Longitudinal Testing for Respiratory and Gastrointestinal Shedding of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Day Care Centers in Hesse, Germany

Hoehl, Sebastian; Kreutzer, Emilie; Schenk, Barbara; Westhaus, Sandra; Foppa, Ivo; Herrmann, Eva; Ettrich, India; Leondaraki, Maria; Schaible, Alexander; Rudych, Olga; Rabenau, Holger F.; Berger, Annemarie; Ciesek, Sandra

doi:10.1093/cid/ciaa1912

Cited by 19 publications

(25 citation statements)

References 24 publications

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“…Several reports have assessed the role of children in the dynamics of SARS-CoV-2 transmission. A study conducted in day care centers in Germany that used buccal mucosal and anal swabs for SARS-CoV-2 detection concluded that day care centers are not relevant reservoirs in a low prevalence setting (12). However, this study used self-testing, lacked oropharyngeal swab specimens, and was conducted during a minimal local incidence rate.…”

Section: Discussionmentioning

confidence: 99%

Weekly SARS-CoV-2 Sentinel Surveillance in Primary Schools, Kindergartens, and Nurseries, Germany, June‒November 2020

Hoch¹,

Vogel²,

Kolberg³

et al. 2021

Emerg. Infect. Dis.

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C hildren have been disproportionately affected by public health measures in the current coronavirus disease (COVID-19) pandemic (1). In contrast to other age groups, children have shown lower rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive cases; lower risk for symptomatic, acute, COVID-19; a generally milder course of disease with the exception of some rare manifestations and the post-COVID-19 multisystem infl ammatory syndrome in children; and lower secondary attack rates (2-4). Susceptibility to infection in <10 years of age is estimated to be lower than that for teenagers. Accumulating evidence shows that, given limited infection control measures, SARS-CoV-2 might spread sustainably in secondary/high schools but to a lesser degree in primary schools and nurseries (2,5).Closure of childcare facilities and schools has been shown to negatively affect the physical and emotional well-being of children, teenagers, and parents, potentially having a long-term impact on their lives (6). Thus, various expert groups called for avoiding closing of these institutions (7,8). Against the background of presymptomatic transmission found in adults, it is critical to public health authorities to be able to rely on real-life data monitoring the number of asymptomatic yet infected children attending educational institutions (9). Some studies have reported low numbers of infected cases in primary schools or childcare facilities but were conducted during a lockdown or semi-lockdown period (5,10). The aim of our study (the Münchner Virenwächter Study) was to implement a real-time sentinel program in a representative number of 5 primary schools and 5 (6 in phase 2) nurseries/kindergartens in Munich, Germany. The StudyThis study was approved by the ethics committee of the Ludwig-Maximilians University under project no. 20-484. We intended to accomplish a timely detection of infected cases and offer an additional level of safety to participating institutions during regular operating mode. The study spanned over 2 phases (Figure 1): phase 1, June 15-July 26, 2020; and phase 2, September 7-November 1, 2020. Participating institutions were randomly selected, and written informed consent was obtained in the fi rst week of each phase. To correct for underrepresentation of younger children (<5 years of age), we included an additional nursery/ kindergarten into phase 2.We tested oropharyngeal swab specimens for SARS-CoV-2 by using real-time reverse transcription PCR (rRT-PCR); weekly samples were obtained from randomly selected children (n = 20) and staff (n = 5) in each institution. Swab specimens were taken on-site by trained medical personnel, and results were timely reported. For rRT-PCR, we processed specimens

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Section: Discussionmentioning

confidence: 99%

Weekly SARS-CoV-2 Sentinel Surveillance in Primary Schools, Kindergartens, and Nurseries, Germany, June‒November 2020

Hoch¹,

Vogel²,

Kolberg³

et al. 2021

Emerg. Infect. Dis.

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“…In 2020, the first pandemic year, children were reported to be less likely to become infected with SARS-CoV-2 compared to adults and elderly. For infants, the reported number of cases were even lower (2)(3)(4).…”

Section: Introductionmentioning

confidence: 93%

Non-Invasive Antibody Assessment in Saliva to Determine SARS-CoV-2 Exposure in Young Children

et al. 2021

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Saliva is a body fluid with hitherto unused potential for the assessment of SARS-CoV-2 antibodies. Specific antibodies can indicate a past SARS-CoV-2 infection and allow to estimate the proportion of individuals with a potential protective immunity. First, we carefully characterized plasma samples obtained from adult control groups with and without prior SARS-CoV-2 infection using certified reference ELISAs. Simultaneously collected saliva samples of confirmed convalescent and negative individuals where then used to validate the herein newly developed ELISA for the detection of SARS-CoV-2 IgG antibodies in saliva. The saliva ELISA was applied to assess SARS-CoV-2 exposure in young children (N = 837) in the age between 1 and 10 years in Tübingen, Germany, towards the end of the first pandemic year 2020. Sensitivity and specificity of the new saliva ELISA was 87% and 100%, respectively. With 12% of all Tübingen children sampled via their respective educational institutions, estimates of SARS-CoV-2 antibody prevalence was 1.6%. Interestingly, only 0.4% preschool kids were positive compared to 3.0% of primary school children. Less than 20% of positive children self-reported symptoms within two months prior to saliva sampling that could be associated - but not exclusively - with a SARS-CoV-2 infection. The saliva ELISA is a valid and suitable protocol to enable population-based surveys for SARS-CoV-2 antibodies. Using non-invasive sampling and saliva ELISA testing, we found that prevalence of SARS-CoV-2 antibodies was significantly lower in young children than in primary school children.

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“…While children of kindergarten age rarely have severe disease when infected with SARS-CoV-2 1-3 measures of public health, such as distancing and wearing of masks, cannot be applied to the same extend in day care centers as in other educational facilities. Nevertheless, a growing body of evidence suggested a limited role of day care centers in community spread of wild type SARS-CoV-2 in Central Europe in 2020 and early 2021 [4][5][6][7][8] . However, some of these studies were conducted during low community activity 4,5 , limiting the transferability to a setting with increased community spread.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, a growing body of evidence suggested a limited role of day care centers in community spread of wild type SARS-CoV-2 in Central Europe in 2020 and early 2021 [4][5][6][7][8] . However, some of these studies were conducted during low community activity 4,5 , limiting the transferability to a setting with increased community spread. One of these studies was the SAFE KiDS study, which we conducted in the summer of 2020 in 50 day care centers in the state of Hesse, Germany 4 .…”

Section: Introductionmentioning

confidence: 99%

“…However, some of these studies were conducted during low community activity 4,5 , limiting the transferability to a setting with increased community spread. One of these studies was the SAFE KiDS study, which we conducted in the summer of 2020 in 50 day care centers in the state of Hesse, Germany 4 . In this 12-week longitudinal study, we neither detected respiratory nor gastrointestinal shedding of SARS-CoV-2 in any of 825 children attending day care, and only in two staff members.…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal testing for SARS-CoV-2 RNA in day care centers in Hesse, Germany, during increased local incidence and with VOC Alpha as dominant variant: Results of the SAFE KiDS 2 and SAFE KiDS 3 study

Schenk

Hoehl

Rudych

et al. 2021

Preprint

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In the summer of 2020, we investigated the rate of inapparent shedding of SARS-CoV-2 in a representative sample of day care centers from Hesse, Germany, and found a low positivity rate during a period of low local community spread. To investigate the influence of a high local incidence setting, we conducted the SAFE KiDS 2 study. 577 children and 334 staff members of 47 daycare centers were tested for respiratory and gastrointestinal shedding of SARS-CoV-2, and three infections with SARS-CoV-2 in the infectious period were detected. We conclude that viral shedding occurred infrequently while the original "wild-type" variant was dominant. The more transmissible SARS-CoV-2 variant Alpha (B.1.1.7) became the dominant strain after the SAFE KiDS 2 was concluded. The SAFE KiDS 3 study investigated the impact of the Alpha variant of SARS-Co-2 on inapparent viral shedding in the day care setting. In this study, 756 children and 226 staff members from 46 day care centers provided self-collected saliva swabs, the so-called "Lollipop" swabs, which were tested by RT-PCR. In the four-week study period, none of the participants tested positive for SARS-CoV-2 RNA, demonstrating that inapparent shedding of SARS-CoV-2 in the day care setting was also rare during the dominance of the Alpha variant. The influence of the variant of concern Delta on day care centers has yet to be examined.

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Longitudinal Testing for Respiratory and Gastrointestinal Shedding of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Day Care Centers in Hesse, Germany

Cited by 19 publications

References 24 publications

Weekly SARS-CoV-2 Sentinel Surveillance in Primary Schools, Kindergartens, and Nurseries, Germany, June‒November 2020

Weekly SARS-CoV-2 Sentinel Surveillance in Primary Schools, Kindergartens, and Nurseries, Germany, June‒November 2020

Non-Invasive Antibody Assessment in Saliva to Determine SARS-CoV-2 Exposure in Young Children

Longitudinal testing for SARS-CoV-2 RNA in day care centers in Hesse, Germany, during increased local incidence and with VOC Alpha as dominant variant: Results of the SAFE KiDS 2 and SAFE KiDS 3 study

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