JMIR Publications

ABSTRACT

Background:

In low-middle income countries (LMIC), such as South Africa, there is paucity of data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections amongst children attending school, including seroprevalence and transmission dynamics.

Objective:

This pilot study aims to assess (i) the prevalence of self-reported or confirmed SARS-CoV-2 prior infections, COVID-19 symptoms (including long-COVID), seroprevalence of SARS-CoV-2 antibodies and general/mental-health (ii) longitudinal changes in SARS-CoV-2 seroprevalence, and (iii) SARS-CoV-2 acute infections, immune responses, transmission dynamics and symptomatic versus asymptomatic contacts among a unique cohort of unvaccinated learners, their parents, teachers and close contacts in urban/semi-urban primary school settings.

Methods:

Learners (grades 1-7) from primary schools in the KwaZulu-Natal province, South Africa, their parents and teachers will be invited to enroll into the COVID kids school study (CoKiDSS). CoKiDSS comprises three parts: a cross-sectional survey (n=640), a follow-up survey (n=300) and a nested case-cohort sub-study. Finger-prick blood and saliva samples will be collected for serological testing in the cross-sectional (451 learners: 147 parents: 42 teachers) and follow-up (210 learners: 70 parents: 20 teachers) surveys. The nested case-cohort sub-study will include ‘cases’ from the cross-sectional and follow-up surveys with confirmed current SARS-CoV-2 infection (n=30) and their close ‘contacts’ (n=up to 10 per infected participant ). Finger prick blood (from all survey participants), venous blood (from ‘cases’) and nasal swabs (from “cases’ and ‘contacts’) will be collected for serological testing, immunological testing and viral genome sequencing, respectively. Questionnaires covering sociodemographic and general- and mental-health information, prior and current SARS-CoV-2 symptoms and testing information, vaccination status, preventative behavior and lifestyle will be administered. Statistical methods will include generalized linear mixed models, intra-cluster correlation (ICC), descriptive analysis and graphical techniques.

Results:

Funding for this pilot study was awarded in quarter 1, 2022. Recruitment into the cross-sectional survey occurred between May to August 2023 and a total of 640 participants were enrolled into the survey as of 29 August 2023. The follow-up survey has commenced on the 11 September 2023 and screening of participants into the nested case cohort sub-study is anticipated to start in early October 2023. Data clean-up and analysis is as follows: 1) the cross-sectional survey is ongoing, and 2) the follow-up survey and nested case sub-study is anticipated to commence in November 2023 and April 2024, respectively. We expect to draft the findings for publication and dissemination for the cross-sectional and follow-up surveys by December 2023 and for the nested case cohort sub-study by May 2024, respectively.

Conclusions:

Expected study outcomes: This study will provide data from a LMIC setting on the impact of SARS-CoV-2 on school-attending learners, their parents and teachers 3 years after the SARS-CoV-2 pandemic was declared and 16-20 months after resumption of normal school attendance. In particular, the study will provide data on prevalence of self-reported or confirmed SARS-CoV-2 prior infection, prior and current symptoms, seroprevalence, changes in seroprevalence, SARS-CoV-2 transmission, SARS-CoV-2 adaptive immune responses, symptoms of long COVID and mental health among a triad of learners, their parents and teachers. Clinical Trial: This is a prospective observational pilot study.