In daycare centres, the close contact of children with other children and employees favours the transmission of infections. The majority of children <6 years attend daycare programmes in Germany, but the role of daycare centres in the SARS-CoV-2 pandemic is unclear. We investigated the transmission risk in daycare centres and the spread of SARS-CoV-2 to associated households. 30 daycare groups with at least one recent laboratory-confirmed SARS-CoV-2 case were enrolled in the study (10/2020-06/2021). Close contact persons within daycare and households were examined over a 12-day period (repeated SARS-CoV-2 PCR tests, genetic sequencing of viruses, symptom diary). Households were interviewed to gain comprehensive information on each outbreak. We determined primary cases for all daycare groups. The number of secondary cases varied considerably between daycare groups. The pooled secondary attack rate (SAR) across all 30 daycare centres was 9.6%. The SAR tended to be higher when the Alpha variant was detected (15.9% vs. 5.1% with evidence of wild type). The household SAR was 53.3%. Exposed daycare children were less likely to get infected with SARS-CoV-2 than employees (7.7% vs. 15.5%). Containment measures in daycare programmes are critical to reduce SARS-CoV-2 transmission, especially to avoid spread to associated households.
Background: Whereas the majority of children under 6 years of age attend daycare centers in Germany, evidence on the role of daycare centers in the transmission of SARS-CoV-2 is scarce. Aims: This study aims to investigate the transmission risk in daycare centers among children and staff and the spread of infections to associated households. Methods: 30 daycare groups with at least one recent laboratory-confirmed SARS-CoV-2 case (child or staff) were enrolled in the study (10/2020-06/2021). Close contacts within the daycare group and households were examined over a 12-day period (repeated SARS-CoV-2 PCR tests, genetic sequencing of viruses, documentation of symptoms). Households, local health authorities and daycare staff were interviewed to gain comprehensive information on each outbreak. We determined primary cases for all daycare groups. Results: The number of secondary cases varied considerably between daycare groups. The pooled secondary attack rate (SAR) across all 30 daycare centers was 9.6%. The SAR tended to be higher in daycare centers in which the Alpha variant of the virus was detected (15.9% vs. 5.1% with evidence of wild type). The SAR in households was 53.3%. Exposed children were less likely to get infected with SARS-CoV-2 in daycare centers, compared to adults (7.7% vs. 15.5%). Conclusion: Containment measures in daycare programs are critical and become increasingly important with highly transmissible new variants to reduce SARS-CoV-2 transmission, especially to avoid spread to associated households. Virus variants may modify transmission dynamics in daycare programs.
Introduction: Until today, the role of children in the transmission dynamics of SARS-CoV-2 and the development of the COVID-19 pandemic seems to be dynamic and is not finally resolved. The primary aim of this study is to investigate the transmission dynamics of SARS-CoV-2 in child day care centers and connected households as well as transmission-related indicators and clinical symptoms among children and adults.Methods and Analysis: COALA (“Corona outbreak-related examinations in day care centers”) is a day care center- and household-based study with a case-ascertained study design. Based on day care centers with at least one reported case of SARS-CoV-2, we include one- to six-year-old children and staff of the affected group in the day care center as well as their respective households. We visit each child's and adult's household. During the home visit we take from each household member a combined mouth and nose swab as well as a saliva sample for analysis of SARS-CoV-2-RNA by real-time reverse transcription polymerase chain reaction (real-time RT-PCR) and a capillary blood sample for a retrospective assessment of an earlier SARS-CoV-2 infection. Furthermore, information on health status, socio-demographics and COVID-19 protective measures are collected via a short telephone interview in the subsequent days. In the following 12 days, household members (or parents for their children) self-collect the same respiratory samples as described above every 3 days and a stool sample for children once. COVID-19 symptoms are documented daily in a symptom diary. Approximately 35 days after testing the index case, every participant who tested positive for SARS-CoV-2 during the study is re-visited at home for another capillary blood sample and a standardized interview. The analysis includes secondary attack rates, by age of primary case, both in the day care center and in households, as well as viral shedding dynamics, including the beginning of shedding relative to symptom onset and viral clearance.Discussion: The results contribute to a better understanding of the epidemiological and virological transmission-related indicators of SARS-CoV-2 among young children, as compared to adults and the interplay between day care and households.
Background Health information (HI) strategies exist in several EU Member States, however, they mainly focus on technical issues and improving governance rather than on content-related priority setting. There is also little research available about national prioritization processes underlying HI development for policy support in the EU. The aim of this study was to broaden the knowledge base on HI prioritization strategies and to encourage expert exchange towards good practice models. A specific focus was put on HI produced for national health reporting, this being a crucial tool for policy advice. Methods We conducted a literature search to identify published and grey literature on national HI prioritization. This was followed by a two-round Policy Delphi study, where we explored which processes and methods exist in EU Member States and associated countries for the prioritization of HI collection. In the first round, information about these processes was gathered in semi-structured questions; in the second round, participants were asked to rank the identified approaches for desirability and feasibility. The survey was conducted online; participants were recruited from the membership of the Joint Action on Health Information (InfAct – Information for Action). Results 119 experts were contacted, representing 40 InfAct partner institutions in 28 EU Member States and associated countries. Of these, 28 experts responded fully or partially to the first round, and six to the second round. In the first round, more than half of the respondents reported the existence of structured HI prioritization processes in their countries. To prioritize HI, a clear preference was given in the second round for a formal, horizontal process which includes different experts and stakeholders. National public health institutes were named desirable key stakeholders in this process, and also desirable and feasible coordinators for stakeholder coordination. Conclusion Health information prioritization methods and procedures reflect the heterogeneity of national public health systems in European countries. Mapping, sharing and ranking prioritization methods and procedures for “good practices” provides a meaningful basis for expert knowledge exchange on HI development. We recommend to make this process part of a future sustainable EU health information system and to use the information gathered in this project to initiate the development of a guidance “Good Practice HI Prioritization” among EU Member States and associated countries.
Background The role of children for the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still unclear. The aim of our case-ascertained study is to examine transmission dynamics of SARS-CoV-2 among children and staff based on outbreaks in day care centres in Germany. Methods Based on day care centres with at least one reported case of SARS-CoV-2 we include 1-6-year-old children and staff of the affected group in the day care centre as well as their respective households. We test each study participant on acute and past SARS-CoV-2 infection with innovative child friendly tests and collect data on sociodemographics and symptoms. At four further measurement points within 12 days, the participants carry out the tests on SARS-CoV-2 by themselves. From October 2020 to May 2021, 25 day care centres with SARS-CoV-2 outbreaks participated and we included n = 244 children 1-6 years and n = 72 staff members in the study. Results First analyses from 25 outbreaks showed that the observed infection events in the examined day care centres were very different. Often, no or only few transmissions were found among the participants in the day care group, but in one day care centre, 13 people were infected: Between 0% and 81% of close contact persons in the day care centres were tested positive for SARS-CoV-2 in the study period. Children showed a similar percentage of secondary SARS-CoV-2 infections compared to adults (both 11%). Conclusions The study has been successful in detecting previously undetected infections of SARS-CoV-2 in day care centres. Results of these outbreaks examinations are presented regularly in public reports to inform public health decision-makers. By studying individual day care centre-related infection dynamics the data supplement the information from national reporting data.
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