SARS-CoV-2 infection in schools in a northern French city: a retrospective serological cohort study in an area of high transmission, France, January to April 2020
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Abstract
Children’s role in SARS-CoV-2 epidemiology remains unclear. We investigated an initially unnoticed SARS-CoV-2 outbreak linked to schools in northern France, beginning as early as mid-January 2020.
Aims
This retrospective observational study documents the extent of SARS-CoV-2 transmission, linked to an affected high school (n = 664 participants) and primary schools (n = 1,340 study participants), in the context of unsuspected SARS-CoV-2 circulation and limited control measures.
Methods
Between 30 March and 30 April 2020, all school staff, as well as pupils and their parents and relatives were invited for SARS-CoV-2 antibody testing and to complete a questionnaire covering symptom history since 13 January 2020.
Results
In the high school, infection attack rates were 38.1% (91/239), 43.4% (23/53), and 59.3% (16/27), in pupils, teachers, and non-teaching staff respectively vs 10.1% (23/228) and 12.0% (14/117) in the pupils’ parents and relatives (p < 0.001). Among the six primary schools, three children attending separate schools at the outbreak start, while symptomatic, might have introduced SARS-CoV-2 there, but symptomatic secondary cases related to them could not be definitely identified. In the primary schools overall, antibody prevalence in pupils sharing classes with symptomatic cases was higher than in pupils from other classes: 15/65 (23.1%) vs 30/445 (6.7%) (p < 0.001). Among 46 SARS-CoV-2 seropositive pupils < 12 years old, 20 were asymptomatic. Whether past HKU1 and OC43 seasonal coronavirus infection protected against SARS-CoV-2 infection in 6–11 year olds could not be inferred.
Conclusions
Viral circulation can occur in high and primary schools so keeping them open requires consideration of appropriate control measures and enhanced surveillance.
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SciScore for 10.1101/2020.04.18.20071134: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Since most pupils were minor, at least one parent was invited to participate in the study, to provide informed consent for their child and for any of the other children over the age of 5 years in the household enrolled in the study. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Antibodies Sentences Resources Laboratory analyses: All serum samples were tested for antibody responses to SARS-CoV-2 using several assays developed by Institut Pasteur : an ELISA N assay, detecting antibodies binding to the N protein; a S-Flow assay, which is a flow-cytometry based assay … SciScore for 10.1101/2020.04.18.20071134: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Since most pupils were minor, at least one parent was invited to participate in the study, to provide informed consent for their child and for any of the other children over the age of 5 years in the household enrolled in the study. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Antibodies Sentences Resources Laboratory analyses: All serum samples were tested for antibody responses to SARS-CoV-2 using several assays developed by Institut Pasteur : an ELISA N assay, detecting antibodies binding to the N protein; a S-Flow assay, which is a flow-cytometry based assay detecting anti-S IgG; and a LIPS assay, which is an immunoprecipitation-based assay detecting anti-N and anti-S1 IgG. anti-S IgGsuggested: Noneanti-Nsuggested: Noneanti-S1 IgGsuggested: NoneResults from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:In the context of the ongoing debates around the contribution of children and schools to viral transmission, these findings are of interest, and the impact of the school closure on the epidemic dynamic is particularly striking, with the limitation that these findings are restricted to high school setting only. High school pupils and their teachers had comparable IAR, similar to what was observed in Iceland when comparing the viral detection proportion between the 10-19 years old and adults in the targeted testing group.9 In the infected study population, the overall hospitalisation rate was 5.3%, and no death was observed. These relatively low figures need to be considered against the young age of a large part of the study population (40% were between 15 and 17 years of age; median age was 37 years; only two were older than 65 years). The current understanding of COVID-19 severity is that clinical presentation, hospitalisation rate and the CFR are lower among younger age groups.3,10,11 The IAR was higher among those with major symptoms, compared to those with minor or no symptoms. As documented before, anosmia and ageusia had high predictive values for COVID-19.12,13 While 17% of the infected had no symptoms during the study period, the true proportion of asymptomatic SARS-CoV-2 infections is likely higher since symptoms among those infected may also be attributable to the other respiratory viruses that were circulating in the community during that time period. Smokers had a ...
Results from TrialIdentifier: We found the following clinical trial numbers in your paper:
Identifier Status Title NCT04325646 Recruiting Sero-epidemiological Study of the SARS-CoV-2 Virus Responsib… Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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SciScore for 10.1101/2020.06.25.20140178: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Since pupils were minor, at least one parent was invited to provide informed consent for their child. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Cell Line Authentication not detected. Table 2: Resources
Experimental Models: Cell Lines Sentences Resources The assay is based on the recognition of the SARS-CoV-2 Spike protein expressed at the surface of 293T cells. 293Tsuggested: NCBI_Iran Cat# C498, RRID:CVCL_0063)Software and Algorithms Sentences Resources All statistical analyses were performed using Stata 15.0 (StataCorp, College Station, TX, USA). StataCorpsuggested: (Stata, RRID:SCR_012763)SciScore for 10.1101/2020.06.25.20140178: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Since pupils were minor, at least one parent was invited to provide informed consent for their child. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Cell Line Authentication not detected. Table 2: Resources
Experimental Models: Cell Lines Sentences Resources The assay is based on the recognition of the SARS-CoV-2 Spike protein expressed at the surface of 293T cells. 293Tsuggested: NCBI_Iran Cat# C498, RRID:CVCL_0063)Software and Algorithms Sentences Resources All statistical analyses were performed using Stata 15.0 (StataCorp, College Station, TX, USA). StataCorpsuggested: (Stata, RRID:SCR_012763)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Another limitation was the incomplete sampling of classes and families, preventing from a full exploration of viral circulation in the schools and households. The clinical findings of our investigation were also limited by the fact that information on symptoms was collected retrospectively, and that other respiratory viruses were circulating concurrently in the study population.
Results from TrialIdentifier: We found the following clinical trial numbers in your paper:
Identifier Status Title NCT04325646 Recruiting Sero-epidemiological Study of the SARS-CoV-2 Virus Responsib… Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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SciScore for 10.1101/2020.04.18.20071134: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Since most pupils were minor , at least one parent was invited to participate in the study , to provide informed consent for their child and for any of the other children over the age of 5 years in the household enrolled in the study . Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable There was no difference in IAR between males and females , while IAR was highest ( 40.0 % ) in the 15-17 years age group . Table 2: Resources
Antibodies Sentences Resources Added value of this study Using a combination of serologic assays with high sensitivity and specificity for anti-SARS-CoV-2 antibodies , we … SciScore for 10.1101/2020.04.18.20071134: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Since most pupils were minor , at least one parent was invited to participate in the study , to provide informed consent for their child and for any of the other children over the age of 5 years in the household enrolled in the study . Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable There was no difference in IAR between males and females , while IAR was highest ( 40.0 % ) in the 15-17 years age group . Table 2: Resources
Antibodies Sentences Resources Added value of this study Using a combination of serologic assays with high sensitivity and specificity for anti-SARS-CoV-2 antibodies , we conducted a retrospective closed cohort study . anti-SARS-CoV-2suggested: NoneLaboratory analyses All serum samples were tested for antibody responses to SARS-CoV-2 using several assays developed by Institut Pasteur : an ELISA N assay , detecting antibodies binding to the N protein; a S-Flow assay , which is a flow-cytometry based assay detecting anti-S IgG; and a LIPS assay , which is an immunoprecipitation-based assay detecting anti-N and anti-S1 IgG . anti-S IgGsuggested: None<div style="margin-bottom:8px"> <div><b>anti-N</b></div> <div>suggested: None</div> </div> <div style="margin-bottom:8px"> <div><b>anti-S1 IgG</b></div> <div>suggested: None</div> </div> </td></tr><tr><td style="min-width:100px;vertical-align:top;border-bottom:1px solid lightgray">We also found 3 % of blood donors residing in the surrounding area to have evidence of anti-SARSCoV-2 antibodies .</td><td style="min-width:100px;border-bottom:1px solid lightgray"> <div style="margin-bottom:8px"> <div><b>anti-SARSCoV-2</b></div> <div>suggested: None</div> </div> </td></tr></table>Results from OddPub: We did not find a statement about open data. We also did not find a statement about open code. Researchers are encouraged to share open data when possible (see Nature blog).
About SciScore
SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.
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