Transmission of SARS-CoV-2 following exposure in school settings: experience from two Helsinki area exposure incidents.
Authors: Dub Timothee , Erra Elina , Hagberg Lotta , Sarvikivi Emmi , Virta Camilla , Järvinen Asko , Österlund Pamela , Ikonen Niina , Haveri Anu , Melin Merit , Lukkarinen Timo , Nohynek Hanna 
Published: July 2020

SummaryBackgroundThe role of children in SARS-CoV-2 transmission is unclear. We investigated two COVID-19 school exposure incidents in the Helsinki area.MethodsWe conducted two retrospective cohort studies after schools exposures, with a household transmission extension. We defined a case as an exposed person with either a positive RT-PCR, or positive microneutralisation testing (MNT) as confirmation of SARS-CoV-2 nucleoprotein IgG antibodies detection via fluorescent microsphere immunoassay (FMIA). We recruited close school contacts and families of school cases, calculated attack rates (AR) on school level and families, and identified transmission chains.FindingsIn incident A, the index was a pupil. Participation rate was 74% (89/121), and no cases were identified. In incident B, the index was a member of school personnel. Participation rate was 81% (51/63). AR was 16% (8/51): 6 pupils and 1 member of school personnel were MNT and FMIA positive; 1 pupil had a positive RT-PCR, but negative serology samples. We visited all school cases’ families (n=8). The AR among close household contacts was 42% (9/20 in 3/8 families) but other plausible sources were always reported. At three months post-exposure, 6/8 school cases were re-sampled and still MNT positive.InterpretationWhen the index was a child, no school transmission was identified, while the occurrence of an adult case led to a 16% AR. Further cases were evidenced in 3 families, but other transmission chains were plausible. It is likely that transmission from children to adults is limited.FundingThe Finnish Institute for Health and Welfare funded this study.Research in contextEvidence before the studyThe first autochthonous case of COVID-19 in Finland was identified on February 29th. Transmission of the virus has led to more than 7250 cases and over 300 deaths (As of July 12th 2020). On March 16th, assuming that children might have a role in transmission, the Finnish government ordered school closures, to the exclusion of pre-school and grades 1-3. Schools were closed from March 18 and reopened on May 14th. At the stage of closure, a very limited number of reports of school related COVID-19 clusters or exposure incidents had been published, and the potential extent of transmission in a school setting was unknown.Added value of this studyWe investigated two exposure incidents in two different schools from the Helsinki area to assess transmission among pupils, school personnel and household contacts of identified cases. In school A, contact with a COVID-19 pupil did not lead to further transmission, while in school B, out of 51 recruited contacts, eight (16%) were proved to have had COVID-19 infection, including one member of staff. Among the close household contacts of pupils who were tested positive, COVID-19 attack rate was 31% (5/16). However, in all investigated households, other sources of infections were plausible; hence household transmission following a pediatric COVID-19 case appears to be limited.Implications of all of the available evidenceIncidence of COVID-19 infections in children following school related exposure was limited, as well as secondary transmission within their household. We hope our findings will help prioritize mitigation measures as well as reduce worry among parents of school aged children as most EU countries are preparing for the start of a new school year in autumn.