Emergence of the delta variant and risk of SARS-CoV-2 infection in secondary school students and staff: Prospective surveillance in 18 schools, England

Shamez N. Ladhani; Georgina Ireland; Frances Baawuah; Joanne Beckmann; Ifeanyichukwu O. Okike; Shazaad Ahmad; Joanna Garstang; Andrew J. Brent; Bernadette Brent; Felicity Aiano; Zahin Amin-Chowdhury; Meaghan Kall; Ray Borrow; Ezra Linley; Maria Zambon; John Poh; Lenesha Warrener; Angie Lackenby; Joanna Ellis; Gayatri Amirthalingam; Kevin E. Brown; Mary E. Ramsay

doi:10.1016/j.eclinm.2022.101319

Emergence of the delta variant and risk of SARS-CoV-2 infection in secondary school students and staff: Prospective surveillance in 18 schools, England

Shamez N. Ladhani, Georgina Ireland^*, Frances Baawuah, Joanne Beckmann, Ifeanyichukwu O. Okike, Shazaad Ahmad, Joanna Garstang, Andrew J. Brent, Bernadette Brent, Felicity Aiano, Zahin Amin-Chowdhury, Meaghan Kall, Ray Borrow, Ezra Linley, Maria Zambon, John Poh, Lenesha Warrener, Angie Lackenby, Joanna Ellis, Gayatri AmirthalingamKevin E. Brown, Mary E. Ramsay

^*Corresponding author for this work

UK Health Security Agency

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: The role of educational settings in SARS-CoV-2 infection and transmission remains controversial. We investigated SARS-CoV-2 infection, seroprevalence, and seroconversion rates in secondary schools during the 2020/21 academic year, which included the emergence of the more transmissible alpha and delta variants, in England.

Methods: The UK Health Security Agency (UKHSA) initiated prospective surveillance in 18 urban English secondary schools. Participants had nasal swabs for SARS-CoV-2 RT-PCR and blood sampling for SARS-CoV-2 nucleoprotein and spike protein antibodies at the start (Round 1: September-October 2020) and end (Round 2: December 2020) of the autumn term, when schools reopened after national lockdown was imposed in January 2021 (Round 3: March-April 2021), and end of the academic year (Round 4: May-July 2021).

Findings: We enrolled 2314 participants (1277 students, 1037 staff; one participant had missing data for PCR testing). In-school testing identified 31 PCR-positive participants (20 students, 11 staff). Another 247 confirmed cases (112 students, 135 staff) were identified after linkage with national surveillance data, giving an overall positivity rate of 12.0% (278/2313; staff: 14.1%, 146/1037 vs students: 10.3%, 132/1276; p = 0.006). Trends were similar to national infection data. Nucleoprotein-antibody seroprevalence increased for students and staff between Rounds 1 and 3 but were similar between Rounds 3 and 4, when the delta variant was the dominant circulating strain. Overall, Nucleoprotein-antibody seroconversion was 18.4% (137/744) in staff and 18.8% (146/778) in students, while Spike-antibody seroconversion was higher in staff (72.8%, 525/721) than students (21.3%, 163/764) because of vaccination.

Interpretation: SARS-CoV-2 infection rates in secondary schools remained low when community infection rates were low, even as the delta variant was emerging in England.

Funding: This study was funded by the UK Department of Health and Social Care.

Original language	English
Article number	101319
Journal	EClinicalMedicine
Volume	45
Early online date	26 Feb 2022
DOIs	https://doi.org/10.1016/j.eclinm.2022.101319
Publication status	Published - Mar 2022

Bibliographical note

Funding Information: This study was funded by the UK Department of Health and Social Care.

MR reports that The Immunisation Department also provides vaccine manufacturers (including Pfizer) with post-marketing surveillance reports about pneumococcal and meningococcal disease which the companies are required to submit to the UK Licensing authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports. RB and EL reports performing contract research on behalf of UKHSA for GSK, Pfizer, Sanofi Pasteur, outside the submitted work. MK reports grants from Gilead Sciences Inc, outside the submitted work. MZ reports and Chair of ISIRV, Member of NERVTAG/SAGE/JCVI, Co-director NIHR HPRU, Imperial College London, Observer position on advisory boards for GSK Antivirals and Janssen RSV. JG reports Birmingham Community Healthcare NHS Trust - the employer of Dr Garstang, received expenses from Public Health England (now the UK Health Security Agency) for conducting the research in this paper. All other authors have nothing to declare.

Open Access: This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Publisher Copyright: Crown Copyright © 2022 Published by Elsevier Ltd.

Citation: Ladhani, Shamez N., et al. "Emergence of the delta variant and risk of SARS-CoV-2 infection in secondary school students and staff: Prospective surveillance in 18 schools, England." EClinicalMedicine 45 (2022): 101319.

DOI: https://doi.org/10.1016/j.eclinm.2022.101319

Keywords

Antibody testing
COVID-19
Education setting
PCR
SARS-CoV-2
Teenagers

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

Ladhani, S. N., Ireland, G., Baawuah, F., Beckmann, J., Okike, I. O., Ahmad, S., Garstang, J., Brent, A. J., Brent, B., Aiano, F., Amin-Chowdhury, Z., Kall, M., Borrow, R., Linley, E., Zambon, M., Poh, J., Warrener, L., Lackenby, A., Ellis, J., ... Ramsay, M. E. (2022). Emergence of the delta variant and risk of SARS-CoV-2 infection in secondary school students and staff: Prospective surveillance in 18 schools, England. EClinicalMedicine, 45, Article 101319. https://doi.org/10.1016/j.eclinm.2022.101319

@article{d4650eff0b114d53880cd485c7a36236,

title = "Emergence of the delta variant and risk of SARS-CoV-2 infection in secondary school students and staff: Prospective surveillance in 18 schools, England",

abstract = "Background: The role of educational settings in SARS-CoV-2 infection and transmission remains controversial. We investigated SARS-CoV-2 infection, seroprevalence, and seroconversion rates in secondary schools during the 2020/21 academic year, which included the emergence of the more transmissible alpha and delta variants, in England. Methods: The UK Health Security Agency (UKHSA) initiated prospective surveillance in 18 urban English secondary schools. Participants had nasal swabs for SARS-CoV-2 RT-PCR and blood sampling for SARS-CoV-2 nucleoprotein and spike protein antibodies at the start (Round 1: September-October 2020) and end (Round 2: December 2020) of the autumn term, when schools reopened after national lockdown was imposed in January 2021 (Round 3: March-April 2021), and end of the academic year (Round 4: May-July 2021). Findings: We enrolled 2314 participants (1277 students, 1037 staff; one participant had missing data for PCR testing). In-school testing identified 31 PCR-positive participants (20 students, 11 staff). Another 247 confirmed cases (112 students, 135 staff) were identified after linkage with national surveillance data, giving an overall positivity rate of 12.0% (278/2313; staff: 14.1%, 146/1037 vs students: 10.3%, 132/1276; p = 0.006). Trends were similar to national infection data. Nucleoprotein-antibody seroprevalence increased for students and staff between Rounds 1 and 3 but were similar between Rounds 3 and 4, when the delta variant was the dominant circulating strain. Overall, Nucleoprotein-antibody seroconversion was 18.4% (137/744) in staff and 18.8% (146/778) in students, while Spike-antibody seroconversion was higher in staff (72.8%, 525/721) than students (21.3%, 163/764) because of vaccination. Interpretation: SARS-CoV-2 infection rates in secondary schools remained low when community infection rates were low, even as the delta variant was emerging in England. Funding: This study was funded by the UK Department of Health and Social Care.",

keywords = "Antibody testing, COVID-19, Education setting, PCR, SARS-CoV-2, Teenagers",

author = "Ladhani, {Shamez N.} and Georgina Ireland and Frances Baawuah and Joanne Beckmann and Okike, {Ifeanyichukwu O.} and Shazaad Ahmad and Joanna Garstang and Brent, {Andrew J.} and Bernadette Brent and Felicity Aiano and Zahin Amin-Chowdhury and Meaghan Kall and Ray Borrow and Ezra Linley and Maria Zambon and John Poh and Lenesha Warrener and Angie Lackenby and Joanna Ellis and Gayatri Amirthalingam and Brown, {Kevin E.} and Ramsay, {Mary E.}",

note = "Funding Information: This study was funded by the UK Department of Health and Social Care. MR reports that The Immunisation Department also provides vaccine manufacturers (including Pfizer) with post-marketing surveillance reports about pneumococcal and meningococcal disease which the companies are required to submit to the UK Licensing authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports. RB and EL reports performing contract research on behalf of UKHSA for GSK, Pfizer, Sanofi Pasteur, outside the submitted work. MK reports grants from Gilead Sciences Inc, outside the submitted work. MZ reports and Chair of ISIRV, Member of NERVTAG/SAGE/JCVI, Co-director NIHR HPRU, Imperial College London, Observer position on advisory boards for GSK Antivirals and Janssen RSV. JG reports Birmingham Community Healthcare NHS Trust - the employer of Dr Garstang, received expenses from Public Health England (now the UK Health Security Agency) for conducting the research in this paper. All other authors have nothing to declare. Open Access: This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) Publisher Copyright: Crown Copyright {\textcopyright} 2022 Published by Elsevier Ltd. Citation: Ladhani, Shamez N., et al. {"}Emergence of the delta variant and risk of SARS-CoV-2 infection in secondary school students and staff: Prospective surveillance in 18 schools, England.{"} EClinicalMedicine 45 (2022): 101319. DOI: https://doi.org/10.1016/j.eclinm.2022.101319",

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doi = "10.1016/j.eclinm.2022.101319",

language = "English",

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Ladhani, SN, Ireland, G, Baawuah, F, Beckmann, J, Okike, IO, Ahmad, S, Garstang, J, Brent, AJ, Brent, B, Aiano, F, Amin-Chowdhury, Z, Kall, M, Borrow, R , Linley, E , Zambon, M, Poh, J, Warrener, L , Lackenby, A, Ellis, J, Amirthalingam, G , Brown, KE & Ramsay, ME 2022, 'Emergence of the delta variant and risk of SARS-CoV-2 infection in secondary school students and staff: Prospective surveillance in 18 schools, England', EClinicalMedicine, vol. 45, 101319. https://doi.org/10.1016/j.eclinm.2022.101319

TY - JOUR

T1 - Emergence of the delta variant and risk of SARS-CoV-2 infection in secondary school students and staff

T2 - Prospective surveillance in 18 schools, England

AU - Ladhani, Shamez N.

AU - Ireland, Georgina

AU - Baawuah, Frances

AU - Beckmann, Joanne

AU - Okike, Ifeanyichukwu O.

AU - Ahmad, Shazaad

AU - Garstang, Joanna

AU - Brent, Andrew J.

AU - Brent, Bernadette

AU - Aiano, Felicity

AU - Amin-Chowdhury, Zahin

AU - Kall, Meaghan

AU - Borrow, Ray

AU - Linley, Ezra

AU - Zambon, Maria

AU - Poh, John

AU - Warrener, Lenesha

AU - Lackenby, Angie

AU - Ellis, Joanna

AU - Amirthalingam, Gayatri

AU - Brown, Kevin E.

AU - Ramsay, Mary E.

N1 - Funding Information: This study was funded by the UK Department of Health and Social Care. MR reports that The Immunisation Department also provides vaccine manufacturers (including Pfizer) with post-marketing surveillance reports about pneumococcal and meningococcal disease which the companies are required to submit to the UK Licensing authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports. RB and EL reports performing contract research on behalf of UKHSA for GSK, Pfizer, Sanofi Pasteur, outside the submitted work. MK reports grants from Gilead Sciences Inc, outside the submitted work. MZ reports and Chair of ISIRV, Member of NERVTAG/SAGE/JCVI, Co-director NIHR HPRU, Imperial College London, Observer position on advisory boards for GSK Antivirals and Janssen RSV. JG reports Birmingham Community Healthcare NHS Trust - the employer of Dr Garstang, received expenses from Public Health England (now the UK Health Security Agency) for conducting the research in this paper. All other authors have nothing to declare. Open Access: This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) Publisher Copyright: Crown Copyright © 2022 Published by Elsevier Ltd. Citation: Ladhani, Shamez N., et al. "Emergence of the delta variant and risk of SARS-CoV-2 infection in secondary school students and staff: Prospective surveillance in 18 schools, England." EClinicalMedicine 45 (2022): 101319. DOI: https://doi.org/10.1016/j.eclinm.2022.101319

PY - 2022/3

Y1 - 2022/3

N2 - Background: The role of educational settings in SARS-CoV-2 infection and transmission remains controversial. We investigated SARS-CoV-2 infection, seroprevalence, and seroconversion rates in secondary schools during the 2020/21 academic year, which included the emergence of the more transmissible alpha and delta variants, in England. Methods: The UK Health Security Agency (UKHSA) initiated prospective surveillance in 18 urban English secondary schools. Participants had nasal swabs for SARS-CoV-2 RT-PCR and blood sampling for SARS-CoV-2 nucleoprotein and spike protein antibodies at the start (Round 1: September-October 2020) and end (Round 2: December 2020) of the autumn term, when schools reopened after national lockdown was imposed in January 2021 (Round 3: March-April 2021), and end of the academic year (Round 4: May-July 2021). Findings: We enrolled 2314 participants (1277 students, 1037 staff; one participant had missing data for PCR testing). In-school testing identified 31 PCR-positive participants (20 students, 11 staff). Another 247 confirmed cases (112 students, 135 staff) were identified after linkage with national surveillance data, giving an overall positivity rate of 12.0% (278/2313; staff: 14.1%, 146/1037 vs students: 10.3%, 132/1276; p = 0.006). Trends were similar to national infection data. Nucleoprotein-antibody seroprevalence increased for students and staff between Rounds 1 and 3 but were similar between Rounds 3 and 4, when the delta variant was the dominant circulating strain. Overall, Nucleoprotein-antibody seroconversion was 18.4% (137/744) in staff and 18.8% (146/778) in students, while Spike-antibody seroconversion was higher in staff (72.8%, 525/721) than students (21.3%, 163/764) because of vaccination. Interpretation: SARS-CoV-2 infection rates in secondary schools remained low when community infection rates were low, even as the delta variant was emerging in England. Funding: This study was funded by the UK Department of Health and Social Care.

AB - Background: The role of educational settings in SARS-CoV-2 infection and transmission remains controversial. We investigated SARS-CoV-2 infection, seroprevalence, and seroconversion rates in secondary schools during the 2020/21 academic year, which included the emergence of the more transmissible alpha and delta variants, in England. Methods: The UK Health Security Agency (UKHSA) initiated prospective surveillance in 18 urban English secondary schools. Participants had nasal swabs for SARS-CoV-2 RT-PCR and blood sampling for SARS-CoV-2 nucleoprotein and spike protein antibodies at the start (Round 1: September-October 2020) and end (Round 2: December 2020) of the autumn term, when schools reopened after national lockdown was imposed in January 2021 (Round 3: March-April 2021), and end of the academic year (Round 4: May-July 2021). Findings: We enrolled 2314 participants (1277 students, 1037 staff; one participant had missing data for PCR testing). In-school testing identified 31 PCR-positive participants (20 students, 11 staff). Another 247 confirmed cases (112 students, 135 staff) were identified after linkage with national surveillance data, giving an overall positivity rate of 12.0% (278/2313; staff: 14.1%, 146/1037 vs students: 10.3%, 132/1276; p = 0.006). Trends were similar to national infection data. Nucleoprotein-antibody seroprevalence increased for students and staff between Rounds 1 and 3 but were similar between Rounds 3 and 4, when the delta variant was the dominant circulating strain. Overall, Nucleoprotein-antibody seroconversion was 18.4% (137/744) in staff and 18.8% (146/778) in students, while Spike-antibody seroconversion was higher in staff (72.8%, 525/721) than students (21.3%, 163/764) because of vaccination. Interpretation: SARS-CoV-2 infection rates in secondary schools remained low when community infection rates were low, even as the delta variant was emerging in England. Funding: This study was funded by the UK Department of Health and Social Care.

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KW - COVID-19

KW - Education setting

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Emergence of the delta variant and risk of SARS-CoV-2 infection in secondary school students and staff: Prospective surveillance in 18 schools, England

Abstract

Bibliographical note

Keywords

UN SDGs

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