Prevalence and Risk Factors for School-Associated Transmission of SARS-CoV-2

Nelson, Sandra; Dugdale, Caitlin M; Brenner, Isaac Ravi; Crawford, Allison; Bilinski, Alyssa; Cosar, Duru; Pollock, Nira R.; Ciaranello, Andrea

doi:10.1001/jamahealthforum.2023.2310

Cited by 3 publications

(5 citation statements)

References 22 publications

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“…Factors associated with transmission risk were the vaccine status of the exposed contact, household density (i.e., the number of people sleeping in the same room), and immunological factors such as the magnitude of cross-reactive memory T cells to SARS-CoV-2 antigens [3][4][5] . In general, the SARs reported in households, and other residential settings 6 , have been far higher than reported in other settings such as schools, where a SAR of 2.8% was reported for exposed students in 10 Massachusetts schools during the Delta wave 7 .…”

Section: Introductionmentioning

confidence: 72%

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Household Transmission during the Omicron Era in Massachusetts: A Prospective, Case-Ascertained Study using Genomic Epidemiology

Banga,

Brock-Fisher,

Petros

et al. 2024

Preprint

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BackgroundHouseholds are a major setting for SARS-CoV-2 infections, but there remains a lack of knowledge regarding the dynamics of viral transmission, particularly in the setting of widespread pre-existing SARS-CoV-2 immunity and evolving variants.MethodsWe conducted a prospective, case-ascertained household transmission study in the greater Boston area in March-July 2022. Anterior nasal swabs, along with clinical and demographic data, were collected for 14 days. Nasal swabs were tested for SARS-CoV-2 by PCR. Whole genome sequencing was performed on high-titer samples.ResultsWe enrolled 33 households in a primary analysis set, with a median age of participants of 25 years old (range 2-66); 98% of whom had received at least 2 doses of a COVID-19 vaccine. 58% of households had a secondary case during follow up and the secondary attack rate (SAR) for contacts infected was 39%. We further examined a strict analysis set of 21 households that had only 1 PCR+ case at baseline, finding an SAR of 22.5%. Genomic epidemiology further determined that there were multiple sources of infection for household contacts, including the index case and outside introductions. When limiting estimates to only highly probable transmissions given epidemiologic and genomic data, the SAR was 18.4%.ConclusionsHousehold contacts of a person newly diagnosed with COVID-19 are at high risk for SARS-CoV-2 infection in the following 2 weeks. This is, however, not only due to infection from the household index case, but also because the presence of an infected household member implies increased SARS-CoV-2 community transmission. Further studies to understand and mitigate household transmission are needed.Key PointsWhen community transmission of SARS-CoV-2 is high, distinguishing household transmissions from independent introductions is difficult with either epidemiologic or genomic data alone. Here, we conducted daily nasal sampling with genomic sequencing to understand the dynamics of viral transmission within households.

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Section: Introductionmentioning

confidence: 72%

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Household Transmission during the Omicron Era in Massachusetts: A Prospective, Case-Ascertained Study using Genomic Epidemiology

Banga,

Brock-Fisher,

Petros

et al. 2024

Preprint

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“…The majority of the few school reopening studies with a low risk of bias reported no associated increases in transmission [ 29 ]. Collectively, the scientific evidence on primary and secondary school closures and reopenings, although still an unresolved issue, agrees that (i) school closures in the early phase of the pandemic were helpful in counteracting the spread of the virus at a time when our understanding of SARS-CoV-2 infection was limited [ 35 ]; (ii) the variability in the results of published studies may reflect problems in study design [ 29 , 30 , 36 ]; and (iii) in-person learning increases children’s performance and well-being and can be safely maintained in school with robust preventive measures [ 5 , 14 , 15 , 36 , 37 ]. In contrast, there are fewer studies on the magnitude of universities’ contribution to community transmission [ 37 ], particularly in respect of strategies that might mitigate the spread of the virus, and the potential benefits of in-person education models on academic, social, mental and physical health outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…In this context, the identification of risk factors for the transmission of SARS-CoV-2 infection is crucial to guide health policy decisions aimed at limiting virus transmission and, at the same time, preserving the normal activities of everyday life as far as possible [2,3]. However, few analytical epidemiological studies have been conducted worldwide to investigate the risk factors for SARS-CoV-2 acquisition [4][5][6][7][8][9][10][11][12][13], particularly in healthy individuals attending community settings and areas posing unique challenges for transmission control, such as schools [14][15][16] and higher education institutions (HEIs) [17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Keeping university open did not increase the risk of SARS-CoV-2 acquisition: A test negative case-control study among students

Renzi,

Baccolini,

Covelli

et al. 2024

PLoS ONE

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Background During the SARS-CoV-2 testing program offered through the RT-PCR test by Sapienza University of Rome, we conducted a test-negative case-control study to identify risk factors for acquiring SARS-CoV-2 infection among university students. Methods Each SARS-CoV-2-positive case detected was matched to two controls randomly selected from students who tested negative on the same day. 122 positive students and 244 negative students were enrolled in the study. Multivariable conditional logistic regression models were built. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. A second model was limited to students who had attended campus. Results Out of 8223 tests for SARS-CoV-2, 173 students tested positive (2.1%), of whom 122 (71.5%) were included in the case-control study. In the first analysis, being a non-Italian student (aOR: 8.93, 95% CI: 2.71–29.41), having received only the primary vaccination course (aOR: 2.94, 95% CI: 1.24–6.96) compared to the booster dose, known exposure to a COVID-19 case or someone with signs/symptoms suggestive of COVID-19 (aOR: 6.51, 95% CI: 3.48–12.18), and visiting discos (aOR: 4.07, 95% CI: 1.52–10.90) in the two weeks before testing increased the likelihood of SARS-CoV-2 infection. Conversely, students attending in-person lectures on campus seemed less likely to become infected (aOR: 0.34, 95% CI: 0.15–0.77). No association was found with other variables. The results of the second model were comparable to the first analysis. Conclusions This study indicates that if universities adopt strict prevention measures, it is safe for students to attend, even in the case of an infectious disease epidemic.

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“…Compared with 2022, the total number of manuscript submissions to the journal increased by 25% to 1255 in 2023, and the number of submitted research manuscripts (Original Investigations, Brief Reports, and Research Letters) also rose by 25% to 894 (Table). With the robust growth in manuscript submissions, the journal’s acceptance rate has dropped from 26% to 21% overall and from 20% to 17% for research manuscripts.…”

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confidence: 99%

“…Articles in JAMA Health Forum were widely covered in the news media and broadly discussed on social media during 2023, as reflected in the 3 articles with the highest Altmetric scores that were greater than 1000 (Table). These 3 articles addressed important issues for policy and practice related to COVID-19 . Among articles published in 2023 with the top 50 Altmetric scores (ranging from 248 to 3043) in 20 peer-reviewed journals of health policy, health economics, and health services research, JAMA Health Forum published 18 of these articles, the largest number in any of the journals.…”

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confidence: 99%