Test-to-Stay After Exposure to SARS-CoV-2 in K-12 Schools.

Abstract

Objectives

We evaluated the safety and efficacy of a test-to-stay program for unvaccinated students and staff who experienced an unmasked, in-school exposure to someone with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Serial testing instead of quarantine was offered to asymptomatic contacts. We measured secondary and tertiary transmission rates within participating schools and in-school days preserved for participants.

Methods

Participating staff or students from universally masked districts in North Carolina underwent rapid antigen testing at set intervals up to 7 days after known exposure. Collected data included location or setting of exposure, participant symptoms, and school absences up to 14 days after enrollment. Outcomes included tertiary transmission, secondary transmission, and school days saved among test-to-stay participants. A prespecified interim safety analysis occurred after 1 month of enrollment.

Results

We enrolled 367 participants and completed 14-day follow-up on all participants for this analysis. Nearly all (215 of 238, 90%) exposure encounters involved an unmasked index case and an unmasked close contact, with most (353 of 366, 96%) occurring indoors, during lunch (137 of 357, 39%) or athletics (45 of 357, 13%). Secondary attack rate was 1.7% (95% confidence interval: 0.6%-4.7%) based on 883 SARS-CoV-2 serial rapid antigen tests with results from 357 participants; no tertiary cases were identified, and 1628 (92%) school days were saved through test-to-stay program implementation out of 1764 days potentially missed.

Conclusion

After unmasked in-school exposure to SARS-CoV-2, even in a mostly unvaccinated population, a test-to-stay strategy is a safe alternative to quarantine.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1542/peds.2021-056045

Publication Info

Campbell, Melissa M, Daniel K Benjamin, Tara Mann, Alex Fist, Hwasoon Kim, Laura Edwards, Zsolt Rak, M Alan Brookhart, et al. (2022). Test-to-Stay After Exposure to SARS-CoV-2 in K-12 Schools. Pediatrics, 149(5). p. e2021056045. 10.1542/peds.2021-056045 Retrieved from https://hdl.handle.net/10161/31154.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Campbell

Melissa M Campbell

Assistant Professor of Pediatrics
Boutzoukas

Angelique Boutzoukas

Assistant Professor of Pediatrics

I am a pediatric infectious disease specialist and pediatric clinical researcher. My research interests are centered around finding the optimal ways to manage infections and minimize harms to patients. Recognizing the growing global threat of antibiotic resistance, I am particularly interested in finding the right dose and duration of antibiotics that children should receive to treat their infections, and studying the epidemiology and prevention of antibiotic resistant infections.   

Moorthy

Ganga Moorthy

Assistant Professor of Pediatrics
Zimmerman

Kanecia Obie Zimmerman

Wilburt C. Davison Distinguished Professor

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