic. To ensure attendance with optimal infection protection, PCR pool testing was conducted during the 2021/22 school year at Bavarian elementary schools and schools for pupils with special needs for timely detection of SARS-CoV-2 infection. This study analyzes the results of PCR pool testing over time stratified by region, school type, and age of children. The data were obtained from classes in elementary and special needs schools, involving pupils aged 6 to 11 years, who participated in the Bavaria-wide PCR pool testing from 09/20/21 to 04/08/22. Samples were collected twice weekly, consisting of PCR pool samples and individual PCR samples, which were only evaluated in case of a positive pool test. A class was considered positive if at least one individual sample from that class was positive within a calendar week (CW). A school (class) was considered to be infection-prone if three or more classes in that school (students in that class) were positive within a CW. The data included 2,430 elementary schools (339 special needs schools) with 23,021 (2,711) classes and 456,478 (29,200) children. A total of 1,157,617 pools (of which 3.37% were positive) and 724,438 individual samples (6.76% positive) were analyzed. Larger schools exhibited higher PR compared to smaller schools. From January 2022, the Omicron variant led to a massive increase in PR across Bavaria. The incidence rates per 100,000 person-weeks within the individual school samples were significantly lower than the concurrently reported age-specific and general infection incidences in the overall Bavarian population. PCR pool testing revealed relatively few positive pools, with an average of four children per one hundred pools testing positive. Schools and classes were rarely considered infection-prone, even during periods of high incidences outside of schools. The combination of PCR pool testing and hygiene measures allowed for a largely safe in-person education for pupils in primary and special needs schools in the school year 2021/22.
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Affiliation(s)
- Verena Loidl
- Institut für Medizinische Informationsverarbeitung, Biometrie
und Epidemiologie (IBE), Ludwig-Maximilians-Universität München,
Medizinische Fakultät, München, Germany
- Pettenkofer School of Public Health,
Ludwig-Maximilians-Universität München, Medizinische
Fakultät, München, Germany
| | - Christina Klinc
- GP1, Bayerisches Landesamt für Gesundheit und
Lebensmittelsicherheit (LGL), Oberschleißheim, Germany
| | - Jakub Fusiak
- Institut für Medizinische Informationsverarbeitung, Biometrie
und Epidemiologie (IBE), Ludwig-Maximilians-Universität München,
Medizinische Fakultät, München, Germany
| | - Alexander Crispin
- Institut für Medizinische Informationsverarbeitung, Biometrie
und Epidemiologie (IBE), Ludwig-Maximilians-Universität München,
Medizinische Fakultät, München, Germany
| | - Verena Sophia Hoffmann
- Institut für Medizinische Informationsverarbeitung, Biometrie
und Epidemiologie (IBE), Ludwig-Maximilians-Universität München,
Medizinische Fakultät, München, Germany
| | - Uta Nennstiel-Ratzel
- GP1, Bayerisches Landesamt für Gesundheit und
Lebensmittelsicherheit (LGL), Oberschleißheim, Germany
| | - Ulrich Mansmann
- Institut für Medizinische Informationsverarbeitung, Biometrie
und Epidemiologie (IBE), Ludwig-Maximilians-Universität München,
Medizinische Fakultät, München, Germany
- Pettenkofer School of Public Health,
Ludwig-Maximilians-Universität München, Medizinische
Fakultät, München, Germany
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4
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Shope TR, Chedid K, Hashikawa AN, Martin ET, Sieber MA, Des Ruisseau G, Williams JV, Wheeler SE, Johnson M, Stiegler M, D’Agostino H, Balasubramani GK, Yahner KA, Wang-Erickson AF. Incidence and Transmission of SARS-CoV-2 in US Child Care Centers After COVID-19 Vaccines. JAMA Netw Open 2023; 6:e2339355. [PMID: 37874566 PMCID: PMC10599125 DOI: 10.1001/jamanetworkopen.2023.39355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/12/2023] [Indexed: 10/25/2023] Open
Abstract
Importance SARS-CoV-2 surveillance studies in US child care centers (CCCs) in the post-COVID-19 vaccine era are needed to provide information on incidence and transmission in this setting. Objective To characterize SARS-CoV-2 incidence and transmission in children attending CCCs (students) and their child care providers (CCPs) and household contacts. Design, Setting, and Participants This prospective surveillance cohort study was conducted from April 22, 2021, through March 31, 2022, and included 11 CCCs in 2 cities. A subset (surveillance group) of CCPs and students participated in active surveillance (weekly reverse transcription-polymerase chain reaction [RT-PCR] swabs, symptom diaries, and optional baseline and end-of-study SARS-CoV-2 serologic testing), as well as all household contacts of surveillance students. Child care center directors reported weekly deidentified self-reported COVID-19 cases from all CCPs and students (self-report group). Exposure SARS-CoV-2 infection in CCC students. Main Outcomes and Measures SARS-CoV-2 incidence, secondary attack rates, and transmission patterns were determined from diary entries, self-reports to CCC directors, and case logs. Incidence rate ratios were measured using Poisson regression clustering on centers with a random intercept and unstructured matrix. Results From a total population of 1154 students and 402 CCPs who self-reported cases to center directors, 83 students (7.2%; mean [SD] age, 3.86 [1.64] years; 55 male [66%]), their 134 household contacts (118 adults [mean (SD) age, 38.39 (5.07) years; 62 female (53%)], 16 children [mean (SD) age, 4.73 (3.37) years; 8 female (50%)]), and 21 CCPs (5.2%; mean [SD] age, 38.5 [12.9] years; 18 female [86%]) participated in weekly active surveillance. There were 154 student cases (13%) and 87 CCP cases (22%), as defined by positive SARS-CoV-2 RT-PCR or home antigen results. Surveillance students had a higher incidence rate than self-report students (incidence rate ratio, 1.9; 95% CI, 1.1-3.3; P = .01). Students were more likely than CCPs to have asymptomatic infection (34% vs 8%, P < .001). The CCC secondary attack rate was 2.7% to 3.0%, with the upper range representing possible but not definite secondary cases. Whether the index case was a student or CCP, transmission within the CCC was not significantly different. Household cumulative incidence was 20.5%, with no significant difference in incidence rate ratio between adults and children. Household secondary attack rates were 50% for children and 67% for adults. Of 30 household cases, only 5 (17%) represented secondary infections caused by 3 students who acquired SARS-CoV-2 from their CCC. Pre- and poststudy seroprevalence rates were 3% and 22%, respectively, with 90% concordance with antigen or RT-PCR results. Conclusions and Relevance In this study of SARS-CoV-2 incidence and transmission in CCCs and students' households, transmission within CCCs and from children infected at CCCs into households was low. These findings suggest that current testing and exclusion recommendations for SARS-CoV-2 in CCCs should be aligned with those for other respiratory viruses with similar morbidity and greater transmission to households.
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Affiliation(s)
- Timothy R. Shope
- Division of General Academic Pediatrics, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Khalil Chedid
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Andrew N. Hashikawa
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Emily T. Martin
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Mary Ann Sieber
- Division of General Academic Pediatrics, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Gabrielle Des Ruisseau
- Division of General Academic Pediatrics, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John V. Williams
- Division of Pediatric Infectious Diseases, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Institute for Infection, Inflammation, and Immunity in Children (i4kids), Pittsburgh, Pennsylvania
| | - Sarah E. Wheeler
- Department of Pathology, University of Pittsburgh School of Medicine, UPMC, Pittsburgh, Pennsylvania
| | - Monika Johnson
- Division of Pediatric Infectious Diseases, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Myla Stiegler
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - Helen D’Agostino
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | | | - Kristin A. Yahner
- Division of General Academic Pediatrics, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Anna F. Wang-Erickson
- Division of Pediatric Infectious Diseases, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Institute for Infection, Inflammation, and Immunity in Children (i4kids), Pittsburgh, Pennsylvania
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5
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Jank M, Oechsle AL, Armann J, Behrends U, Berner R, Chao CM, Diffloth N, Doenhardt M, Hansen G, Hufnagel M, Lander F, Liese JG, Muntau AC, Niehues T, von Both U, Verjans E, Weil K, von Kries R, Schroten H. Comparing SARS-CoV-2 variants among children and adolescents in Germany: relative risk of COVID-19-related hospitalization, ICU admission and mortality. Infection 2023; 51:1357-1367. [PMID: 36787015 PMCID: PMC9925936 DOI: 10.1007/s15010-023-01996-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/31/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE SARS-CoV-2 infections cause COVID-19 and have a wide spectrum of morbidity. Severe disease courses among children are rare. To date, data on the variability of morbidity in relation to variant of concern (VOC) in children has been sparse and inconclusive. We compare the clinical severity of SARS-CoV-2 infection among children and adolescents in Germany during the Wildtype and Alpha combined, Delta and Omicron phases of the COVID-19 pandemic. METHODS Comparing risk of COVID-19-related hospitalization, intensive care unit (ICU) admission and death due to COVID-19 in children and adolescents, we used: (1) a multi-center seroprevalence study (SARS-CoV-2-KIDS study); (2) a nationwide registry of pediatric patients hospitalized with SARS-CoV-2 infections; and (3) compulsory national reporting for RT-PCR-confirmed SARS-CoV-2 infections in Germany. RESULTS During the Delta predominant phase, risk of COVID-19-related hospitalization among all SARS-CoV-2 seropositive children was 3.35, ICU admission 1.19 and fatality 0.09 per 10,000; hence about halved for hospitalization and ICU admission and unchanged for deaths as compared to the Wildtype- and Alpha-dominant period. The relative risk for COVID-19-related hospitalization and ICU admission compared to the alpha period decreased during Delta [0.60 (95% CI 0.54; 0.67) and 0.51 (95% CI 0.42; 0.61)] and Omicron [0.27 (95% CI 0.24; 0.30) and 0.06 (95% CI 0.05; 0.08)] period except for the < 5-year-olds. The rate of case fatalities decreased slightly during Delta, and substantially during Omicron phase. CONCLUSION Morbidity caused by SARS-CoV-2 infections among children and adolescents in Germany decreased over the course of the COVID-19 pandemic, as different VOCs) emerged.
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Affiliation(s)
- Marietta Jank
- Department of Pediatrics, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
- Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Anna-Lisa Oechsle
- Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, 80336, Munich, Germany
| | - Jakob Armann
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Uta Behrends
- Department of Pediatrics, Faculty of Medicine, Technical University Munich, 80804, Munich, Germany
| | - Reinhard Berner
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Cho-Ming Chao
- Department of Pediatrics, Helios University Medical Center, Witten/Herdecke University, Heusnerstr. 40, 42283, Wuppertal, Germany
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Justus-Liebig University Giessen, Giessen, Germany
| | - Natalie Diffloth
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Maren Doenhardt
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Gesine Hansen
- Centre for Pediatrics and Adolescent Medicine, Hannover Medical School, Excellence Cluster RESIST, Deutsche Forschungsgemeinschaft (DFG), EXS 2155, 30625, Hannover, Germany
| | - Markus Hufnagel
- Department of Pediatrics and Adolescent Medicine, Medical Faculty, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Fabian Lander
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Johannes G Liese
- Division of Paediatric Infectious Diseases, Department of Pediatrics, University Hospital of Wuerzburg, 97080, Würzburg, Germany
| | - Ania C Muntau
- Medical Center Hamburg-Eppendorf, University Children's Hospital, Martinistrasse 52, 20246, Hamburg, Germany
| | - Tim Niehues
- Department of Pediatrics, Helios Klinikum Krefeld, 47805, Krefeld, Germany
| | - Ulrich von Both
- Dr von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, 80337, Munich, Germany
| | - Eva Verjans
- Department of Pediatrics, Medical Faculty, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Katharina Weil
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, Medical Faculty, University Hospital, Heinrich-Heine-University Düsseldorf, 40225, Düsseldorf, Germany
| | - Rüdiger von Kries
- Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, 80336, Munich, Germany
| | - Horst Schroten
- Department of Pediatrics, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Soriano-Arandes A, Brett A, Buonsenso D, Emilsson L, de la Fuente Garcia I, Gkentzi D, Helve O, Kepp KP, Mossberg M, Muka T, Munro A, Papan C, Perramon-Malavez A, Schaltz-Buchholzer F, Smeesters PR, Zimmermann P. Policies on children and schools during the SARS-CoV-2 pandemic in Western Europe. Front Public Health 2023; 11:1175444. [PMID: 37564427 PMCID: PMC10411527 DOI: 10.3389/fpubh.2023.1175444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/26/2023] [Indexed: 08/12/2023] Open
Abstract
During the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mitigation policies for children have been a topic of considerable uncertainty and debate. Although some children have co-morbidities which increase their risk for severe coronavirus disease (COVID-19), and complications such as multisystem inflammatory syndrome and long COVID, most children only get mild COVID-19. On the other hand, consistent evidence shows that mass mitigation measures had enormous adverse impacts on children. A central question can thus be posed: What amount of mitigation should children bear, in response to a disease that is disproportionally affecting older people? In this review, we analyze the distinct child versus adult epidemiology, policies, mitigation trade-offs and outcomes in children in Western Europe. The highly heterogenous European policies applied to children compared to adults did not lead to significant measurable differences in outcomes. Remarkably, the relative epidemiological importance of transmission from school-age children to other age groups remains uncertain, with current evidence suggesting that schools often follow, rather than lead, community transmission. Important learning points for future pandemics are summarized.
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Affiliation(s)
- Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ana Brett
- Infectious Diseases Unit and Emergency Service, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Milan, Italy
| | - Louise Emilsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Isabel de la Fuente Garcia
- Pediatric Infectious Diseases, National Pediatric Center, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Despoina Gkentzi
- Department of Paediatrics, Patras Medical School, Patras, Greece
| | - Otto Helve
- Department of Health Security, Institute for Health and Welfare, Helsinki, Finland
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Kasper P. Kepp
- Section of Biophysical and Biomedicinal Chemistry, DTU Chemistry, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Maria Mossberg
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Epistudia, Bern, Switzerland
| | - Alasdair Munro
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Faculty of Medicine, Institute of Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Cihan Papan
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Aida Perramon-Malavez
- Computational Biology and Complex Systems (BIOCOM-SC) Group, Department of Physics, Universitat Politècnica de Catalunya (UPC·BarcelonaTech), Barcelona, Spain
| | | | - Pierre R. Smeesters
- Department of Pediatrics, University Hospital Brussels, Academic Children’s Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Petra Zimmermann
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland
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7
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Fritz C, De Nicola G, Rave M, Weigert M, Khazaei Y, Berger U, Küchenhoff H, Kauermann G. Statistical modelling of COVID-19 data: Putting generalized additive models to work. STAT MODEL 2022. [DOI: 10.1177/1471082x221124628] [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]
Abstract
Over the course of the COVID-19 pandemic, Generalized Additive Models (GAMs) have been successfully employed on numerous occasions to obtain vital data-driven insights. In this article we further substantiate the success story of GAMs, demonstrating their flexibility by focusing on three relevant pandemic-related issues. First, we examine the interdepency among infections in different age groups, concentrating on school children. In this context, we derive the setting under which parameter estimates are independent of the (unknown) case-detection ratio, which plays an important role in COVID-19 surveillance data. Second, we model the incidence of hospitalizations, for which data is only available with a temporal delay. We illustrate how correcting for this reporting delay through a nowcasting procedure can be naturally incorporated into the GAM framework as an offset term. Third, we propose a multinomial model for the weekly occupancy of intensive care units (ICU), where we distinguish between the number of COVID-19 patients, other patients and vacant beds. With these three examples, we aim to showcase the practical and ‘off-the-shelf’ applicability of GAMs to gain new insights from real-world data.
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Affiliation(s)
- Cornelius Fritz
- Department of Statistics, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Giacomo De Nicola
- Department of Statistics, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Martje Rave
- Department of Statistics, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Maximilian Weigert
- Department of Statistics, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Yeganeh Khazaei
- Department of Statistics, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ursula Berger
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Helmut Küchenhoff
- Department of Statistics, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Göran Kauermann
- Department of Statistics, Ludwig-Maximilians-University Munich, Munich, Germany
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8
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Kern A, Kuhlmann PH, Matl S, Ege M, Maison N, Eckert J, von Both U, Behrends U, Anger M, Frühwald MC, Gerstlauer M, Woelfle J, Neubert A, Melter M, Liese J, Goettler D, Sing A, Liebl B, Hübner J, Klein C. Surveillance of Acute SARS-CoV-2 Infections in Elementary Schools and Daycare Facilities in Bavaria, Germany (09/2020-03/2021). Front Pediatr 2022; 10:888498. [PMID: 35874561 PMCID: PMC9298551 DOI: 10.3389/fped.2022.888498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Here we report our results of a multi-center, open cohort study ("COVID-Kids-Bavaria") investigating the distribution of acute SARS-CoV-2 infections among children and staff in 99 daycare facilities and 48 elementary schools in Bavaria, Germany. Materials and Methods Overall, 2,568 children (1,337 school children, 1,231 preschool children) and 1,288 adults (466 teachers, 822 daycare staff) consented to participate in the study and were randomly tested in three consecutive phases (September/October 2020, November/December 2020, March 2021). In total, 7,062 throat swabs were analyzed for SARS-CoV-2 by commercial RT-PCR kits. Results In phase I, only one daycare worker tested positive. In phase II, SARS-CoV-2 was detected in three daycare workers, two preschool children, and seven school children. In phase III, no sample tested positive. This corresponds to a positive test rate of 0.05% in phase I, 0.4% in phase II and 0% in phase III. Correlation of a positive PCR test result with the local-7-day incidence values showed a strong association of a 7-day-incidence of more than 100/100,000 as compared to <100/100,000 (OR = 10.3 [1.5-438], p < 0.005). After phase III, antibody testing was offered to 713 study participants in elementary schools. A seroprevalence rate of 7.7% (students) and 4.5% (teachers) was determined. Discussion During the initial waves of the SARS-CoV-2 pandemic, the risk of a positive SARS-CoV-2 result correlated positively with the local 7-day incidence. Hence, the occurrence of SARS-CoV-2 infections were reflected in schools and daycare facilities. An increased risk of SARS-CoV-2 transmission in the setting of daycare and elementary schooling was unlikely.
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Affiliation(s)
- Anna Kern
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany
| | - Pia H. Kuhlmann
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany
| | - Stefan Matl
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany
| | - Markus Ege
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Lung Research (DZL), Munich, Germany
| | - Nicole Maison
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Lung Research (DZL), Munich, Germany
- Helmholtz Center Munich, Institute for Asthma- and Allergy Prevention (IAP), German Research Center for Environmental Health (GmbH), Munich, Germany
| | - Jana Eckert
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany
| | - Ulrich von Both
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Uta Behrends
- Department of Pediatrics, Kinderklinik München Schwabing, StKM GmbH und Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Melanie Anger
- Department of Pediatrics, Kinderklinik München Schwabing, StKM GmbH und Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Michael C. Frühwald
- Paediatric and Adolescent Medicine University Hospital Augsburg, Augsburg, Germany
| | - Michael Gerstlauer
- Paediatric and Adolescent Medicine University Hospital Augsburg, Augsburg, Germany
| | - Joachim Woelfle
- Department of Paediatric and Adolescent Medicine, Erlangen University Hospital, Erlangen, Germany
| | - Antje Neubert
- Department of Paediatric and Adolescent Medicine, Erlangen University Hospital, Erlangen, Germany
| | - Michael Melter
- University Children's Hospital Regensburg (KUNO), Regensburg, Germany
| | - Johannes Liese
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - David Goettler
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Sing
- Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Bernhard Liebl
- Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Johannes Hübner
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany
| | - Christoph Klein
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany
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9
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Berger U, Fritz C, Kauermann G. [Mandatory Testing in Schools can Significantly Reduce Underreporting of COVID-19 Infections Among Students with in-Class Teaching Compared to Home Schooling]. DAS GESUNDHEITSWESEN 2022; 84:495-502. [PMID: 35675830 PMCID: PMC11248797 DOI: 10.1055/a-1813-9778] [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] [Indexed: 10/18/2022]
Abstract
Aim of the study The aim of this was to study investigate the effectiveness of mandatory Covid-19 tests for in-classroom teaching in reopened schools as a containment measure in the pandemic. In Bavaria, mandatory testing at schools was implemented directly after the Easter vacations in 2021. For the first week after the vacations, this resulted in a natural experiment that allowed us to quantify the impact of the new testing strategy on reported Covid-19 cases.Methods We compared changes in the reported 7-day incidence of new infections between districts with in-classroom teaching at school and districts with closed schools. During the calendar week 15, districts with reported incidences below 100 were allowed to reopen schools and have in-classroom teaching if mandatory COVID-19 testing was performed at school with rapid antigen tests. We do not have data on the rapid test results; however, positive test results in the rapid antigen test were verified by a PCR test, and cases of positive PCR test results were reported at the district level by age groups. In the calendar weeks 13 and 14, all schools in Bavaria were closed due to Easter vacations. Taking into account a latency period of about 3-4 days and a reporting period of 1-2 days, this means that any additional increase in reported incidences for districts with in-class teaching and mandatory testing in the week after the vacation cannot be attributed to transmissions at schools, but reflects the reduction of underreporting due to the newly implemented testing strategy.Results Reported incidence increased by a factor of 6.6 for 5-11 year old and by 1.7 for 12-20 year old pupils in districts with in-classroom teaching and mandatory testing at schools. This increase was accompanied by a reduction in underreporting and was significant compared to districts with school closure. Given the situation of a natural experiment, this increase in the reported incidence among school children can be attributed to the testing strategy. For the same time period, no differences in reported incidences were found for the other age groups.Conclusion In-class teaching with mandatory testing in reopened schools changes the role of schools in the pandemic. Our analyses show that reopening schools with a mandatory testing approach is beneficial from an epidemiologic perspective as it can strongly reduce the dark figure of COVID-19 cases among children.
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Affiliation(s)
- Ursula Berger
- IBE – Institute for Medical Information Processing, Biometry
and Epidemiology, Ludwig-Maximilians-Universität München,
Munchen, Germany
| | - Cornelius Fritz
- Statistik, LMU München Fakultät für Mathematik
Informatik und Statistik, Munchen, Germany
| | - Göran Kauermann
- Statistik, LMU München Fakultät für Mathematik
Informatik und Statistik, Munchen, Germany
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10
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Maison N, Peck A, Illi S, Meyer-Buehn M, von Mutius E, Hübner J, von Both U. The rising of old foes: impact of lockdown periods on "non-SARS-CoV-2" viral respiratory and gastrointestinal infections. Infection 2022; 50:519-524. [PMID: 35076891 PMCID: PMC8787179 DOI: 10.1007/s15010-022-01756-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/10/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND During COVID-19-related public health non-pharmaceutical prevention measures, such as social distancing, lockdown periods and use of face masks, a decrease in viral respiratory and gastroenterological infections was observed worldwide. Following discontinuation of preventative measures, a potential increase of respective infections outside of their usual seasons was a matter of concern. METHOD We aimed to illustrate annual distribution of confirmed viral infections between 2017 and 2021 based on 32,506 clinical samples in a German pediatric tertiary care center and to explore the impact of the COVID-19 pandemic on the epidemiology of these infections in children. RESULTS While a decrease in overall viral infections was observed during the first and second lockdown period, an extraordinary increase in the number of viral respiratory infections, predominantly caused by human Rhino-/Enterovirus and respiratory syncytial virus (RSV), was observed after relaxation of preventive measures. Notably, Rhino-/Enterovirus infections increased 4-fold (2020 vs. 2019) and 16-fold (2021 vs. 2019). The occurrence of RSV was observed beginning from June to August 2021 and reached an all-time record with a 25- to 50-fold increase in numbers in September and October 2021 in relation to previous pre-pandemic years (2017-2019). In contrast, for non-respiratory viruses (i.e. Rota-/Norovirus), the effect on respective seasonal patterns was only minimal compared to previous years. CONCLUSION The observed increase in respiratory infections in children is worrying and is already causing hospitals to become overburdened. Enhanced vigilance will be key to face clinical challenges due to these epidemiological changes in viral disease patterns in the months to come.
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Affiliation(s)
- Nicole Maison
- Department for Asthma and Allergy, Dr Von Hauner Children's Hospital, Ludwig Maximilians University, Lindwurmstr. 4, 80337, Munich, Germany.
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Center Munich, German Research Center for Environmental Health (GmbH), Munich, Germany.
- German Center for Lung Research (DZL), Munich, Germany.
| | - Ana Peck
- Department for Asthma and Allergy, Dr Von Hauner Children's Hospital, Ludwig Maximilians University, Lindwurmstr. 4, 80337, Munich, Germany
| | - Sabina Illi
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Center Munich, German Research Center for Environmental Health (GmbH), Munich, Germany
- German Center for Lung Research (DZL), Munich, Germany
| | - Melanie Meyer-Buehn
- Department of Infectious Diseases, Dr Von Hauner Children's Hospital, LMU University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Erika von Mutius
- Department for Asthma and Allergy, Dr Von Hauner Children's Hospital, Ludwig Maximilians University, Lindwurmstr. 4, 80337, Munich, Germany
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Center Munich, German Research Center for Environmental Health (GmbH), Munich, Germany
- German Center for Lung Research (DZL), Munich, Germany
| | - Johannes Hübner
- Department of Infectious Diseases, Dr Von Hauner Children's Hospital, LMU University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Ulrich von Both
- Department of Infectious Diseases, Dr Von Hauner Children's Hospital, LMU University Hospital, Ludwig Maximilians University, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
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11
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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 2022; 84:361-382. [PMID: 34953911 PMCID: PMC8694793 DOI: 10.1016/j.jinf.2021.12.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [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 to 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, United Kingdom.
| | | | | | | | - Joana Cruz
- Population, Policy and Practice, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - Joseph Ward
- Population, Policy and Practice, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | | | | | - Chris Bonell
- London School of Hygiene and Tropical Medicine, United Kingdom
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12
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Vogel S, von Both U, Nowak E, Ludwig J, Köhler A, Lee N, Dick E, Rack-Hoch A, Wicklein B, Neusser J, Wagner T, Schubö A, Ustinov M, Schimana W, Busche S, Kolberg L, Hoch M. SARS-CoV-2 Saliva Mass Screening in Primary Schools: A 10-Week Sentinel Surveillance Study in Munich, Germany. Diagnostics (Basel) 2022; 12:162. [PMID: 35054329 PMCID: PMC8774979 DOI: 10.3390/diagnostics12010162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 12/12/2022] Open
Abstract
Representative, actively collected surveillance data on asymptomatic SARS-CoV-2 infections in primary schoolchildren remain scarce. We evaluated the feasibility of a saliva mass screening concept and assessed infectious activity in primary schools. During a 10-week period from 3 March to 21 May 2021, schoolchildren and staff from 17 primary schools in Munich participated in the sentinel surveillance, cohort study. Participants were tested using the Salivette® system, testing was supervised by trained school staff, and samples were processed via reverse transcription quantitative polymerase chain reaction (RT-qPCR). We included 4433 participants: 3752 children (median age, 8 [range, 6-13] years; 1926 girls [51%]) and 681 staff members (median age, 41 [range, 14-71] years; 592 women [87%]). In total, 23,905 samples were processed (4640 from staff), with participants representing 8.3% of all primary schoolchildren in Munich. Only eight cases were detected: Five out of 3752 participating children (0.13%) and three out of 681 staff members (0.44%). There were no secondary cases. In conclusion, supervised Salivette® self-sampling was feasible, reliable, and safe and thus constituted an ideal method for SARS-CoV-2 mass screenings in primary schoolchildren. Our findings suggest that infectious activity among asymptomatic primary schoolchildren and staff was low. Primary schools appear to continue to play a minor role in the spread of SARS-CoV-2 despite high community incidence rates.
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Affiliation(s)
- Sebastian Vogel
- Department Task Force Infectious Diseases, Bavarian Health and Food Safety Authority, Lazarettstrasse 67, 80636 Munich, Germany; (E.N.); (J.L.); (A.K.); (N.L.); (E.D.); (B.W.); (J.N.); (T.W.); (A.S.); (M.U.); (M.H.)
| | - Ulrich von Both
- Dr. von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilians-University, Lindwurmstrasse 4, 80337 Munich, Germany; (U.v.B.); (A.R.-H.); (L.K.)
- German Center for Infection Research (DZIF), Partner Site Munich, 80337 Munich, Germany
| | - Elisabeth Nowak
- Department Task Force Infectious Diseases, Bavarian Health and Food Safety Authority, Lazarettstrasse 67, 80636 Munich, Germany; (E.N.); (J.L.); (A.K.); (N.L.); (E.D.); (B.W.); (J.N.); (T.W.); (A.S.); (M.U.); (M.H.)
- Dr. von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilians-University, Lindwurmstrasse 4, 80337 Munich, Germany; (U.v.B.); (A.R.-H.); (L.K.)
| | - Janina Ludwig
- Department Task Force Infectious Diseases, Bavarian Health and Food Safety Authority, Lazarettstrasse 67, 80636 Munich, Germany; (E.N.); (J.L.); (A.K.); (N.L.); (E.D.); (B.W.); (J.N.); (T.W.); (A.S.); (M.U.); (M.H.)
| | - Alexandra Köhler
- Department Task Force Infectious Diseases, Bavarian Health and Food Safety Authority, Lazarettstrasse 67, 80636 Munich, Germany; (E.N.); (J.L.); (A.K.); (N.L.); (E.D.); (B.W.); (J.N.); (T.W.); (A.S.); (M.U.); (M.H.)
| | - Noah Lee
- Department Task Force Infectious Diseases, Bavarian Health and Food Safety Authority, Lazarettstrasse 67, 80636 Munich, Germany; (E.N.); (J.L.); (A.K.); (N.L.); (E.D.); (B.W.); (J.N.); (T.W.); (A.S.); (M.U.); (M.H.)
| | - Elisabeth Dick
- Department Task Force Infectious Diseases, Bavarian Health and Food Safety Authority, Lazarettstrasse 67, 80636 Munich, Germany; (E.N.); (J.L.); (A.K.); (N.L.); (E.D.); (B.W.); (J.N.); (T.W.); (A.S.); (M.U.); (M.H.)
- Dr. von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilians-University, Lindwurmstrasse 4, 80337 Munich, Germany; (U.v.B.); (A.R.-H.); (L.K.)
| | - Anita Rack-Hoch
- Dr. von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilians-University, Lindwurmstrasse 4, 80337 Munich, Germany; (U.v.B.); (A.R.-H.); (L.K.)
| | - Bernd Wicklein
- Department Task Force Infectious Diseases, Bavarian Health and Food Safety Authority, Lazarettstrasse 67, 80636 Munich, Germany; (E.N.); (J.L.); (A.K.); (N.L.); (E.D.); (B.W.); (J.N.); (T.W.); (A.S.); (M.U.); (M.H.)
| | - Jessica Neusser
- Department Task Force Infectious Diseases, Bavarian Health and Food Safety Authority, Lazarettstrasse 67, 80636 Munich, Germany; (E.N.); (J.L.); (A.K.); (N.L.); (E.D.); (B.W.); (J.N.); (T.W.); (A.S.); (M.U.); (M.H.)
| | - Tobias Wagner
- Department Task Force Infectious Diseases, Bavarian Health and Food Safety Authority, Lazarettstrasse 67, 80636 Munich, Germany; (E.N.); (J.L.); (A.K.); (N.L.); (E.D.); (B.W.); (J.N.); (T.W.); (A.S.); (M.U.); (M.H.)
| | - Alexandra Schubö
- Department Task Force Infectious Diseases, Bavarian Health and Food Safety Authority, Lazarettstrasse 67, 80636 Munich, Germany; (E.N.); (J.L.); (A.K.); (N.L.); (E.D.); (B.W.); (J.N.); (T.W.); (A.S.); (M.U.); (M.H.)
| | - Maxim Ustinov
- Department Task Force Infectious Diseases, Bavarian Health and Food Safety Authority, Lazarettstrasse 67, 80636 Munich, Germany; (E.N.); (J.L.); (A.K.); (N.L.); (E.D.); (B.W.); (J.N.); (T.W.); (A.S.); (M.U.); (M.H.)
| | - Werner Schimana
- Gesundheitsreferat Stadt München (GSR)/Public Health Department Munich, 80335 Munich, Germany;
| | | | - Laura Kolberg
- Dr. von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilians-University, Lindwurmstrasse 4, 80337 Munich, Germany; (U.v.B.); (A.R.-H.); (L.K.)
| | - Martin Hoch
- Department Task Force Infectious Diseases, Bavarian Health and Food Safety Authority, Lazarettstrasse 67, 80636 Munich, Germany; (E.N.); (J.L.); (A.K.); (N.L.); (E.D.); (B.W.); (J.N.); (T.W.); (A.S.); (M.U.); (M.H.)
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Nakel J, Robitaille A, Günther T, Rosenau L, Czech-Sioli M, Plenge-Bönig A, Bühler S, Wille A, Jakubowski E, Pruskil S, Wahlen M, Indenbirken D, Nörz D, Lütgehetmann M, Aepfelbacher M, Grundhoff A, Grolle B, Fischer N. Comparing susceptibility and contagiousness in concurrent outbreaks with a non-VOC and the VOC SARS-CoV-2 variant B.1.1.7 in daycare centers in Hamburg, Germany. Int J Hyg Environ Health 2022; 240:113928. [PMID: 35093719 PMCID: PMC8784653 DOI: 10.1016/j.ijheh.2022.113928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 12/03/2022]
Abstract
We describe two outbreaks of SARS-CoV-2 in daycare centers in the metropolitan area of Hamburg, Germany. The outbreaks occurred in rapid chronological succession, in neighborhoods with a very similar sociodemographic structure, thus allowing for cross-comparison of these events. We combined classical and molecular epidemiologic investigation methods to study infection entry, spread within the facilities, and subsequent transmission of infections to households. Epidemiologic and molecular evidence suggests a superspreading event with a non-variant of concern (non-VOC) SARS CoV-2 strain at the root of the first outbreak. The second outbreak involved two childcare facilities experiencing infection activity with the variant of concern (VOC) B.1.1.7 (Alpha). We show that the index cases in all outbreaks had been childcare workers, and that children contributed substantially to secondary transmission of SARS-CoV-2 infection from childcare facilities to households. The frequency of secondary transmissions in households originating from B.1.1.7-infected children was increased compared to children with non-VOC infections. Self-reported symptoms, particularly cough and rhinitis, occurred more frequently in B.1.1.7-infected children. Especially in light of the rapidly spreading VOC B.1.617.2 (Delta), our data underline the notion that rigorous SARS-CoV-2 testing in combination with screening of contacts regardless of symptoms is an important measure to prevent SARS-CoV-2 infection of unvaccinated individuals in daycare centers and associated households.
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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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15
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Lücker P, Ehmke M, Rabes A, Emmerich AS, Kästner A, Reisinger EC, Hoffmann W, Sombetzki M. [Challenges of the COVID-19 Pandemic for Schools in Mecklenburg-Vorpommern - First Results of a Prospective Case Study]. DAS GESUNDHEITSWESEN 2021; 83:890-893. [PMID: 34571553 PMCID: PMC11248191 DOI: 10.1055/a-1630-7707] [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] [Indexed: 10/20/2022]
Abstract
BACKGROUND The current risk of infection with SARS-CoV-2 in schools continues to be a subject of controversy. METHODOLOGY "schugi-MV" collects data on the incidence of infection, hygiene management and other factors in structured inspections of schools in Mecklenburg-Western Pomerania. Recommendations for safe teaching are to be derived from the results. This article presents information on the first 10 schools visited between 18.12.2020 and 20.01.2021. RESULTS At the schools visited, the ratio of the number of index cases among adults and children was 1:1.25. The inspections showed a great heterogeneity of schools and school buildings and the resulting possibilities for implementing infection control measures. CONCLUSION Based on the present preliminary results, hygiene and infection control measures at schools in Mecklenburg-Western Pomerania cannot be standardised, but should leave room for design.
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Affiliation(s)
- Petra Lücker
- Institut für Community Medicine, Universitätsmedizin
Greifswald, Greifswald, Deutschland
| | - Manja Ehmke
- Abt. für Tropenmedizin und Infektionskrankheiten und Sektion
Nephrologie, Universitätsmedizin Rostock Zentrum für Innere
Medizin, Rostock, Deutschland
| | - Anne Rabes
- Abt. für Tropenmedizin und Infektionskrankheiten und Sektion
Nephrologie, Universitätsmedizin Rostock Zentrum für Innere
Medizin, Rostock, Deutschland
| | - Anna-Sabina Emmerich
- Abt. für Tropenmedizin und Infektionskrankheiten und Sektion
Nephrologie, Universitätsmedizin Rostock Zentrum für Innere
Medizin, Rostock, Deutschland
| | - Anika Kästner
- Institut für Community Medicine, Universitätsmedizin
Greifswald, Greifswald, Deutschland
| | - Emil C. Reisinger
- Abt. für Tropenmedizin und Infektionskrankheiten und Sektion
Nephrologie, Universitätsmedizin Rostock Zentrum für Innere
Medizin, Rostock, Deutschland
| | - Wolfgang Hoffmann
- Institut für Community Medicine, Universität
Greifswald, Greifswald, Deutschland
| | - Martina Sombetzki
- Abt. für Tropenmedizin und Infektionskrankheiten und Sektion
Nephrologie, Universitätsmedizin Rostock Zentrum für Innere
Medizin, Rostock, Deutschland
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16
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Feasibility and Diagnostic Accuracy of Saliva-Based SARS-CoV-2 Screening in Educational Settings and Children Aged <12 Years. Diagnostics (Basel) 2021; 11:diagnostics11101797. [PMID: 34679495 PMCID: PMC8534592 DOI: 10.3390/diagnostics11101797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 01/04/2023] Open
Abstract
Children have been disproportionately affected during the COVID-19 pandemic. We aimed to assess a saliva-based algorithm for SARS-CoV-2 testing to be used in schools and childcare institutions under pandemic conditions. A weekly SARS-CoV-2 sentinel study in primary schools, kindergartens, and childcare facilities was conducted over a 12-week-period. In a sub-study covering 7 weeks, 1895 paired oropharyngeal and saliva samples were processed for SARS-CoV-2 rRT-PCR testing in both asymptomatic children (n = 1243) and staff (n = 652). Forty-nine additional concurrent swab and saliva samples were collected from SARS-CoV-2 infected patients (patient cohort). The Salivette® system was used for saliva collection and assessed for feasibility and diagnostic performance. For children, a mean of 1.18 mL saliva could be obtained. Based on results from both cohorts, the Salivette® testing algorithm demonstrated the specificity of 100% (95% CI 99.7–100) and sensitivity of 94.9% (95% CI 81.4–99.1) with oropharyngeal swabs as reference. Agreement between sampling systems was 100% for moderate to high viral load situations (defined as Ct-values <33 from oropharyngeal swabs). Comparative analysis of Ct-values derived from saliva vs. oropharyngeal swabs demonstrated a significant difference (mean 4.23; 95% CI 2.48–6.00). In conclusion, the Salivette® system proved to be an easy-to-use, safe and feasible saliva collection method and a more pleasant alternative to oropharyngeal swabs for SARS-CoV-2 testing in children aged 3 years and above.
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17
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Guenver C, Oualha M, Levy C, Antona D, Madhi F, Toubiana J, Lachaume N, Javouhey E, Lorrot M, Yang DD, Levy M, Caseris M, Galeotti C, Ovaert C, Wiedemann A, Girardin ML, Rybak A, Cohen R, Belot A, Angoulvant F, Ouldali N. Educational Setting and SARS-CoV-2 Transmission Among Children With Multisystem Inflammatory Syndrome: A French National Surveillance System. Front Pediatr 2021; 9:745364. [PMID: 34765576 PMCID: PMC8576449 DOI: 10.3389/fped.2021.745364] [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: 07/21/2021] [Accepted: 09/29/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Multisystem inflammatory syndrome in children (MIS-C) is the most severe form associated with SARS-CoV-2 infection in children. To reduce the spread of SARS-CoV-2 at the population level, educational setting closure have been implemented in many countries. However, the direct benefit of school closure on the MIS-C burden remains to be explored. We aimed to assess the role of educational settings in SARS-CoV-2 transmission among children with MIS-C. Methods: We conducted a French national prospective surveillance of MIS-C, coordinated by Public Health France, from April 2020 to March 2021. During this period, we included all children with MIS-C fulfilling the WHO definition who were reported to Public Health France. For each child, we traced the source of SARS-CoV-2 transmission. The main outcome was the proportion of children with MIS-C, with educational setting-related SARS-CoV-2 infection, during the period of school opening. Results: We included 142 children fulfilling WHO criteria for MIS-C: 104 (70%) cases occurred during school opening periods. In total, 62/104 children (60%, 95%CI [50; 69]) had been contaminated by a household contact and 5/104 in educational settings (5%, 95%CI [2; 11]). Among children with MIS-C occurring during school closure periods, the proportion of household transmission remained similar (66%, 25/38). Conclusion: Children with MIS-C were mainly infected by SARS-CoV-2 within their family environment, and the educational setting played a marginal role in this transmission. This suggests that mitigating school attendance may not reduce substantially the burden of MIS-C.
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Affiliation(s)
- Celia Guenver
- Assistance Publique-Hôpitaux de Paris, Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France.,Sorbonne Université, Université de Paris, Paris, France
| | - Mehdi Oualha
- Assistance Publique-Hôpitaux de Paris, Paediatric Intensive Care Unit, Necker-Enfants Malades University Hospital, Université de Paris, Paris, France
| | - Corinne Levy
- Centre Hospitalier Intercommunal, Research Centre, Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
| | - Denise Antona
- Santé Publique France, Agence nationale de Santé publique, Saint-Maurice, France
| | - Fouad Madhi
- Centre Hospitalier Intercommunal, Paediatric Department, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Julie Toubiana
- Assistance Publique-Hôpitaux de Paris, Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants-Malades University Hospital, Université de Paris, Paris, France.,Institut Pasteur, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Noémie Lachaume
- Assistance Publique-Hôpitaux de Paris, Paediatric Emergency Department, Louis Mourier University Hospital, Colombes, France
| | - Etienne Javouhey
- Hospices Civils de Lyon, Paediatric Intensive Care Unit, Hopital Femme, Mère Enfant, University of Lyon, Le Born, France.,EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", University Claude Bernard Lyon 1, Hospices Civils of Lyon, Lyon, France
| | - Mathie Lorrot
- Assistance Publique-Hôpitaux de Paris, Department of General Paediatric, Armand Trousseau University Hospital, Sorbonne Université, Paris, France
| | - David Dawei Yang
- Assistance Publique-Hôpitaux de Paris, Paediatric Emergency Department, Necker-Enfants Malades University Hospital, Université de Paris, Paris, France
| | - Michael Levy
- Assistance Publique-Hôpitaux de Paris, Paediatric Intensive Care Unit, Robert Debré University Hospital, Université de Paris, Paris, France
| | - Marion Caseris
- Assistance Publique-Hôpitaux de Paris, Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France
| | - Caroline Galeotti
- Assistance Publique-Hôpitaux de Paris, Department of Paediatric Rheumatology, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Bicêtre University hospital, Université de Paris Saclay, Le Kremlin-Bicêtre, France
| | - Caroline Ovaert
- Assistance Publique-Hôpitaux de Marseille, Paediatric and Congenital Cardiology, Timone Hospital Marseille, University Hospital, Marseille, France.,INSERM, Marseille Medical Genetics, UMR 1251, Aix Marseille Université, Marseille, France
| | - Arnaud Wiedemann
- Children's Hospital, University Hospital of Nancy, Paediatric Department, Université de Lorraine, Vandoeuvre les Nancy, France.,INSERM UMRS 1256 NGERE, Nutrition, Genetics, and Environmental Risk Exposure, National Center of Inborn Errors of Metabolism, Université de Lorraine, Vandoeuvre les Nancy, France
| | - Marie-Laure Girardin
- Strasbourg University Hospital, Paediatric Intensive Care Unit, Hautepierre University Hospital, Strasbourg, France
| | - Alexis Rybak
- Assistance Publique-Hôpitaux de Paris, Pediatric Emergency Department, Robert Debré University Hospital, Université de Paris, Paris, France
| | - Robert Cohen
- Centre Hospitalier Intercommunal, Research Centre, Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
| | - Alexandre Belot
- Hospices Civils de Lyon, Paediatric Nephrology, Rheumatology, Dermatology, Hopital Femme, Mère Enfant, & Centre International de Recherche en Infectiologie/INSERM U1111, Bron, France
| | - François Angoulvant
- Assistance Publique-Hôpitaux de Paris, Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France.,INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Sorbonne Université, Université de Paris, Paris, France
| | - Naïm Ouldali
- Assistance Publique-Hôpitaux de Paris, Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France.,ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,Université de Paris, INSERM UMR 1123, ECEVE, Paris, France
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