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A team of German scientists tested children and staff members from several nursery schools in the state of Hesse, Germany, to detect the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Their findings suggest that SARS-CoV-2 infection rarely occurs in daycare centers and, therefore, these centers should not be considered potential reservoirs of the virus. The study is currently available on medRxiv* prepress server.
Since the emergence of the 2019 coronavirus disease (COVID-19) pandemic, many studies have been conducted to identify susceptible individuals who are at the greatest risk of developing a serious SARS-CoV-2 infection. While most of these studies indicated that older adults are highly susceptible to severe infections, preschool children are mostly considered to be the low-risk population in terms of contracting a severe infection.
However, the closure of schools and day care centers during the isolation period at the start of the COVID-19 outbreak in Germany was found to have a negative impact on the overall well-being of children. Children from low socio-economic backgrounds and those with special educational needs (SENs) are believed to have been severely affected by the limited access to education related to blocking measures.
Since children infected with SARS-CoV-2 remain mostly asymptomatic or mildly symptomatic, they may unknowingly pass the virus on to their caregivers, teachers, and schoolmates while attending school or daycare. Therefore, it is generally assumed that children with subtle signs and symptoms should be tested frequently for possible viral infections to help break the chain of transmission.
Current study design
The SAFE-KiDS-Study by researchers at Goethe University, the German Center for Infection Research, the Fraunhofer Institute and the Hessian State Bureau of Examination and Investigation (HLPUG), was conducted for the early detection of infection from SARS-CoV-2 in state nurseries in Hesse, Germany, using both respiratory (buccal mucosa swab) and gastrointestinal (anal swab) samples. Scientists did not use nasopharyngeal or oropharyngeal swab samples to collect these samples as this approach requires careful supervision by healthcare professionals. Conversely, the buccal mucosa and anal swabs can be easily collected by children from their parents.
Scientists tested 825 children (age range: 3 months to 8 years) and 372 staff members (age range: 19 to 64 years) from 50 daycare centers located across the state for respiratory and gastrointestinal elimination by SARS-CoV-2. They conducted the tests weekly for a period of 12 weeks.
Under government rules, children and staff with respiratory infection symptoms, with the exception of a runny nose, were not allowed to enter the day care centers. Children and staff members with possible contact history or with symptomatic family members were also not admitted to the centers. However, wearing the mask was not mandatory for children or staff members.
Important remarks
Scientists tested a total of 7,366 buccal mucosal swabs and 5,907 anal swabs. Detection of SARS-CoV-2 was performed by real-time polymerase chain reaction (RT-PCR) tests, which look for the genetic code of the virus in host cell samples.
Of all study participants, only two staff members from different daycare centers tested positive for SARS-CoV-2. One of them was asymptomatic and was unaware that he had the infection at the time of the test. The other person was symptomatic. All staff members and children from these two nurseries were sent to home quarantine. None of the children in the study tested positive for SARS-CoV-2.
At the end of the study, the scientists conducted a survey to see if any participant had been diagnosed with COVID-19 during the home quarantine period. However, none of them reported having a positive diagnosis.
In the study regions, the overall prevalence of SARS-CoV-2 infection was low in the general population and in children younger than 6 years of age during the study period. Although the number of COVID-19 cases varied between regions and study weeks, the highest prevalence was 66 cases per 100,000 residents.
Meaning of the study
The study results indicate that the risk of active transmission of SARS-CoV-2 infection among children and daycare staff can be considerably low in regions with a low prevalence of COVID-19. Unlike other respiratory viruses, such as the influenza A virus, where children are highly susceptible to contracting and further transmitting the infection, SARS-CoV-2 appears to be rarely transmitted through children, at least in confined environments.
The study indicates that schools or day care centers do not appear to be potential viral transmission centers, at least in regions where the overall incidence of COVID-19 cases is low. Proper implementation of control measures, such as restricted access to facilities, can be vital to contain the spread of SARS-CoV-2.
*Important Notice
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or treated as consolidated information.
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