Feasibility of SARS-CoV-2 Surveillance Testing Among Children and Childcare Workers at German Day Care Centers: A Nonrandomized Controlled Trial
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Published on: June 23, 2022
Johannes Forster1, Andrea Streng2, Paul Rudolph3
1Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany.
Insights
Day care closures negatively impact children. Continuous SARS-CoV-2 surveillance using biweekly saliva testing in childcare settings is feasible and accepted, minimizing viral spread and enabling continued operations.
Area of Science:
- Epidemiology
- Public Health
- Infectious Disease Surveillance
Background:
- Day care center closures during the COVID-19 pandemic negatively affected children's health and psychosocial well-being.
- Effective surveillance strategies are needed to prevent viral spread in childcare settings while maintaining operations.
Purpose of the Study:
- To assess the feasibility and acceptance of different SARS-CoV-2 surveillance modules in day care centers.
- To model the efficacy of surveillance strategies in preventing viral spread among children and childcare workers.
Main Methods:
- A nonrandomized controlled trial involving 9 German day care centers from October 2020 to March 2021.
- Four surveillance modules were implemented: continuous PCR testing (nasal swabs or saliva) and symptom-based testing.
- Mathematical modeling was used to estimate viral spread and identify optimal surveillance requirements.
Main Results:
- 62% of eligible individuals (442 children, 150 childcare workers) participated.
- Biweekly saliva testing showed the highest acceptance (67.9%) and lowest dropout rates (4%).
- Mathematical modeling indicated biweekly testing of at least 50% of attendees is required to limit secondary infections.
Conclusions:
- SARS-CoV-2 surveillance in day care centers is feasible and well-accepted by participants.
- Continuous surveillance, particularly using biweekly saliva testing, can effectively minimize viral spread.
- These findings support the implementation of surveillance programs to maintain institutional childcare during pandemics.
Importance:
Closure of day care centers has been implemented globally to contain the COVID-19 pandemic but has negative effects on children's health and psychosocial well-being.
Objective:
To investigate the feasibility of surveillance among children and childcare workers and to model the efficacy of surveillance on viral spread prevention.
Design, Setting, And Participants:
This nonrandomized controlled trial was conducted at 9 day care centers in Wuerzburg, Germany, from October 2020 to March 2021. Participants included children attending day care, childcare workers, and household members. Participating day care centers were assigned to different surveillance modules in a nonrandomized feasibility study. A mathematical model for SARS-CoV-2 spread in day care centers was developed to identify optimal surveillance.
Interventions:
Modules 1, 2, and 3 involved continuous surveillance of asymptomatic children and childcare workers by SARS-CoV-2 polymerase chain reaction testing of either midturbinate nasal swabs twice weekly (module 1) or once weekly (module 2) or self-sampled saliva samples twice weekly (module 3). Module 4 involved symptom-based, on-demand testing of children, childcare workers, and their household members by oropharyngeal swabs. All participants underwent SARS-CoV-2 antibody status testing before and after the sampling period. Questionnaires on attitudes and perception of the pandemic were administered in weeks 1, 6, and 12. Mathematical modeling was used to estimate SARS-CoV-2 spread in day care centers.
Main Outcomes And Measures:
The primary outcomes were acceptance of the respective surveillance protocols (feasibility study) and the estimated number of secondary infections (mathematical modeling).
Results:
Of 954 eligible individuals (772 children and 182 childcare workers), 592 (62%), including 442 children (median [IQR] age, 3 [2-4] years; 214 [48.6%] female) and 150 childcare workers (median [IQR] age, 29 [25-44] years; 129 [90.8%] female) participated in the surveillance. In total, 4755 tests for SARS-CoV-2 detected 2 infections (1 childcare worker and 1 adult household member). Acceptance for continuous surveillance was highest for biweekly saliva testing (150 of 221 eligible individuals [67.9%; 95% CI, 61.5%-73.7%]) compared with biweekly (51 of 117 individuals [43.6%; 95% CI, 35.0%-52.6%]) and weekly (44 of 128 individuals [34.4%; 95% CI, 26.7%-43.0%]) midturbinate swabbing (P < .001). Dropout rates were higher for midturbinate swabbing (biweekly, 11 of 62 participants [18%]; once weekly, 11 of 55 participants [20%]) than for saliva testing (6 of 156 participants [4%]). Mathematical modeling based on study and literature data identified biweekly testing of at least 50% of children and childcare workers as minimal requirements to limit secondary infections.
Conclusions And Relevance:
In this nonrandomized controlled trial, surveillance for SARS-CoV-2 in 9 German day care centers was feasible and well accepted. Mathematical modeling estimated that testing can minimize the spread of SARS-CoV-2 in day care centers. These findings enable setup of surveillance programs to maintain institutional childcare.
Trial Registration:
German Registry for Clinical Trials Identifier: DRKS00023721.
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