Feasibility of SARS-CoV-2 Surveillance Testing Among Children and Childcare Workers at German Day Care Centers
Authors: Johannes Forster, Andrea Streng, Paul Rudolph, Viktoria Rücker, Julia Wallstabe, Sandra Timme, Franziska Pietsch, Katrin Hartmann, Maike Krauthausen, Julia Schmidt, Timo Ludwig, David Gierszewski, Thomas Jans, Geraldine Engels, Benedikt Weißbrich, Marcel Romanos, Lars Dölken, Peter Heuschmann, Christoph Härtel, Ildikó Gágyor, Marc Thilo Figge, Oliver Kurzai, Johannes Liese, Anastasia Besenfelder, Lena Buechner, Kathrin Frei, Theresa Höferth, Thiên-Trí Lam, Sabrina Mündlein, Christoph Schoen, Alexandra Schubert-Unkmeir, Lars Wallstabe, Kerstin Knies, Rebecca Richter, Abdullah Almamy, Maxi Bettkober, Viktoria Engert, Phillipp Fecher, Jonas Fischer, Robin Khan, Fabian Kleindiek, Mirja Müller, Lara Müller-Scholden, Pauline Nehm, Jacobe Rapp, Christina Pfann, Maria Riedmeier, George Robinson, Sarah Schnee, Anna-Lena Sieg, Max Siegl, Fumi Sugihara, Anne Thieme, Gvantsa Uturgaidze, Brigitte Wehner
Journal: JAMA Network Open (2022)

<h3>Importance</h3> Closure of day care centers has been implemented globally to contain the COVID-19 pandemic but has negative effects on children's health and psychosocial well-being. <h3>Objective</h3> To investigate the feasibility of surveillance among children and childcare workers and to model the efficacy of surveillance on viral spread prevention. <h3>Design, Setting, and Participants</h3> This nonrandomized controlled trial was conducted at 9 day care centers in Wuerzburg, Germany, from October 2020 to March 2021. Participants included children attending day care, childcare workers, and household members. Participating day care centers were assigned to different surveillance modules in a nonrandomized feasibility study. A mathematical model for SARS-CoV-2 spread in day care centers was developed to identify optimal surveillance. <h3>Interventions</h3> Modules 1, 2, and 3 involved continuous surveillance of asymptomatic children and childcare workers by SARS-CoV-2 polymerase chain reaction testing of either midturbinate nasal swabs twice weekly (module 1) or once weekly (module 2) or self-sampled saliva samples twice weekly (module 3). Module 4 involved symptom-based, on-demand testing of children, childcare workers, and their household members by oropharyngeal swabs. All participants underwent SARS-CoV-2 antibody status testing before and after the sampling period. Questionnaires on attitudes and perception of the pandemic were administered in weeks 1, 6, and 12. Mathematical modeling was used to estimate SARS-CoV-2 spread in day care centers. <h3>Main Outcomes and Measures</h3> The primary outcomes were acceptance of the respective surveillance protocols (feasibility study) and the estimated number of secondary infections (mathematical modeling). <h3>Results</h3> Of 954 eligible individuals (772 children and 182 childcare workers), 592 (62%), including 442 children (median [IQR] age, 3 [2-4] years; 214 [48.6%] female) and 150 childcare workers (median [IQR] age, 29 [25-44] years; 129 [90.8%] female) participated in the surveillance. In total, 4755 tests for SARS-CoV-2 detected 2 infections (1 childcare worker and 1 adult household member). Acceptance for continuous surveillance was highest for biweekly saliva testing (150 of 221 eligible individuals [67.9%; 95% CI, 61.5%-73.7%]) compared with biweekly (51 of 117 individuals [43.6%; 95% CI, 35.0%-52.6%]) and weekly (44 of 128 individuals [34.4%; 95% CI, 26.7%-43.0%]) midturbinate swabbing (<i>P</i> &lt; .001). Dropout rates were higher for midturbinate swabbing (biweekly, 11 of 62 participants [18%]; once weekly, 11 of 55 participants [20%]) than for saliva testing (6 of 156 participants [4%]). Mathematical modeling based on study and literature data identified biweekly testing of at least 50% of children and childcare workers as minimal requirements to limit secondary infections. <h3>Conclusions and Relevance</h3> In this nonrandomized controlled trial, surveillance for SARS-CoV-2 in 9 German day care centers was feasible and well accepted. Mathematical modeling estimated that testing can minimize the spread of SARS-CoV-2 in day care centers. These findings enable setup of surveillance programs to maintain institutional childcare. <h3>Trial Registration</h3> German Registry for Clinical Trials Identifier:DRKS00023721