SARS-CoV-2 Circulation in the School Setting: A Systematic Review and Meta-Analysis

• Published in: International journal of environmental research and public health Vol. 19; no. 9; p. 5384
• Main Authors: Caini, Saverio, Martinoli, Chiara, La Vecchia, Carlo, Raimondi, Sara, Bellerba, Federica, D'Ecclesiis, Oriana, Sasso, Clementina, Basso, Alessandra, Cammarata, Giulio, Gandini, Sara
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 28.04.2022; MDPI
• Subjects: Adults; Children; Confidence intervals; Contact Tracing; Coronaviruses; COVID-19; COVID-19 - epidemiology; Disease transmission; Estimates; Humans; Infections; Literature reviews; Meta-analysis; Pandemics; Review; SARS-CoV-2; Schools; Seroepidemiologic Studies; Serology; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Software; Students; Systematic review; United States > US; SARS-CoV-2; screening; susceptibility; schools; teachers; infections; meta-analysis; students; contract tracing
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph19095384

The contribution of children to viral spread in schools is still debated. We conducted a systematic review and meta-analysis of studies to investigate SARS-CoV-2 transmission in the school setting. Literature searches on 15 May 2021 yielded a total of 1088 publications, including screening, contact tracing, and seroprevalence studies. MOOSE guidelines were followed, and data were analyzed using random-effects models. From screening studies involving more than 120,000 subjects, we estimated 0.31% (95% confidence interval (CI) 0.05-0.81) SARS-CoV-2 point prevalence in schools. Contact tracing studies, involving a total of 112,622 contacts of children and adults, showed that onward viral transmission was limited (2.54%, 95% CI 0.76-5.31). Young index cases were found to be 74% significantly less likely than adults to favor viral spread (odds ratio (OR) 0.26, 95% CI 0.11-0.63) and less susceptible to infection (OR 0.60; 95% CI 0.25-1.47). Lastly, from seroprevalence studies, with a total of 17,879 subjects involved, we estimated that children were 43% significantly less likely than adults to test positive for antibodies (OR 0.57, 95% CI 0.49-0.68). These findings may not applied to the Omicron phase, we further planned a randomized controlled trial to verify these results.