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Neil-Sztramko SE, Belita E, Traynor RL, Hagerman L, Akaraci S, Burnett P, Kostopoulos A, Dobbins M. What is the specific role of schools and daycares in COVID-19 transmission? A final report from a living rapid review. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:290-300. [PMID: 38368895 DOI: 10.1016/s2352-4642(23)00312-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 02/20/2024]
Abstract
Due to rapidly evolving conditions, the question of how to safely operate schools and daycares remained a top priority throughout the COVID-19 pandemic. In response to growing and changing evidence, the National Collaborating Centre for Methods and Tools in Canada maintained a living rapid review on the role of schools and daycares in COVID-19 transmission to guide evidence-informed decision making. This Review presents the final iteration of this living rapid review. 31 sources were searched until Oct 17, 2022. In the final version, eligible studies reported data from Jan 1, 2021 onward on transmission of COVID-19 in school or daycare settings, the effect of infection prevention and control measures on transmission, or the effect of operating schools or daycares on community-level COVID-19 rates. As a rapid review, titles and abstracts were screened by a single reviewer with artificial intelligence integrated into later versions. Full-text screening, data extraction, and critical appraisal were completed by one reviewer and checked by a second reviewer. The Johanna Briggs Institute tools were used for critical appraisal. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach, and results were synthesised narratively. Three citizen partners provided input for the final interpretation. This final update includes 73 primary studies. Secondary attack rates were low within school settings when infection prevention and control measures were in place (moderate certainty). Masks might reduce transmission, test-to-stay policies might not increase transmission risk compared with mandatory quarantine, cohorting and hybrid learning might make little to no difference in transmission (low certainty), and the effect of surveillance testing within schools remained inconclusive (very low certainty). Findings indicate that school settings do not substantially contribute to community incidence, hospitalisations, or mortality (low certainty). This living review provides a synthesis of global evidence for the role of schools and daycares during COVID-19, which might be helpful in future pandemics.
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Affiliation(s)
- Sarah E Neil-Sztramko
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.
| | - Emily Belita
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Robyn L Traynor
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, ON, Canada
| | - Leah Hagerman
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, ON, Canada
| | - Selin Akaraci
- Centre for Public Health, Queen's University Belfast, Belfast, UK; Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
| | - Patricia Burnett
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, ON, Canada
| | - Alyssa Kostopoulos
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, ON, Canada
| | - Maureen Dobbins
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, ON, Canada; School of Nursing, McMaster University, Hamilton, ON, Canada
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Zheng B, Chen H, Xia W, Jiang Y, Zhang J. Secondary infections of COVID-19 in schools and the effectiveness of school-based interventions: a systematic review and meta-analysis. Public Health 2024; 229:42-49. [PMID: 38394706 DOI: 10.1016/j.puhe.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/17/2023] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES This meta-analysis explored secondary infections of SARS-CoV-2 and the effectiveness of non-pharmaceutical interventions (NPIs) in school settings, with the aim of providing a reference to formulate scientific prevention and response strategies for similar major public health emergencies in specific settings. STUDY DESIGN This was a systematic review and meta-analysis. METHODS Systematic searches were conducted in PubMed, Web of Science and the Cochrane Library through to 1 August 2022 using the following key search terms: COVID-19, SARS-CoV-2, secondary attack rate, school, transmission, etc. The IVhet model was used for the meta-analysis, and the I2 index and Cochran's Q-test were used to assess heterogeneity. Publication bias was examined using Doi plot, Galbraith plots and Luis Furuya-Kanamori index. Prevalence Critical Appraisal Tool was used to assess the quality of the included articles, while Grading of Recommendations Assessment, Development, and Evaluation was used to rate the quality of the evidence. Subgroup analyses were conducted to explore the potential source of heterogeneity. RESULTS Thirty-four studies involving 226,727 school contacts and 2216 secondary cases were included in this study. The pooled secondary attack rates (SARs) of close contacts, staff contacts and student contacts were 0.67% (95% confidence interval [CI]: 0.11, 1.56), 0.79% (95% CI: 0.00, 6.72) and 0.50% (95% CI: 0.00, 4.48), respectively. Subgroup analysis suggested that multiple or specific combinations (e.g. the combination of contact restriction and hygiene action) of NPIs appeared to be associated with lower SARs. CONCLUSIONS The SAR of SARS-CoV-2 was low in schools. Multiple or specific combinations of prevention strategies appear to mitigate SARS-CoV-2 transmission in school settings. These findings provide a basis for continuous improvement of response strategies to major public health emergencies in the school environment.
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Affiliation(s)
- B Zheng
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Key Laboratory of Environment & Health (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China.
| | - H Chen
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Key Laboratory of Environment & Health (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China.
| | - W Xia
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Key Laboratory of Environment & Health (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China.
| | - Y Jiang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Key Laboratory of Environment & Health (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China.
| | - J Zhang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Key Laboratory of Environment & Health (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China.
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Silverberg SL, Shulha HP, McMillan B, He G, Lee A, Márquez AC, Bartlett SR, Gill V, Abu-Raya B, Bettinger JA, Cabrera A, Coombs D, Gantt S, Goldfarb DM, Sauvé L, Krajden M, Morshed M, Sekirov I, Jassem AN, Sadarangani M. Factors associated with SARS-CoV-2 infection in unvaccinated children and young adults. BMC Infect Dis 2024; 24:91. [PMID: 38225625 PMCID: PMC10790408 DOI: 10.1186/s12879-023-08950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/24/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric COVID-19 cases are often mild or asymptomatic, which has complicated estimations of disease burden using existing testing practices. We aimed to determine the age-specific population seropositivity and risk factors of SARS-CoV-2 seropositivity among children and young adults during the pandemic in British Columbia (BC). METHODS We conducted two cross-sectional serosurveys: phase 1 enrolled children and adults < 25 years between November 2020-May 2021 and phase 2 enrolled children < 10 years between June 2021-May 2022 in BC. Participants completed electronic surveys and self-collected finger-prick dried blood spot (DBS) samples. Samples were tested for immunoglobulin G antibodies against ancestral spike protein (S). Descriptive statistics from survey data were reported and two multivariable analyses were conducted to evaluate factors associated with seropositivity. RESULTS A total of 2864 participants were enrolled, of which 95/2167 (4.4%) participants were S-seropositive in phase 1 across all ages, and 61/697 (8.8%) unvaccinated children aged under ten years were S-seropositive in phase 2. Overall, South Asian participants had a higher seropositivity than other ethnicities (13.5% vs. 5.2%). Of 156 seropositive participants in both phases, 120 had no prior positive SARS-CoV-2 test. Young infants and young adults had the highest reported seropositivity rates (7.0% and 7.2% respectively vs. 3.0-5.6% across other age groups). CONCLUSIONS SARS-CoV-2 seropositivity among unvaccinated children and young adults was low in May 2022, and South Asians were disproportionately infected. This work demonstrates the need for improved diagnostics and reporting strategies that account for age-specific differences in pandemic dynamics and acceptability of testing mechanisms.
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Affiliation(s)
- Sarah L Silverberg
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, 950 West 28th Ave Vancouver, V5Z 4H4, Vancouver, BC, Canada
- Division of Infectious Diseases, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Hennady P Shulha
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, 950 West 28th Ave Vancouver, V5Z 4H4, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Brynn McMillan
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, 950 West 28th Ave Vancouver, V5Z 4H4, Vancouver, BC, Canada
- Experimental Medicine Program, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Guanyuhui He
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, 950 West 28th Ave Vancouver, V5Z 4H4, Vancouver, BC, Canada
| | - Amy Lee
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, 950 West 28th Ave Vancouver, V5Z 4H4, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Ana Citlali Márquez
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Sofia R Bartlett
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Vivek Gill
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, 950 West 28th Ave Vancouver, V5Z 4H4, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Bahaa Abu-Raya
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, 950 West 28th Ave Vancouver, V5Z 4H4, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, 950 West 28th Ave Vancouver, V5Z 4H4, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Adriana Cabrera
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, 950 West 28th Ave Vancouver, V5Z 4H4, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Coombs
- Department of Mathematics, University of British Columbia, Vancouver, BC, Canada
| | - Soren Gantt
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, 950 West 28th Ave Vancouver, V5Z 4H4, Vancouver, BC, Canada
- Centre de Recherche du CHU Sainte-Justine, Montreal, QC, Canada
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laura Sauvé
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, 950 West 28th Ave Vancouver, V5Z 4H4, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Mel Krajden
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Muhammad Morshed
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Inna Sekirov
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Agatha N Jassem
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, 950 West 28th Ave Vancouver, V5Z 4H4, Vancouver, BC, Canada.
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
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Watts AW, Mâsse LC, Goldfarb DM, Irvine MA, Hutchison SM, Muttucomaroe L, Poon B, Barakauskas VE, O'Reilly C, Bosman E, Reicherz F, Coombs D, Pitblado M, O'Brien SF, Lavoie PM. SARS-CoV-2 cross-sectional seroprevalence study among public school staff in Metro Vancouver after the first Omicron wave in British Columbia, Canada. BMJ Open 2023; 13:e071228. [PMID: 37308276 DOI: 10.1136/bmjopen-2022-071228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE To determine the SARS-CoV-2 seroprevalence among school workers within the Greater Vancouver area, British Columbia, Canada, after the first Omicron wave. DESIGN Cross-sectional study by online questionnaire, with blood serology testing. SETTING Three main school districts (Vancouver, Richmond and Delta) in the Vancouver metropolitan area. PARTICIPANTS Active school staff enrolled from January to April 2022, with serology testing between 27 January and 8 April 2022. Seroprevalence estimates were compared with data obtained from Canadian blood donors weighted over the same sampling period, age, sex and postal code distribution. PRIMARY AND SECONDARY OUTCOMES SARS-CoV-2 nucleocapsid antibody testing results adjusted for test sensitivity and specificity, and regional variation across school districts using Bayesian models. RESULTS Of 1850 school staff enrolled, 65.8% (1214/1845) reported close contact with a COVID-19 case outside the household. Of those close contacts, 51.5% (625/1214) were a student and 54.9% (666/1214) were a coworker. Cumulative incidence of COVID-19 positive testing by self-reported nucleic acid or rapid antigen testing since the beginning of the pandemic was 15.8% (291/1845). In a representative sample of 1620 school staff who completed serology testing (87.6%), the adjusted seroprevalence was 26.5% (95% CrI 23.9% to 29.3%), compared with 32.4% (95% CrI 30.6% to 34.5%) among 7164 blood donors. CONCLUSION Despite frequent COVID-19 exposures reported, SARS-CoV-2 seroprevalence among school staff in this setting remained no greater than the community reference group. Results are consistent with the premise that many infections were acquired outside the school setting, even with Omicron.
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Affiliation(s)
- Allison W Watts
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Louise C Mâsse
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - David M Goldfarb
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mike A Irvine
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Sarah M Hutchison
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Lauren Muttucomaroe
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Bethany Poon
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Vilte E Barakauskas
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Else Bosman
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Frederic Reicherz
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Daniel Coombs
- Department of Mathematics and Institute of Applied Mathematics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Pitblado
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Sheila F O'Brien
- Canadian Blood Services, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Pascal M Lavoie
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Methi F, Madslien EH. Lower transmissibility of SARS-CoV-2 among asymptomatic cases: evidence from contact tracing data in Oslo, Norway. BMC Med 2022; 20:427. [PMID: 36348327 PMCID: PMC9641677 DOI: 10.1186/s12916-022-02642-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Asymptomatic COVID-19 cases have complicated the surveillance and tracking of the pandemic. Previous studies have estimated that 15-25% of all infectees remain asymptomatic. METHODS Based on contact tracing data from Oslo, Norway, we estimated transmission and susceptibility dynamics among symptomatic and asymptomatic cases and their contacts as identified by manual contact tracing between September 1, 2020, and September 1, 2021. RESULTS Among 27,473 indexes and 164,153 registered contacts, the secondary attack rate (SAR-14) was estimated to be 28% lower through asymptomatic exposure (13%) compared to symptomatic exposure (18%). Furthermore, those infected by asymptomatic cases were almost three times more likely to be asymptomatic compared to those infected by symptomatic cases. CONCLUSIONS Symptomatic cases spread the virus to a greater extent than asymptomatic, and infectees are more likely to be asymptomatic if their assumed infector was asymptomatic.
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Affiliation(s)
- Fredrik Methi
- Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway.
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