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

Area of Science:

• Epidemiology
• Public Health
• Infectious Diseases

Background:

• The role of children in the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within school environments remains a subject of ongoing scientific debate and public health concern.
• Understanding transmission dynamics is crucial for implementing effective control measures in educational settings.

Purpose of the Study:

• To systematically review and analyze existing literature to quantify the contribution of children to SARS-CoV-2 spread in schools.
• To compare the susceptibility and transmission potential of children versus adults regarding SARS-CoV-2 infection.

Main Methods:

• A comprehensive systematic review and meta-analysis of published studies was conducted, adhering to MOOSE guidelines.
• Data from screening, contact tracing, and seroprevalence studies involving over 150,000 participants were analyzed using random-effects models.
• Odds ratios (OR) and confidence intervals (CI) were calculated to assess differences in prevalence, transmission, and susceptibility between children and adults.

Main Results:

• Point prevalence of SARS-CoV-2 in schools was estimated at 0.31% (95% CI 0.05-0.81) based on screening studies.
• Onward viral transmission from identified cases in contact tracing studies was limited, with a 2.54% (95% CI 0.76-5.31) transmission rate.
• Children were significantly less likely than adults to spread the virus (OR 0.26, 95% CI 0.11-0.63) and showed lower susceptibility (OR 0.60, 95% CI 0.25-1.47).
• Seroprevalence studies indicated children were 43% less likely to test positive for antibodies (OR 0.57, 95% CI 0.49-0.68).

Conclusions:

• The findings suggest that children play a limited role in SARS-CoV-2 transmission within schools.
• Children appear to be less susceptible to infection and less likely to transmit the virus compared to adults.
• Further research, including a planned randomized controlled trial, is warranted to validate these findings, particularly in light of emerging variants like Omicron.