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Meta-Analysis
. 2022 Apr 28;19(9):5384.
doi: 10.3390/ijerph19095384.

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

Saverio Caini  1 , Chiara Martinoli  2 , Carlo La Vecchia  3 , Sara Raimondi  2 , Federica Bellerba  2 , Oriana D'Ecclesiis  2 , Clementina Sasso  4 , Alessandra Basso  5 , Giulio Cammarata  2 , Sara Gandini  2
Affiliations
Meta-Analysis

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

Saverio Caini et al. Int J Environ Res Public Health. .

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.

Keywords: SARS-CoV-2; contract tracing; infections; meta-analysis; schools; screening; students; susceptibility; teachers.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of study.
Figure 2
Figure 2
Pooled estimates for SARS-CoV-2 screening studies [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]. (a) Pooled estimate of testing positive for SARS-CoV-2. (b) Summary odds ratio of testing positive for SARS-CoV-2 for children versus adults linked to educational settings.
Figure 3
Figure 3
Pooled estimates for SARS-CoV-2 seroprevalence studies [14,16,18,27,34,35,36,37,38]. (a) Pooled estimate of testing positive for antibodies for SARS-CoV-2. (b) Pooled estimate of odds of testing positive for antibodies for SARS-CoV-2 for children versus adults.
Figure 4
Figure 4
Pooled estimates for contact tracing studies [16,41,42,43,44,45,46,47,48,49,50,51,52,53,54]. (a) Pooled estimate of testing positive for SARS-CoV-2 after a contact with a case in the school setting. (b) Summary OR of testing positive for SARS-CoV-2 after a contact with a young versus an adult case in the school setting. (c) Summary OR of testing positive for SARS-CoV-2 in young versus adults after a contact with a case.
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