SARS-CoV-2 Transmission Risk in the School Environment: a pilot case-ascertained prospective study to inform future school-based surveillance.

Authors

  • N L Siegfried Health Systems Research Unit, South African Medical Council, Tygerberg, South Africa. Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  • A de Voux SouthAfricanFieldEpidemiologyTrainingProgramme,DivisionofPublicHealth,SurveillanceandResponse,NationalInstituteforCommunicable Diseases of the National Health Laboratory Service, and Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  • K Jona Health Systems Research Unit, South African Medical Council, and Faculty of Health Sciences, University of Cape Town, South Africa
  • J A Yun Health Systems Research Unit, South African Medical Council, and Faculty of Health Sciences, University of Cape Town, South Africa
  • T Chetty SouthAfricanFieldEpidemiologyTrainingProgramme,DivisionofPublicHealth,SurveillanceandResponse,NationalInstituteforCommunicable Diseases of the National Health Laboratory Service, and Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  • M Mabona SouthAfricanFieldEpidemiologyTrainingProgramme,DivisionofPublicHealth,SurveillanceandResponse,NationalInstituteforCommunicable Diseases of the National Health Laboratory Service, and Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  • F Els SouthAfricanFieldEpidemiologyTrainingProgramme,DivisionofPublicHealth,SurveillanceandResponse,NationalInstituteforCommunicable Diseases of the National Health Laboratory Service, and Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  • H Mdose SouthAfricanFieldEpidemiologyTrainingProgramme,DivisionofPublicHealth,SurveillanceandResponse,NationalInstituteforCommunicable Diseases of the National Health Laboratory Service, and Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  • L Kuonza SouthAfricanFieldEpidemiologyTrainingProgramme,DivisionofPublicHealth,SurveillanceandResponse,NationalInstituteforCommunicable Diseases of the National Health Laboratory Service, and Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  • M Hsiao SouthAfricanFieldEpidemiologyTrainingProgramme,DivisionofPublicHealth,SurveillanceandResponse,NationalInstituteforCommunicable Diseases of the National Health Laboratory Service, and Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  • C Mathews Health Systems Research Unit, South African Medical Council, and Faculty of Health Sciences, University of Cape Town, South Africa

DOI:

https://doi.org/10.7196/SAMJ.2023.v113i5.16736

Keywords:

SARS-CoV-2 Transmission, school environment

Abstract

Background. There is no current active or passive disease surveillance programme focused on schools in South Africa. As such the country is missing an opportunity to rapidly and effectively flag and address pathogen outbreaks, for example SARS-CoV-2, in a key closed setting. Furthermore, the role of school transmission in the spread of the SARS-CoV-2 virus within communities is uncertain. 

Objective. This pilot study, conducted during March 2022 in Cape Town, aimed to indicate the feasibility of conducting intense active contact-tracing in a school environment prior to a large national study to compare school versus community SARS-CoV-2 transmission risk. 

Methods. We conducted a pilot school-level case-ascertained prospective study with a component of enhanced surveillance. Following study initiation, the first learner at a participating school who tested SARS-CoV-2 positive (via Polymerase Chain Reaction (PCR) or a Rapid Antigen Test (RAT)) was invited to join the study as the index case and all their school-based close contacts were followed up telephonically, monitored for symptoms for 14 days, and tested using a PCR if any symptoms were reported. 

Results. On 8th March 2022, a student with RAT laboratory-confirmed COVID-19 was identified and they and their guardian consented to participate as the index case. Of the 11 eligible close contacts, six provided consent/assent and completed symptom monitoring calls until the end of the 14-day study period. The Secondary Attack Rate (SAR) was 2/11 (18.18%) of all close contacts who were at risk of infection, 2/4 (50.0%) of all those close contacts who developed symptoms, and 2/4 (50.0%) of all those close contacts who developed symptoms and were tested for SARS-CoV-2. During the same period, the school reported that nine of the 926 learner body tested COVID-19 positive (0.97%). Total hours spent conducting monitoring for 6 learners was 27 hours, with each learner requiring approximately 4.5 hours of contact time during the study period. 

Conclusion. This is the first South African school-based COVID-19 transmission study, the results of which can inform national discussions regarding the role of schools and school-based active and passive surveillance in pathogen prevention and control. 

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Published

2023-05-05

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Section

Research

How to Cite

1.
Siegfried NL, de Voux A, Jona K, Yun JA, Chetty T, Mabona M, et al. SARS-CoV-2 Transmission Risk in the School Environment: a pilot case-ascertained prospective study to inform future school-based surveillance. . S Afr Med J [Internet]. 2023 May 5 [cited 2024 Jun. 12];113(5):30-8. Available from: https://samajournals.co.za/index.php/samj/article/view/835

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