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

  1. Saverio Caini
  2. Chiara Martinoli
  3. Carlo La Vecchia
  4. Sara Raimondi
  5. Federica Bellerba
  6. Oriana D’Ecclesiis
  7. Clementina Sasso
  8. Alessandra Basso
  9. Giulio Cammarata
  10. Sara Gandini

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

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.

Article activity feed

  1. Version published to 10.3390/ijerph19095384
  2. ScreenIT

    SciScore for 10.1101/2021.09.03.21263088: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Cell Line AuthenticationAuthentication: We performed a systematic literature review using validated search strategies from these databases: • PUBMED (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) • Ovid MEDLINE database • ISI Web of Science: Science Citation Index Expanded (SCI Expanded) and Living Evidence on COVID database (https://zika.ispm.unibe.ch/assets/data/pub/search_beta/) to identify papers on SARS-CoV-2 transmission in the educational setting (Flow-chart Figure 1).

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All the statistical analyses were performed using SAS software (SAS Institute Inc., Cary, NC; version 9.4) and R software, version 4.0.2 (http://www.r-project.org).
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)
    http://www.r-project.org
    suggested: (R Project for Statistical Computing, RRID:SCR_001905)

    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: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    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.

    Results from scite Reference Check: We found no unreliable references.

    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 checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.09.03.21263088v1 on medRxiv