SARS-CoV-2 infection characteristics among students and staff in a large high school COVID-19 outbreak and secondary transmission in households

Chen Stein-Zamir; Ora Sinai-Zaken; Eti Zvulun; Ghada Najajra; Rinat Pinto; Shahar Koren; Hanna Shoob; Nitza Abramson

doi:10.1016/j.imj.2023.02.003

Infectious Medicine 2023, 2(1): 36-43 https://doi.org/10.1016/j.imj.2023.02.003

Original Article |

Open Access | Issue | Published: 02 March 2023

SARS-CoV-2 infection characteristics among students and staff in a large high school COVID-19 outbreak and secondary transmission in households

Show Author's Information Hide Author's Information Chen Stein-Zamir^{^a^,^b}(

), Ora Sinai-Zaken^{^a}, Eti Zvulun^{^a}, Ghada Najajra^{^a}, Rinat Pinto^{^a}, Shahar Koren^{^a^,^b}, Hanna Shoob^{^a}, Nitza Abramson^{^a}

Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel

Faculty of Medicine, The Hebrew University of Jerusalem, The Hebrew University and Hadassah Braun School of Public Health and Community Medicine, Jerusalem, Israel

Keywords:

COVID-19, Transmission, Epidemiology, School, Adolescents, Household

Cite this article:

Stein-Zamir C, Sinai-Zaken O, Zvulun E, et al. SARS-CoV-2 infection characteristics among students and staff in a large high school COVID-19 outbreak and secondary transmission in households. Infectious Medicine, 2023, 2(1): 36-43. https://doi.org/10.1016/j.imj.2023.02.003

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Abstract Full text About this article

Abstract

Background

SARS-CoV-2 clinical presentation is associated with the patients’ age group. Overall, young individuals present higher proportions of asymptomatic or mild COVID-19 infection, compared to adults. Data on secondary COVID-19 transmission in households, according to the cases’ age group, are accumulating.

Methods

We performed a follow-up cohort study including all COVID-19 real-time polymerase chain reaction (RT-PCR)-confirmed cases (adolescent students and school staff) diagnosed in an epidemiological investigation of a large high school outbreak. We compared the adolescent and adult groups regarding clinical symptoms, time to negative COVID-19 RT-PCR tests, and infection transmission in households.

Results

The study population included 817 persons. The confirmed COVID-19 RT-PCR outbreak cases (n = 178) were followed (students aged 12–19 years, median age 14 years, n = 153, school staff aged 24–67 years, median age 39 years, n = 25) and the cases’ household close contacts (n = 639) were tested. The adolescents had lower symptomatic infection rates, shorter time to negative COVID-19 RT-PCR tests, and lower transmission rates to household members, compared to the adults. The general transmission rate among household contacts was 13.5%, (86/639) ranging from 8.6% in asymptomatic students’ contacts to 27.3% in symptomatic staff contacts. COVID-19 transmission rates were significantly higher in contacts of symptomatic cases compared to asymptomatic cases (odds ratio: 2.06, 95% CI 1.26–3.4) and higher in adults compared to adolescents (odds ratio: 2.69, 95% CI 1.43–4.89).

Conclusions

Adolescents and adults diagnosed in an outbreak investigation differ as to COVID-19 clinical presentation and transmission. As adolescents may show mild or no symptoms, COVID-19 prevention in school settings is challenging. Implementing nonpharmaceutical measures and promoting vaccination programs in eligible staff and students should be considered.

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About this article

SARS-CoV-2 infection characteristics among students and staff in a large high school COVID-19 outbreak and secondary transmission in households

Show Author's information Hide Author's Information Chen Stein-Zamir^{^a^,^b}(

), Ora Sinai-Zaken^{^a}, Eti Zvulun^{^a}, Ghada Najajra^{^a}, Rinat Pinto^{^a}, Shahar Koren^{^a^,^b}, Hanna Shoob^{^a}, Nitza Abramson^{^a}

Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel

Faculty of Medicine, The Hebrew University of Jerusalem, The Hebrew University and Hadassah Braun School of Public Health and Community Medicine, Jerusalem, Israel

Abstract

Background

Methods

Results

Conclusions

Keywords: COVID-19, Transmission, Epidemiology, School, Adolescents, Household

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Acknowledgements

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Publication history

Received: 19 November 2022

Revised: 21 February 2023

Accepted: 21 February 2023

Published: 02 March 2023

Issue date: March 2023

Copyright

Acknowledgements

The authors would like to thank the devoted public health teams in the Jerusalem district health office, the 4 heath funds in Jerusalem, the school’s community (board, staff, students and parents) and the municipality of Jerusalem. The authors thank Shir Yaniv MD, MPH for preparing the graphical abstract.

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This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)