SARS-CoV-2 Transmission Risk in the School Environment: a pilot case-ascertained prospective study to inform future school-based surveillance.
Keywords:SARS-CoV-2 Transmission, school environment
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.
Xu W, Li X, Dong Y, et al. SARS-CoV-2 transmission in schools: An updated living systematic review (version 2; November 2020). J Glob Health 2021;11:10004. https://doi.org/10.7189/jogh.11.10004
Krishnaratne S, Littlecott H, Sell K, et al. Measures implemented in the school setting to contain
the COVID-19 pandemic. Cochrane Database Syst Rev 2022;1(1):CD015029. https://doi.
Walsh S, Chowdhury A, Braithwaite V, et al. Do school closures and school reopenings affect community transmission of COVID-19? A systematic review of observational studies. BMJ Open 2021;11(8):e053371. https://doi.org/10.1136/bmjopen-2021-053371
South Africa. National Health Act No. 61 of 2003.
Morifi M, Malevu N, Odayan S, McCarthy K, Kufa T. Congenital syphilis case surveillance in South
Africa 2017 - 19: Experience, challenges and opportunities. J Trop Pediatr 2021;67(4):fmab079. https:// doi.org/10.1093/tropej/fmab079
Department of Basic Education, South Africa. Standard Operating Procedure for the containment and management of COVID-19 for schools and communities (September 2020). https://www.education.gov. za/Resources/Publications.aspx (accessed 20 May 2022).
Department of Basic Education, South Africa. Standard Operating Procedure for the containment and management of COVID-19 for schools and communities (February 2022). https://www.education.gov. za/Resources/Publications.aspx (accessed 20 May 2022).
Lenkokile R, Hlongwane P, Clapper V. Implementation of the integrated school health policy in public primary schools in region C, Gauteng Province. Afr J Public Affairs 2019;11(1):196-211.
Rasesemola RM, Matshoge GP, Ramukumba TS. Compliance to the Integrated School Health Policy: Intersectoral and multisectoral collaboration. Curationis 2019;42(1):e1-e8. https://doi.org/10.4102/ curationis.v42i1.1912
JansevanRensburgAP,RauA.AssessingtheimplementationoftheIntegratedSchoolHealthProgramme (ISHP) in anonymised local municipality, Free State Province. Bloemfontein: Centre for Health Systems Research & Development, 2017.
HarrisPA,TaylorR,MinorBL,etal.TheREDCapconsortium:Buildinganinternationalcommunityof software platform partners. J Biomed Inform 2019;95:103208. https://doi.org/10.1016/j.jbi.2019.103208
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42(2):377-381. https://doi.org/10.1016/j. jbi.2008.08.010
Macartney K, Quinn HE, Pillsbury AJ, et al. Transmission of SARS-CoV-2 in Australian educational settings: A prospective cohort study. Lancet Child Adolesc Health 2020;4(11):807-816. https://doi. org/10.1016/s2352-4642(20)30251-0
Heymann DL, Rodier GR, Ryan MJ. Ebola vaccines: Keep the clinical trial protocols on the shelf and ready to roll out. Lancet 2015;385(9980):1913-1915. https://doi:10.1016/S0140-6736(15)60645-6
Copyright (c) 2023 N L Siegfried
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.