Impacts of testing and immunity acquired through vaccination and infection on covid-19 cases in Massachusetts elementary and secondary students

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Pubblicato in:Communications Medicine vol. 4, no. 1 (Dec 2024), p. 202
Autore principale: Branch-Elliman, Westyn
Altri autori: Ertem, Melissa Zeynep, Nelson, Richard E., Danesharasteh, Anseh, Berlin, David, Fisher, Lloyd, Schechter-Perkins, Elissa M.
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Springer Nature B.V.
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024 7 |a 10.1038/s43856-024-00619-3  |2 doi 
035 |a 3117219979 
045 2 |b d20241201  |b d20241231 
100 1 |a Branch-Elliman, Westyn  |u VA Boston Center for Healthcare Optimization and Implementation Research (CHOIR), Boston, US; Section of Infectious Diseases, VA Boston Healthcare System, Department of Medicine, Boston, US (GRID:grid.410370.1) (ISNI:0000 0004 4657 1992); Department of Medicine, Harvard Medical School, Boston, US (GRID:grid.38142.3c) (ISNI:000000041936754X) 
245 1 |a Impacts of testing and immunity acquired through vaccination and infection on covid-19 cases in Massachusetts elementary and secondary students 
260 |b Springer Nature B.V.  |c Dec 2024 
513 |a Journal Article 
520 3 |a BackgroundDuring 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.MethodsCommunity-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.ResultsHere 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.ConclusionsTesting 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.Plain language summaryDuring the height of the Covid-19 pandemic, multiple strategies were used to enable students to participate in in-person elementary and secondary schools. Little is known about the overall impact of prior immunity and in-person testing programs on the ability to maintain protection from Covid-19 in schools. This study, conducted in Massachusetts during the 2021-2022 academic year, found that community immunity gained through prior infection or vaccination, combined with testing strategies including testing programs to monitor infection and test to-stay modified quarantine programs, were safe and effective for allowing in-person learning. These data can be used to shape policy about in-school practices during future respiratory virus pandemics. 
651 4 |a United States--US 
651 4 |a Massachusetts 
653 |a Infections 
653 |a COVID-19 vaccines 
653 |a Students 
653 |a Classrooms 
653 |a Severe acute respiratory syndrome coronavirus 2 
653 |a Asymptomatic 
653 |a Participation 
653 |a Elementary schools 
653 |a Contact tracing 
653 |a Quarantine 
653 |a Antigens 
653 |a COVID-19 diagnostic tests 
653 |a Surveillance 
653 |a Learning 
653 |a Masks 
653 |a School districts 
653 |a Consent 
653 |a Immunity (Disease) 
700 1 |a Ertem, Melissa Zeynep  |u State University of New York, School of Systems Science and Industrial Engineering, Binghamton University, New York, US (GRID:grid.410412.2) (ISNI:0000 0004 0384 8998) 
700 1 |a Nelson, Richard E.  |u University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, US (GRID:grid.223827.e) (ISNI:0000 0001 2193 0096); Veterans Affairs Salt Lake City Healthcare System, IDEAS Center, Salt Lake City, US (GRID:grid.280807.5) (ISNI:0000 0000 9555 3716) 
700 1 |a Danesharasteh, Anseh  |u State University of New York, School of Systems Science and Industrial Engineering, Binghamton University, New York, US (GRID:grid.410412.2) (ISNI:0000 0004 0384 8998) 
700 1 |a Berlin, David  |u CIC Health, Cambridge, US (GRID:grid.410412.2) 
700 1 |a Fisher, Lloyd  |u Reliant Medical Group, Worchester, US (GRID:grid.417798.4) (ISNI:0000 0004 0413 6247); Department of Pediatrics, UMass Medical School, Worchester, US (GRID:grid.168645.8) (ISNI:0000 0001 0742 0364) 
700 1 |a Schechter-Perkins, Elissa M.  |u Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Department of Emergency Medicine, Boston, US (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558) 
773 0 |t Communications Medicine  |g vol. 4, no. 1 (Dec 2024), p. 202 
786 0 |d ProQuest  |t Healthcare Administration Database 
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