SARS-CoV-2 infection and transmission in educational settings: a prospective, cross-sectional analysis of infection clusters and outbreaks in England.
SARS-CoV-2 infection and transmission in educational settings: a prospective, cross-sectional analysis of infection clusters and outbreaks in England.
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SARS-CoV-2在教育环境中的感染和传播：英国感染聚集性和暴发的前瞻性横断面分析。
DOI：
10.1016/s1473-3099(20)30882-3
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Ladhani SN
中科院分区：
文献类型：
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作者：
Ismail SA;Saliba V;Lopez Bernal J;Ramsay ME;Ladhani SN
了解严重急性呼吸系统综合征冠状病毒2型（SARS-CoV-2）在教育环境中的感染和传播，对于确保工作人员和儿童在COVID-19大流行期间的安全至关重要。我们估计了英格兰夏季半学期（2020年6月至7月）教育环境中工作人员和学生的SARS-CoV-2感染率和爆发率。在这项前瞻性的横断面分析中，英格兰公共卫生部在英格兰的教育环境中启动了加强的国家监测，这些教育环境在2020年6月1日至7月17日首次全国封锁后重新开放。教育环境分为幼儿园（5岁以下儿童）、小学（5-11岁儿童;仅允许1年级和6年级儿童返回）、中学（11-18岁儿童;仅允许10年级和12年级儿童返回）或混合年龄环境（包括上述环境）。继续教育学院被排除在外。数据记录在HPZone中，这是一个需要公共卫生管理的事件的在线国家数据库。RT-PCR证实的SARS-CoV-2事件率和病例率计算工作人员和学生，并根据症状发作和检测日期推断传播方向。事件被分类为单一病例、共同主要病例（48小时内至少有两例确诊病例，通常发生在同一家庭）和暴发（至少有两例流行病学相关病例，在同一教育环境中14天内诊断出连续病例）。所有事件在教育机构因暑假关闭后随访28天。负二项回归被用来关联教育环境事件与区域人口，人口密度和社区发病率。平均每天开放38，000所幼儿园（IQR 35，500-41，500），15，600所小学（13，450-17，300）和4，000所中学（3，700 - 4，200），平均每天有928，000名学生（630，000-1，230，000）。 有113例SARS-CoV-2感染的单一病例，9例共同原发病例和55起疫情。社区发病率每增加5例/10万人口，暴发风险增加72%（95%CI 28-130）（p<0.0001）。工作人员的发病率高于学生（工作人员中每天每10万人中有27例[95%CI 23-32]，而幼儿学生中有18例[14-24]，小学生中有6.0例[4.3 - 8.2]，中学生中有6.8例[2.7 -14]），与暴发有关的大多数病例发生在工作人员中（210例总病例中，工作人员154例[73%]，儿童56例[27%]）。 可能的传播方向是26起疫情中的工作人员到工作人员，8起疫情中的工作人员到学生，16起疫情中的学生到工作人员，5起疫情中的学生到学生。暴发中继发病例的中位数为1例（IQR 1-2）学生指数病例和1例（1-5）员工指数病例。SARS-CoV-2感染和爆发在英格兰夏季半学期的教育环境中并不常见。与区域COVID-19发病率的密切联系强调了控制社区传播以保护教育环境的重要性。干预措施应侧重于减少工作人员内部和之间的传播。英国公共卫生
Understanding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and transmission in educational settings is crucial for ensuring the safety of staff and children during the COVID-19 pandemic. We estimated the rate of SARS-CoV-2 infection and outbreaks among staff and students in educational settings during the summer half-term (June–July, 2020) in England. In this prospective, cross-sectional analysis, Public Health England initiated enhanced national surveillance in educational settings in England that had reopened after the first national lockdown, from June 1 to July 17, 2020. Educational settings were categorised as early years settings (<5-year-olds), primary schools (5–11-year-olds; only years 1 and 6 allowed to return), secondary schools (11–18-year-olds; only years 10 and 12), or mixed-age settings (spanning a combination of the above). Further education colleges were excluded. Data were recorded in HPZone, an online national database for events that require public health management. RT-PCR-confirmed SARS-CoV-2 event rates and case rates were calculated for staff and students, and direction of transmission was inferred on the basis of symptom onset and testing dates. Events were classified as single cases, coprimary cases (at least two confirmed cases within 48 h, typically within the same household), and outbreaks (at least two epidemiologically linked cases, with sequential cases diagnosed within 14 days in the same educational setting). All events were followed up for 28 days after educational settings closed for the summer holidays. Negative binomial regression was used to correlate educational setting events with regional population, population density, and community incidence. A median of 38 000 early years settings (IQR 35 500–41 500), 15 600 primary schools (13 450–17 300), and 4000 secondary schools (3700–4200) were open each day, with a median daily attendance of 928 000 students (630 000–1 230 000) overall. There were 113 single cases of SARS-CoV-2 infection, nine coprimary cases, and 55 outbreaks. The risk of an outbreak increased by 72% (95% CI 28–130) for every five cases per 100 000 population increase in community incidence (p<0·0001). Staff had higher incidence than students (27 cases [95% CI 23–32] per 100 000 per day among staff compared with 18 cases [14–24] in early years students, 6·0 cases [4·3–8·2] in primary schools students, and 6·8 cases [2·7–14] in secondary school students]), and most cases linked to outbreaks were in staff members (154 [73%] staff vs 56 [27%] children of 210 total cases). Probable direction of transmission was staff to staff in 26 outbreaks, staff to student in eight outbreaks, student to staff in 16 outbreaks, and student to student in five outbreaks. The median number of secondary cases in outbreaks was one (IQR 1–2) for student index cases and one (1–5) for staff index cases. SARS-CoV-2 infections and outbreaks were uncommon in educational settings during the summer half-term in England. The strong association with regional COVID-19 incidence emphasises the importance of controlling community transmission to protect educational settings. Interventions should focus on reducing transmission in and among staff. Public Health England.