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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 DOI: 10.1055/a-2216-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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Lampl BMJ, Schöberl P, Atzenbeck N, Erdl M, Dillitzer N, Wallbrecher J, Weigl M, Sauer M, Kheiroddin P, Niggel J, Mauerer R, Ambrosch A, Kabesch M. Effects of infection control measures towards preventing SARS-CoV-2 outbreaks in a German choir boarding school from March 2020 to April 2022. Front Pediatr 2023; 11:1215678. [PMID: 37614901 PMCID: PMC10442800 DOI: 10.3389/fped.2023.1215678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023] Open
Abstract
Background Singing in a choir was associated with larger outbreaks in the beginning of the SARS-CoV-2 pandemic. Materials and methods We report on the effect and acceptance of various infection control measures on the occurrence of SARS-CoV-2 infections in the world famous Domspatzen boys' choir from March 2020 to April 2022. Results In addition to basic general hygiene measures, systematic rRT-PCR testing and scientifically approved concepts of distancing during singing were applied. While single infections of choir members could not be avoided, singing-related outbreaks were not observed. Until the Omicron variant emerged, potential transmission of SARS-CoV-2 in the school was limited to only one case. Incidences at the school were never higher than in the comparable general population until then. While the impact of the pandemic on daily life and singing was rated as severe, especially by staff members, most students agreed with the usefulness of protection measures and rated them as acceptable. Students viewed regular testing as the most important tool to increase safety in the school. Discussion A bundle of infection control measures including regular testing can prevent outbreaks of SARS-CoV-2 even in the setting of choir singing. Measures are acceptable for choir members if they allow to continue with singing and performing.
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Affiliation(s)
- Benedikt M. J. Lampl
- Division of Infection Control and Prevention, Regensburg Department of Public Health, Regensburg, Germany
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Patricia Schöberl
- University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | | | | | | | | | | | | | - Parastoo Kheiroddin
- University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | | | | | - Andreas Ambrosch
- Institute of Laboratory Medicine, Microbiology and Hygiene, Hospital of the Order of St. John, Regensburg, Germany
| | - Michael Kabesch
- University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
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Gruendl M, Kheiroddin P, Althammer M, Schöberl P, Rohrmanstorfer R, Wallerstorfer D, Ambrosch A, Kabesch M. Analysis of COVID-19 Infection Chains in a School Setting: Data From a School-Based rRT-PCR-Gargle Pool Test System. Disaster Med Public Health Prep 2023; 17:e312. [PMID: 36789767 PMCID: PMC9947041 DOI: 10.1017/dmp.2022.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND School testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was implemented in some countries to monitor and prevent SARS-CoV-2 transmissions. Here, we analyze infection chains in primary schools and household members of infected students based on systematic real-time reverse-transcriptase polymerase-chain-reaction (rRT-PCR)-gargle pool testing. METHODS Students and school staff (N = 4300) of all 38 primary schools in the rural county of Cham, Germany, were tested twice per week with a gargle pool rRT-PCR system from April to July of 2021. Infection chains of all 8 positive cases identified by school testing were followed up. RESULTS In total, 8 positive cases were found by gargle pool PCR testing based on 96,764 school tests. While no transmissions occurred in the school setting, 20 of 27 household members of the 8 cases tested positive. The overall attack rate was 74.1% in families. CONCLUSIONS No school outbreaks occurred during the study period. All cases but 1 were initially picked up by school testing. No transmission from school to families was observed.
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Affiliation(s)
- Magdalena Gruendl
- Public Health Office, Cham, Germany
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John and the University of Regensburg, Regensburg, Germany
| | - Parastoo Kheiroddin
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John and the University of Regensburg, Regensburg, Germany
| | - Michael Althammer
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John and the University of Regensburg, Regensburg, Germany
| | - Patricia Schöberl
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John and the University of Regensburg, Regensburg, Germany
- Member of the Science and Innovation Campus Regensburg (WECARE) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | | | | | - Andreas Ambrosch
- Institute of Laboratory Medicine, Microbiology and Hygiene, Hospital of the Order of St. John, Regensburg, Germany
| | - Michael Kabesch
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John and the University of Regensburg, Regensburg, Germany
- Member of the Science and Innovation Campus Regensburg (WECARE) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
- Corresponding author: Michael Kabesch,
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Quantitative analysis of different respiratory specimens on two automated test systems for detection of SARS-CoV-2 RNA. Diagn Microbiol Infect Dis 2023; 105:115800. [PMID: 36252283 PMCID: PMC9411103 DOI: 10.1016/j.diagmicrobio.2022.115800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/12/2022] [Accepted: 08/20/2022] [Indexed: 12/04/2022]
Abstract
Molecular testing of SARS-CoV-2 RNA is essential during the pandemic. Here, we compared the results of different respiratory specimens including anterior nasal swabs, pharyngeal swabs, saliva swabs, and gargle lavage samples to nasopharyngeal swabs on two automated SARS-CoV-2 test systems. Samples were collected and tested simultaneously from a total of 36 hospitalized symptomatic COVID-19 patients. Detection and quantification of SARS-CoV-2 was performed on cobas®6800 (Roche) and NeuMoDx™ (Qiagen) systems. Both assays showed reliable detection and quantification of SARS-CoV-2 RNA, with nasopharyngeal swabs showing the highest sensitivity. SARS-CoV-2 RNA concentrations in other respiratory specimens were lower (mean 2.5 log10 copies/ml) or even undetectable in up to 20%. These data clearly indicate that not all respiratory materials are equally suitable for the management of hospitalized patients, especially, in the late phase of COVID-19, when the viral phase subsides and inflammation becomes the predominant factor, making detection of even lower viral loads increasingly important.
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Bertram R, Grebenstein L, Gualdi S, Seibold B, Birkmann R, Korn K, Bisping J, Schabik R. Detection of asymptomatic SARS-CoV-2 infections in daycare centers, schools, and companies for regional pandemic containment by a PCR testing laboratory cooperative between July 2021 and June 2022. GMS HYGIENE AND INFECTION CONTROL 2022; 17:Doc22. [PMID: 36570819 PMCID: PMC9761790 DOI: 10.3205/dgkh000425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
As an important element in the regional containment of the COVID-19 pandemic a PCR testing laboratory with a cooperative character was founded in spring 2021 to screen for SARS-CoV-2 in the Nuremberg region, Germany. The aim was to detect asymptomatic infections in day care facilities for children, schools, and companies. The laboratory used an established RT-PCR protocol and analyzed approximately 18,500 pools of up to 25 pooled samples each from gargles or swabs ("lollipops") from up to 135 facilities between July 2021 and June 2022. Usually, the participating facilities were informed about positive pools within a few hours. Retention samples from positive pools were usually analyzed on the same day, and the results were reported to the facilities as well as the German Electronic Reporting and Information System (DEMIS). In the laboratory results, both the local incidences and the transition from the Delta- to the Omicron surge in early 2022 were well reflected. It is plausible that about 4,800 secondary infections could be prevented from the approximately 1,570 positive individual samples detected in conjunction with appropriate isolation measures. Such a PCR laboratory, which is characterized by short response times and high flexibility, can thus provide valuable services for regional surveillance of infection incidence.
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Affiliation(s)
- Ralph Bertram
- Klinikum Nürnberg, Universitätsinstitut für Klinikhygiene, Medizinische Mikrobiologie und Klinische Infektiologie, Paracelsus Medizinische Privatuniversität, Nürnberg, Germany,Wirtschaftskraft Nürnberger Land GmbH, Lauf a.d. Pegnitz, Germany
| | | | - Stefanie Gualdi
- Wirtschaftskraft Nürnberger Land GmbH, Lauf a.d. Pegnitz, Germany
| | - Bernd Seibold
- Wirtschaftskraft Nürnberger Land GmbH, Lauf a.d. Pegnitz, Germany
| | - Ralf Birkmann
- Bisping & Bisping GmbH & Co. KG, Lauf a.d. Pegnitz, Germany
| | - Klaus Korn
- Universitätsklinikum Erlangen, Virologisches Institut, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Gremany
| | - Johannes Bisping
- Wirtschaftskraft Nürnberger Land GmbH, Lauf a.d. Pegnitz, Germany,Bisping & Bisping GmbH & Co. KG, Lauf a.d. Pegnitz, Germany
| | - Ralf Schabik
- Wirtschaftskraft Nürnberger Land GmbH, Lauf a.d. Pegnitz, Germany,A.S.S. Apotheker. Service. Schabik., Altdorf bei Nürnberg, Germany,*To whom correspondence should be addressed: Ralf Schabik, Wirtschaftskraft Nürnberger Land GmbH, Oskar-Sembach-Ring 10, 91207 Lauf a.d. Pegnitz, Germany, Phone: +49 9123 1573 961, E-mail:
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Kästner A, Lücker P, Sombetzki M, Ehmke M, Koslowski N, Mittmann S, Hannich A, Schwarz A, Meinck K, Schmeyers L, Schmidt K, Reisinger EC, Hoffmann W. SARS-CoV-2 surveillance by RT-qPCR-based pool testing of saliva swabs (lollipop method) at primary and special schools—A pilot study on feasibility and acceptability. PLoS One 2022; 17:e0274545. [PMID: 36099277 PMCID: PMC9469960 DOI: 10.1371/journal.pone.0274545] [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: 05/22/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background Since the onset of the COVID-19 pandemic, children have been mentally and physically burdened, particularly due to school closures, with an associated loss of learning. Therefore, efficient testing strategies with high sensitivity are necessary to keep schools open. Apart from individual rapid antigen testing, various methods have been investigated, such as PCR-based pool-testing of nasopharyngeal swabs, gargle, or saliva samples. To date, previous validation studies have found the PCR-based saliva swab pool testing method to be an effective screening method, however, the acceptability and feasibility of a widespread implementation in the school-setting among stakeholders has not been comprehensively evaluated. Methods In this pilot study, SARS-CoV-2 saliva swab pool testing of up to 15 swabs per pool was conducted in ten primary and special schools in Mecklenburg-Western Pomerania, Germany, over a period of one month. Thereafter, parents, teachers and school principals of the participating schools as well as the participating laboratories were surveyed about the feasibility and acceptability of this method, its large-scale implementation and challenges. Data were analyzed quantitatively and qualitatively. Results During the study period, 1,630 saliva swab pools were analyzed, of which 22 tested SARS-CoV-2 positive (1.3%). A total of N = 315 participants took part in the survey. Across all groups, the saliva swab pool testing method was perceived as more child-friendly (>87%), convenient (>82%), and easier (>81%) compared to rapid antigen testing by an anterior nasal swab. Over 80% of all participants favored widespread, regular use of the saliva swab method. Conclusion In school settings in particular, a high acceptability of the test method is crucial for a successful SARS-CoV-2 surveillance strategy. All respondents clearly preferred the saliva swab method, which can be used safely without complications in children six years of age and older. Hurdles and suggestions for improvement of an area-wide implementation were outlined.
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Affiliation(s)
- Anika Kästner
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
- * E-mail:
| | - Petra Lücker
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Martina Sombetzki
- Department of Tropical Medicine and Infectious Diseases, University Medical Center Rostock, Rostock, Germany
| | - Manja Ehmke
- Department of Tropical Medicine and Infectious Diseases, University Medical Center Rostock, Rostock, Germany
| | - Nicole Koslowski
- Department of Tropical Medicine and Infectious Diseases, University Medical Center Rostock, Rostock, Germany
| | - Swantje Mittmann
- Department of Tropical Medicine and Infectious Diseases, University Medical Center Rostock, Rostock, Germany
| | - Arne Hannich
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | | | | | - Lena Schmeyers
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Katrin Schmidt
- Department of Tropical Medicine and Infectious Diseases, University Medical Center Rostock, Rostock, Germany
| | - Emil C. Reisinger
- Department of Tropical Medicine and Infectious Diseases, University Medical Center Rostock, Rostock, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
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Kılcı EN. Convergence of testing and positivity rates for the COVID-19 pandemic: evidence from Germany and Italy. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2022. [DOI: 10.1108/ijhg-03-2022-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis paper aims to analyze the convergence of the testing and positivity rates for the COVID-19 pandemic focusing on Germany and Italy.Design/methodology/approachThe authors employ the two-regime threshold autoregressive (TAR) panel unit root test by using the weekly data in the period of 2020:03-2021:04.FindingsFollowing finding out that the testing and positivity rates are nonlinear, the authors determine that the transition country between the two regimes is Italy for the testing rates and Germany for the positivity rates. Their findings support the partial convergence for the testing rates for Germany and Italy. On the other hand, the authors could not find any convergence for the positivity rates of these two countries.Originality/valueThis paper contributes to academic literature in several ways. Firstly, to the best of their knowledge, this paper is the first study that analyzes the convergence of testing and positivity data. This paper further focuses on two Euro-Area countries which have suffered significantly from the COVID-19 pandemic. In addition, the authors employ the two-regime threshold autoregressive (TAR) panel unit root proposed by Beyaert and Camacho (2008) in their empirical analysis. This recent panel data methodology aims to test real convergence in a nonlinear framework by incorporating the threshold model, panel data unit root test and the calculation of critical values by bootstrap simulation.
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Gargle Pool PCR Testing in a Hospital during medium and high SARS-CoV-2 incidence. J Hosp Infect 2022; 127:69-76. [PMID: 35671860 PMCID: PMC9166272 DOI: 10.1016/j.jhin.2022.05.018] [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: 04/13/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 11/22/2022]
Abstract
Background Hospitals need to be protected from SARS-CoV-2 infections to protect vulnerable patients. Thus, a safe, efficient, and cost-effective SARS-CoV-2 testing system for hospitals, in addition to standard hygiene measures and vaccination of staff, is necessary. Here we report on the feasibility and performance of a pool real-time reverse-transcriptase polymerase-chain-reaction (rRT-PCR) test system at, medium and high incidence. Methods We implemented a testing concept based on gargling at home and pooling of samples in the hospital before PCR testing in the laboratory. We used two PCR systems (point of care and standard 96-well plate system) to adapt to challenges in the hospital setting and respond to a rising incidence in the Omicron wave. Findings During our 10-week study period, we performed 697 pool PCRs (8793 tests in total) and identified 65 asymptomatic staff members by pool PCR and 94 symptomatic staff members by positive individual PCR. Virus loads in those detected by pool testing were significantly lower (P<0.001). The test system remained workable even during the peak of the Omicron wave and no outbreaks occurred in any specific area of the hospital during the study period. Unvaccinated individuals were over-represented in the positively tested (37% vs 22% positive tests, P=0.04). The test procedure was well accepted by a majority of the hospital staff (84%). Conclusion Repeated gargle pool rRT-PCR testing can be implemented quickly in hospitals and is an effective, easily adaptable and well-accepted test system for hospitals, even during phases with very high infection rates.
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