To close the knowledge gap on the role of school children in the COVID-19 pandemic the VCDI has initiated large-scale monitoring projects at Austrian schools using gargling in combination with pooling and RT-qPCR.
The role of (school) children in the COVID-19 pandemics is not well understood
Children can be infected with SARS-CoV-2 and the virus titer in their throat is comparable to adults. However, children appear to be more often oligo- or asymptomatic than adult COVID-19 patients and they are thus easily overlooked in testing campaigns focusing on symptomatic persons. Currently, inconsistent information is available regarding the importance of children and schools for spreading SARS-CoV-2. While schools apparently did not massively contribute to infection clusters in some countries, in other countries like Israel many clusters could be traced back to schools.
VCDI spearheaded school monitoring programs in Austria based on gargling
In order to help closing the knowledge gap on the role of schools in the COVID-19 pandemic and to provide data for judging the effectiveness of measures implemented at schools to prevent spread of the virus, the VCDI has initiated in collaboration with the Austrian Ministry of Education, Science and Research SARS-CoV-2 monitoring studies at Austrian schools. For this purpose, the gargling protocol developed by the VCDI is used for sample generation, samples are pooled to increase testing capacity and to reduce the amount of required consumables and subsequently the pools are analyzed after RNA extraction by RT-qPCR using the highly automized VCDI pipeline (Standard Operating Procedures). If a pooled sample tests positive, the respective individual samples are re-analyzed in order to identify the infected person(s).
Successful pilot study at 11 Viennese schools
In June and July 2020 a pilot study financed by the Austrian Ministry of Education, Science and Research and the City of Vienna was conducted at 11 Viennese schools (primary schools grade 1 - 4 and five secondary schools where only grades 5 - 8 were enrolled; pupils and teachers) and more than 5.000 gargling samples were obtained and analyzed. The pilot study led by the VCDI member Michael Wagner (University of Vienna) and by Manuela Födinger (Wiener Gesundheitsverbund) revealed that high quality gargling samples could be obtained from almost 90% of the pupils and teachers and even among first graders about 80% of the gargling samples were obtained es desired (after 1 min of gargling; no eating or drinking one hour before gargling). As the pilot study was performed during a period of very low COVID-19 infection prevalence, only one teacher tested positive. In addition, all team members and students involved in sample generation and processing were tested and one of the students tested positive, too. Both positively tested persons were immediately isolated.
Establishment of a sentinel surveillance system at Austrian Schools
Based on the successful pilot study, a large-scale SARS-CoV-2 sentinel surveillance system was suggested by the VCDI to Austrian Ministry of Education, Science and Research and is now implemented at Austrian schools for the school year 2020/2021. In total, approx. 14.000 pupils and 1.200 teachers from 250 schools will be invited to participate in this study and all participating persons will be tested via gargling ten times during the school year. The sentinel surveillance study will be coordinated by Michael Wagner and is performed in close collaboration between the VCDI, the University of Vienna, the Medical University of Graz, the Medical University of Innsbruck, and the medical faculty of the University of Linz. The project is financed by the ministry. The result of this monitoring study will allow obtaining high quality data that can be used to signal trends, identify outbreaks and monitor the burden of COVID-19 and to judge the effectiveness of preventive measures established in schools.
In the sentinel study school doctors will supervise the gargling and perform the sample handling at schools. The video above shows the individual steps involved in this process.