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Engels G, Forster J, Streng A, Rücker V, Rudolph P, Pietsch F, Wallstabe J, Wallstabe L, Krauthausen M, Schmidt J, Ludwig T, Bauer C, Gierszewski D, Bendig J, Timme S, Jans T, Weißbrich B, Romanos M, Dölken L, Heuschmann P, Härtel C, Gágyor I, Figge MT, Liese J, Kurzai O. Acceptance of Different Self-sampling Methods for Semiweekly SARS-CoV-2 Testing in Asymptomatic Children and Childcare Workers at German Day Care Centers: A Nonrandomized Controlled Trial. JAMA Netw Open 2022; 5:e2231798. [PMID: 36107424 PMCID: PMC9478779 DOI: 10.1001/jamanetworkopen.2022.31798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Closure of day care centers (DCCs) to contain the COVID-19 pandemic has been associated with negative effects on children's health and well-being. OBJECTIVE To investigate the acceptance of self-sampling methods for continuous SARS-CoV-2 surveillance among asymptomatic children and childcare workers (CCWs) in DCCs. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized pilot study included children and CCWs at 9 DCCs in Wuerzburg, Germany, from May to July 2021. INTERVENTIONS Twice weekly testing for SARS-CoV-2 was conducted by self-sampled mouth-rinsing fluid (saliva sampling [SAL], with subsequent pooled polymerase chain reaction test) plus nasal rapid antigen self-test (RAgT) (group 1), SAL only (group 2), or RAgT only (group 3) in children and CCWs. MAIN OUTCOMES AND MEASURES Main outcomes were rates for initial acceptance and successful (≥60% of scheduled samples) long-term participation. The probability of SARS-CoV-2 introduction into DCCs was modeled as a function of age-adjusted background incidence and DCC size. RESULTS Of 836 eligible children, 452 (54.1%; 95% CI, 50.7%-57.4%) participated (median [IQR] age: 4 [3-5] years; 213 [47.1%] girls), including 215 (47.6%) in group 1, 172 (38.1%) in group 2, and 65 (14.4%) in group 3. Of 190 CCWs, 139 (73.2%; 95% CI, 66.4%-79.0%) participated (median [IQR] age: 30 [25-46] years; 128 [92.1%] women), including 96 (69.1%) in group 1, 29 (20.9%) in group 2, and 14 (10.1%) in group 3. Overall, SARS-CoV-2 PCR tests on 5306 SAL samples and 2896 RAgTs were performed in children, with 1 asymptomatic child detected by PCR from SAL. Successful long-term participation was highest in group 2 (SAL only; children: 111 of 172 [64.5%]; CCWs: 18 of 29 [62.1%]). Weekly participation rates in children ranged from 54.0% to 83.8% for SAL and from 44.6% to 61.4% for RAgT. Participation rates decreased during the study course (P < .001). The probability of SARS-CoV-2 introduction into a DCC with 50 children was estimated to reach at most 5% for an age-adjusted SARS-CoV-2 incidence below 143. CONCLUSIONS AND RELEVANCE Self-sampling for continuous SARS-CoV-2 testing was well accepted, with SAL being the preferred method. Given the high number of negative tests, thresholds for initiating continuous testing should be established based on age-adjusted SARS-CoV-2 incidence rates. TRIAL REGISTRATION German Registry for Clinical Trials Identifier: DRKS00025546.
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Affiliation(s)
- Geraldine Engels
- Department of Pediatrics, University Hospital Wuerzburg, Würzburg, Germany
| | - Johannes Forster
- Institute for Hygiene and Microbiology, University of Wuerzburg, Würzburg, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital Wuerzburg, Würzburg, Germany
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
| | - Paul Rudolph
- Leibniz Institute for Natural Product Research and Infection Biology–Hans-Knoell-Institute, Jena, Germany
| | - Franziska Pietsch
- Institute for Hygiene and Microbiology, University of Wuerzburg, Würzburg, Germany
| | - Julia Wallstabe
- Institute for Hygiene and Microbiology, University of Wuerzburg, Würzburg, Germany
| | - Lars Wallstabe
- Institute for Hygiene and Microbiology, University of Wuerzburg, Würzburg, Germany
| | - Maike Krauthausen
- Department of General Practice, University Hospital Wuerzburg, Würzburg, Germany
| | - Julia Schmidt
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
| | - Timo Ludwig
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
| | - Carsten Bauer
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
| | - David Gierszewski
- Department of General Practice, University Hospital Wuerzburg, Würzburg, Germany
| | - Jesper Bendig
- Department of Pediatrics, University Hospital Wuerzburg, Würzburg, Germany
| | - Sandra Timme
- Leibniz Institute for Natural Product Research and Infection Biology–Hans-Knoell-Institute, Jena, Germany
| | - Thomas Jans
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Würzburg, Germany
| | - Benedikt Weißbrich
- Institute for Virology and Immunobiology, University of Wuerzburg, Würzburg, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Würzburg, Germany
| | - Lars Dölken
- Institute for Virology and Immunobiology, University of Wuerzburg, Würzburg, Germany
| | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
- Clinical Trial Center Wuerzburg, University Hospital Wuerzburg, Würzburg, Germany
| | - Christoph Härtel
- Department of Pediatrics, University Hospital Wuerzburg, Würzburg, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Wuerzburg, Würzburg, Germany
| | - Marc Thilo Figge
- Leibniz Institute for Natural Product Research and Infection Biology–Hans-Knoell-Institute, Jena, Germany
| | - Johannes Liese
- Department of Pediatrics, University Hospital Wuerzburg, Würzburg, Germany
| | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Wuerzburg, Würzburg, Germany
- Leibniz Institute for Natural Product Research and Infection Biology–Hans-Knoell-Institute, Jena, Germany
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