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. 2023 Dec;116(12):413-424.
doi: 10.1177/01410768231181268. Epub 2023 Jun 22.

Trends in SARS-CoV-2 infection and vaccination in school staff, students and their household members from 2020 to 2022 in Wales, UK: an electronic cohort study

Emily Lowthian  1   2 , Hoda Abbasizanjani  1 , Stuart Bedston  1 , Ashley Akbari  1 , Laura Cowley  1 , Richard Fry  1 , Rhiannon K Owen  1 , Joe Hollinghurst  1 , Igor Rudan  3 , Jillian Beggs  4 , Emily Marchant  1   2 , Fatemeh Torabi  1 , Simon de Lusignan  5 , Tom Crick  2 , Graham Moore  6 , Aziz Sheikh  4 , Ronan A Lyons  1
Affiliations

Trends in SARS-CoV-2 infection and vaccination in school staff, students and their household members from 2020 to 2022 in Wales, UK: an electronic cohort study

Emily Lowthian et al. J R Soc Med. 2023 Dec.

Abstract

Objectives: We investigated SARS-CoV-2 infection trends, risk of SARS-CoV-2 infection and COVID-19 vaccination uptake among school staff, students and their household members in Wales, UK.

Design: Seven-day average of SARS-CoV-2 infections and polymerase chain reaction tests per 1000 people daily, cumulative incidence of COVID-19 vaccination uptake and multi-level Poisson models with time-varying covariates.

Setting: National electronic cohort between September 2020 and May 2022 when several variants were predominant in the UK (Alpha, Delta and Omicron).

Participants: School students aged 4 to 10/11 years (primary school and younger middle school, n = 238,163), and 11 to 15/16 years (secondary school and older middle school, n = 182,775), school staff in Wales (n = 47,963) and the household members of students and staff (n = 697,659).

Main outcome measures: SARS-CoV-2 infection and COVID-19 vaccination uptake.

Results: School students had a sustained period of high infection rates compared with household members after August 2021. Primary schedule vaccination uptake was highest among staff (96.3%) but lower for household members (72.2%), secondary and older middle school students (59.8%), and primary and younger middle school students (3.3%). Multi-level Poisson models showed that vaccination was associated with a lower risk of SARS-CoV-2 infection. The Delta variant posed a greater infection risk for students than the Alpha variant. However, Omicron was a larger risk for staff and household members.

Conclusions: Public health bodies should be informed of the protection COVID-19 vaccines afford, with more research being required for younger populations. Furthermore, schools require additional support in managing new, highly transmissible variants. Further research should examine the mechanisms between child deprivation and SARS-CoV-2 infection.

Keywords: COVID-19; pandemic; population health; schools; social restrictions.

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Conflict of interest statement

RKO is a member of the National Institute for Health and Care Excellence (NICE) Technology Appraisal Committee, member of the NICE Decision Support Unit and associate member of the NICE Technical Support Unit. She has served as a paid consultant providing unrelated methodological advice to the pharmaceutical industry generally. She reports teaching fees from the Association of British Pharmaceutical Industry and the University of Bristol. TC is an independent member/non-executive director of Swansea Bay University Health Board, the local health board for NHS Wales serving Swansea and Neath Port Talbot. RAL is a member of the Welsh Government COVID-19 Technical Advisory Group.

Figures

Figure 1.
Figure 1.
Health and administrative education data linkage.
Figure 2.
Figure 2.
Crude rate of infections and PCR tests per 1000 (rolling 7-day average) from September 2020 to May 2022 for primary and younger middle (purple) and secondary and older middle school students (blue), school staff (pink) and household members (yellow). Dashed lines = rate of PCR tests, Solid fill = rate of positive PCR tests. Events are shown for dominant variant, vaccination programmes, school restrictions and social restrictions, whereby higher alert levels indicate greater restrictions (FB = firebreak). Note: PCR testing for the public ends on 31 March 2022.
Figure 3.
Figure 3.
Cumulative percentage of vaccination uptake from 3 September 2020 to 31 May 2022 for (a) primary and middle and (b) secondary and middle school students, (c) school staff and (d) the household members. Green indicates first dose, purple second and orange booster dose.
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