Branch-Elliman Westyn, Ertem Melissa Zeynep, Nelson Richard E, Danesharasteh Anseh, Berlin David, Fisher Lloyd, Schechter-Perkins Elissa M
VA Boston Center for Healthcare Optimization and Implementation Research (CHOIR), Boston, MA, US.
VA Boston Healthcare System, Department of Medicine, Section of Infectious Diseases, Boston, MA, US.
Commun Med (Lond). 2024 Oct 16;4(1):202. doi: 10.1038/s43856-024-00619-3.
During the 2021-22 academic year, Massachusetts supported several in-school testing programs to facilitate in-person learning. Additionally, COVID-19 vaccines became available to all school-aged children and many were infected with SARS-CoV-2. There are limited studies evaluating the impacts of these testing programs on SARS-CoV-2 cases in elementary and secondary school settings. The aim of this state-wide, retrospective cohort study was to assess the impact of testing programs and immunity on SARS-CoV-2 case rates in elementary and secondary students.
Community-level vaccination and cumulative incidence rates were combined with data about participation in and results of in-school testing programs (test-to-stay, pooled surveillance testing). School-level impacts of surveillance testing programs on SARS-CoV-2 cases in students were estimated using generalized estimating equations within a target trial emulation approach stratified by school type (elementary/middle/high). Impacts of immunity and vaccination were estimated using random effects linear regression.
Here we show that among N = 652,353 students at 2141 schools participating in in-school testing programs, surveillance testing is associated with a small but measurable decrease in in-school positivity rates. During delta, pooled testing positivity rates are higher in communities with higher cumulative incidence of infection. During omicron, when immunity from prior infection became more prevalent, the effect reversed, such that communities with lower burden of infection during the earlier phases of the pandemic had higher infection rates.
Testing programs are an effective strategy for supporting in-person learning. Fluctuating levels of immunity acquired via natural infection or vaccination are a major determinant of SARS-CoV-2 cases in schools.
在2021 - 22学年，马萨诸塞州支持了多个校内检测项目以促进面对面学习。此外，所有学龄儿童都可接种新冠病毒疫苗，且许多儿童感染了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）。评估这些检测项目对中小学环境中SARS-CoV-2病例影响的研究有限。这项全州范围的回顾性队列研究的目的是评估检测项目和免疫力对中小学生SARS-CoV-2发病率的影响。
将社区层面的疫苗接种情况和累积发病率与校内检测项目（检测后留校、混合监测检测）的参与情况及结果数据相结合。在按学校类型（小学/初中/高中）分层的目标试验模拟方法中，使用广义估计方程估计监测检测项目对学生中SARS-CoV-2病例的学校层面影响。使用随机效应线性回归估计免疫力和疫苗接种的影响。
我们在此表明，在参与校内检测项目的2141所学校的N = 652,353名学生中，监测检测与校内阳性率的小幅但可测量的下降相关。在德尔塔变异株流行期间，感染累积发病率较高的社区混合检测阳性率也较高。在奥密克戎变异株流行期间，当既往感染产生的免疫力更为普遍时，这种效应发生了逆转，即疫情早期感染负担较低的社区感染率较高。
检测项目是支持面对面学习的有效策略。通过自然感染或疫苗接种获得的免疫力水平波动是学校中SARS-CoV-2病例的主要决定因素。
