Novel Coronavirus 2019 Transmission Risk in Educational Settings

Yung, Chee Fu; Kam, Kai Qian; Nadua, Karen Donceras; Chong, Chia Yin; Tan, Natalie Woon Hui; Li, Jiahui; Lee, Khai Pin; Chan, Yoke Hwee; Thoon, Koh Cheng; Ng, Kee Chong

doi:10.1093/cid/ciaa794

Cited by 94 publications

(119 citation statements)

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“…In total, 32 studies comprising 41 640 children and adolescents and 268 945 adults were included (Table), 7,10,12, with quality and bias assessments shown in eTable 1 in the Supplement and weblinks for included studies shown in eTable 2 in the Supplement. A total of 18 studies were contact-tracing studies (CTSs), 7,10,12,16-31 with 3 based in schools, [29][30][31] and 14 studies were population screening studies. 7, [32][33][34][35][36][37][38][39][40][41][42][43][44][45] Two were high quality, 33,35 22 were medium quality, 10,12,16,21,22,[24][25][26][27][29][30][31][32]34,36,38,[40][41][42][43][44][45] 7 were low quality, [17][18][19][20]…”

Section: Resultsmentioning

confidence: 99%

“…A total of 6 studies were from mainland China, 10,16,18,20,22,24 2 from the US, 25,26 and 1 each from Taiwan, 17 Japan, 19 South Korea, 12 Israel, 21 the Netherlands, 7,28 Brunei, 27 and India, 23 with 3 CTSs based in schools from Australia, 29 Ireland, 30 and Singapore. 31 Lower secondary attack rates in children and adolescents compared with adults were reported by 11 studies: 5 from provinces of China, including Hunan, 10,22 Hubei, 16,18 and Beijing, 20 and 6 from other countries, including Taiwan, 17 Japan, 19 the US, 25,26 Israel, 21 and the Netherlands, 7,28 although confidence intervals were wide in some studies. No significant differences in secondary attack rates by age were reported in 3 studies from Guangdong province, China, 24 Brunei, 27 and the states of Tamil Nadu and Andhra Pradesh in India, 23 with 1 study from South Korea 12 reporting high secondary attack rates in those younger than 19 years.…”

Section: Contact-tracing Studiesmentioning

confidence: 98%

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Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults

et al. 2021

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The degree to which children and adolescents are infected by and transmit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear. The role of children and adolescents in transmission of SARS-CoV-2 is dependent on susceptibility, symptoms, viral load, social contact patterns, and behavior. OBJECTIVE To systematically review the susceptibility to and transmission of SARS-CoV-2 among children and adolescents compared with adults. DATA SOURCES PubMed and medRxiv were searched from database inception to July 28, 2020, and a total of 13 926 studies were identified, with additional studies identified through hand searching of cited references and professional contacts. STUDY SELECTION Studies that provided data on the prevalence of SARS-CoV-2 in children and adolescents (younger than 20 years) compared with adults (20 years and older) derived from contact tracing or population screening were included. Single-household studies were excluded. DATA EXTRACTION AND SYNTHESIS PRISMA guidelines for abstracting data were followed, which was performed independently by 2 reviewers. Quality was assessed using a critical appraisal checklist for prevalence studies. Random-effects meta-analysis was undertaken. MAIN OUTCOMES AND MEASURES Secondary infection rate (contact-tracing studies) or prevalence or seroprevalence (population screening studies) among children and adolescents compared with adults. RESULTS A total of 32 studies comprising 41 640 children and adolescents and 268 945 adults met inclusion criteria, including 18 contact-tracing studies and 14 population screening studies. The pooled odds ratio of being an infected contact in children compared with adults was 0.56 (95% CI, 0.37-0.85), with substantial heterogeneity (I 2 = 94.6%). Three school-based contact-tracing studies found minimal transmission from child or teacher index cases. Findings from population screening studies were heterogenous and were not suitable for meta-analysis. Most studies were consistent with lower seroprevalence in children compared with adults, although seroprevalence in adolescents appeared similar to adults. CONCLUSIONS AND RELEVANCE In this meta-analysis, there is preliminary evidence that children and adolescents have lower susceptibility to SARS-CoV-2, with an odds ratio of 0.56 for being an infected contact compared with adults. There is weak evidence that children and adolescents play a lesser role than adults in transmission of SARS-CoV-2 at a population level. This study provides no information on the infectivity of children.

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Section: Resultsmentioning

confidence: 99%

Section: Contact-tracing Studiesmentioning

confidence: 98%

Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults

et al. 2021

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“…Thus, detecting transmission between children specifically is difficult; quantifying it is all the more challenging. An analysis of contact tracing data from Singapore suggests that per contact transmission between children, particularly in educational settings, is low compared to adult-adult transmission [24]. Yet the number of contacts between children is expected to be significantly higher compared to other age groups [26].…”

Section: Methodsmentioning

confidence: 99%

An examination of school reopening strategies during the SARS-CoV-2 pandemic

Landeros¹,

Lange

et al. 2020

Preprint

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The SARS-CoV-2 pandemic led to the closure of nearly all K-12 schools in the United States of America in March 2020. Although reopening K-12 schools for in-person schooling is desirable for many reasons, officials also understand that risk reduction strategies and detection of cases must be in place to allow children to safely return to school. Furthermore, the consequences of reclosing recently reopened schools are substantial and impact teachers, parents, and ultimately the educational experience in children. Using a stratified Susceptible-Exposed-Infected-Removed model, we explore the influences of reduced class density, transmission mitigation (such as the use of masks, desk shields, frequent surface cleaning, or outdoor instruction), and viral detection on cumulative prevalence. Our model predicts that a combination of all three approaches will substantially reduce SARS-CoV-2 prevalence. The model also shows that reduction of class density and the implementation of rapid viral testing, even with imperfect detection, have greater impact than moderate measures for transmission mitigation.

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“…During February and March, nationwide surveillance and contact-tracing in Singapore identified two SARS-CoV-2 positive students (5-year-old and 12-year-old) who attended pre-school and secondary school on the first day of their symptoms before subsequently being diagnosed with COVID-19, and one school staff who worked in a pre-school [15]. Screening of 119 students and staff who were close contacts (secondary school: n=8; pre-school 1: n=34; pre-school 2: n=77) did not detect any SARS-CoV-2 infection.…”

Section: Cohort Studiesmentioning

confidence: 99%

What is the evidence for transmission of COVID-19 by children in schools? A living systematic review

Dozier

et al. 2020

Preprint

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Background: It is of paramount importance to understand the transmission of SARS-CoV-2 in schools, which could support the decision-making about educational facilities closure or re-opening with effective prevention and control measures in place. Methods: We conducted a systematic review and meta-analysis to investigate the extent of SARS-CoV-2 transmission in schools. We performed risk of bias evaluation of all included studies using the Newcastle- Ottawa Scale (NOS). Results: 2,178 articles were retrieved and 11 studies were included. Five cohort studies reported a combined 22 student and 21 staff index cases that exposed 3,345 contacts with 18 transmissions [overall infection attack rate (IAR): 0.08% (95% CI: 0.00%-0.86%)]. IARs for students and school staff were 0.15% (95% CI: 0.00%-0.93%) and 0.70% (95% CI: 0.00%-3.56%) respectively. Six cross-sectional studies reported 639 SARS-CoV-2 positive cases in 6,682 study participants tested [overall SARS-CoV-2 positivity rate: 8.00% (95% CI: 2.17%-16.95%)]. SARS-CoV-2 positivity rate was estimated to be 8.74% (95% CI: 2.34%-18.53%) among students, compared to 13.68% (95% CI: 1.68%-33.89%) among school staff. Gender differences were not found for secondary infection (OR: 1.44, 95% CI: 0.50-4.14, P= 0.49) and SARS-CoV-2 positivity (OR: 0.90, 95% CI: 0.72-1.13, P= 0.36) in schools. Fever, cough, dyspnea, ageusia, anosmia, rhinitis, sore throat, headache, myalgia, asthenia, and diarrhoea were all associated with the detection of SARS-CoV-2 antibodies (based on two studies). Overall, study quality was judged to be poor with risk of performance and attrition bias, limiting the confidence in the results. Conclusions: There is limited high-quality evidence available to quantify the extent of SARS-CoV-2 transmission in schools or to compare it to community transmission. Emerging evidence suggests lower IAR and SARS-CoV-2 positivity rate in students compared to school staff. Future prospective and adequately controlled cohort studies are necessary to confirm this finding.

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Novel Coronavirus 2019 Transmission Risk in Educational Settings

Cited by 94 publications

References 10 publications

Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults

Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults

An examination of school reopening strategies during the SARS-CoV-2 pandemic

What is the evidence for transmission of COVID-19 by children in schools? A living systematic review

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