Feasibility of SARS-CoV-2 Surveillance Testing Among Children and Childcare Workers at German Day Care Centers

Abstract

IMPORTANCEClosure of day care centers has been implemented globally to contain the COVID-19 pandemic but has negative effects on children's health and psychosocial well-being. OBJECTIVE To investigate the feasibility of surveillance among children and childcare workers and to model the efficacy of surveillance on viral spread prevention. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled trial was conducted at 9 day care centers in Wuerzburg, Germany, from October 2020 to March 2021. Participants included children attending day care, childcare workers, and household members. Participating day care centers were assigned to different surveillance modules in a nonrandomized feasibility study. A mathematical model for SARS-CoV-2 spread in day care centers was developed to identify optimal surveillance. INTERVENTIONS Modules 1, 2, and 3 involved continuous surveillance of asymptomatic children and childcare workers by SARS-CoV-2 polymerase chain reaction testing of either midturbinate nasal swabs twice weekly (module 1) or once weekly (module 2) or self-sampled saliva samples twice weekly (module 3). Module 4 involved symptom-based, on-demand testing of children, childcare workers, and their household members by oropharyngeal swabs. All participants underwent SARS-CoV-2 antibody status testing before and after the sampling period. Questionnaires on attitudes and perception of the pandemic were administered in weeks 1, 6, and 12. Mathematical modeling was used to estimate SARS-CoV-2 spread in day care centers. MAIN OUTCOMES AND MEASURES The primary outcomes were acceptance of the respective surveillance protocols (feasibility study) and the estimated number of secondary infections (mathematical modeling). RESULTS Of 954 eligible individuals (772 children and 182 childcare workers), 592 (62%), including 442 children (median [IQR] age, 3 [2-4] years; 214 [48.6%] female) and 150 childcare workers (median [IQR] age, 29 [25-44] years; 129 [90.8%] female) participated in the surveillance. In total, 4755 tests for SARS-CoV-2 detected 2 infections (1 childcare worker and 1 adult household member). Acceptance for continuous surveillance was highest for biweekly saliva testing (150 of 221 eligible individuals [67.9%; 95% CI, 61.5%-73.7%]) compared with biweekly (51 of 117 individuals [43.6%; 95% CI, 35.0%-52.6%]) and weekly (44 of 128 individuals [34.4%; 95% CI, 26.7%-43.0%]) midturbinate swabbing (P < .001). Dropout rates were higher for midturbinate swabbing (biweekly, 11 of 62 participants [18%]; once weekly, 11 of 55 participants [20%]) than for saliva testing (6 of 156 (continued) Key Points Question Is continuous SARS-CoV-2 testing accepted by children, parents, and childcare workers and can it prevent viral spreading in day care centers? Findings In this nonrandomized controlled trial, surveillance testing for SARS-CoV-2 among 954 eligible individuals was well accepted by children, parents, and childcare workers if saliva sampling at home was used. Mathematical modeling based on study and literature data iden...

Surveillance of Acute SARS-CoV-2 Infections in Elementary Schools and Daycare Facilities in Bavaria, Germany (09/2020–03/2021)

“…Nevertheless, our study is in line with the idea that hygiene measures and testing strategies during the early waves of Covid-19 contained the pandemic in elementary schools and daycare settings, particularly when the Bavarian incidence was high (i.e., phase II during the second wave). With systematic and comprehensive testing strategies ( 32 , 33 ), maintaining hygiene measures and increasing vaccination rates we may be in a better situation to face the currently prevailing Delta and Omicron variants without falling back to less sophisticated measures such as extensive and complete closing of schools and daycare facilities. Recent German studies have clearly pointed out the magnitude of side effects of school closures including a lack of opportunities to learn and socialize leading to an increased risk of psychiatric problems and chronic disease ( 4 , 34 ) as well as a rise in educational inequality ( 35 ).…”

Acceptance of Different Self-sampling Methods for Semiweekly SARS-CoV-2 Testing in Asymptomatic Children and Childcare Workers at German Day Care Centers

“…All 9 DCCs, covering approximately 20% of all DCC-attending children in the area, had participated in a previous surveillance study. 16 …”

“…Different sampling methods have been investigated (eg, anal or buccal swab, saliva, midturbinate swab), and pooling has been proposed to save resources. 13 , 14 , 15 , 16 …”

Low rate of SARS-CoV-2 incident infection identified by weekly screening PCR in a prospective year-long cohort study

“…Surveillance for SARS2 has been recommended as a modality to limit transmission of infection from unvaccinated individuals with asymptomatic or pre-symptomatic infection [ 3 ]. While acceptance of long-term surveillance testing was extremely high among our study population as demonstrated by high adherence to collection and return of swabs, the utility of weekly surveillance by rtPCR in our population was of limited value because of our extremely low rate of detecting asymptomatic or pre-symptomatic infection in unvaccinated participants.…”

“…Periodic testing for SARS2 infection may detect asymptomatic or pre-symptomatic infections, which have been reported to represent a significant proportion of infections particularly amongst healthy populations without comorbidities [ 1 ]. Asymptomatic and pre-symptomatic infections may contribute to transmission, albeit less than symptomatic infection [ 2 ], and therefore surveillance has been recommended to detect such cases [ 3 ]. Weekly testing for SARS2 infection is recommended for United States federal government employees who are unvaccinated when transmission risk is medium or high to reduce work-place transmission [ 4 ].…”