S3-Guideline on Measures for the Prevention and Control of SARS-CoV-2
                    Transmission in Schools

Reinhard Berner; Ulrike Ravens-Sieberer; Brigitte Strahwald; Judith Blankenburg; Anne Kaman; Sabine Topf; Lydia Yao Li; Lisa Pfadenhauer; Lisa Strelow; Annic Weyersberg; Ingeborg Krägeloh-Mann; Dietrich Rothenbacher; Henriette Rudolph; Freia De Bock; Eva Annette Rehfuess

doi:10.1055/a-2508-4479

Klinische Pädiatrie, Table of Contents

Klin Padiatr 2025; 237(04): 191-201
DOI: 10.1055/a-2508-4479

Guideline

S3-Guideline on Measures for the Prevention and Control of SARS-CoV-2 Transmission in Schools

S3-Leitlinie Maßnahmen zur Prävention und Kontrolle der SARS-CoV-2-Übertragung in Schulen

Reinhard Berner

¹Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Dresden, Germany

⁴DGKJ, German Society of Pediatrics and Adolescent Medicine, Berlin, Germany

,

Ulrike Ravens-Sieberer

²Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Brigitte Strahwald

³Faculty of Medicine, Ludwig-Maximilians-Universität München, München, Germany

,

Judith Blankenburg

¹Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Dresden, Germany

,

Anne Kaman

²Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Sabine Topf

²Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Lydia Yao Li

²Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Lisa Pfadenhauer

³Faculty of Medicine, Ludwig-Maximilians-Universität München, München, Germany

,

Lisa Strelow

²Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Annic Weyersberg

⁵Department of Pediatrics, University Hospital Cologne, Köln, Germany

,

Ingeborg Krägeloh-Mann

⁶Department of Paediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany

,

Dietrich Rothenbacher

⁷Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany

⁸Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany

,

Henriette Rudolph

⁹Department of Pediatrics, Goethe University Frankfurt, Frankfurt am Main, Germany

,

Freia De Bock

¹⁰Institute of Medical Sociology and Rehabilitation Science, Charité Berlin, Berlin, Germany

,

Eva Annette Rehfuess

³Faculty of Medicine, Ludwig-Maximilians-Universität München, München, Germany

› Author Affiliations

Abstract

Aim

This guideline is concerned with measures to prevent and control the transmission of SARS-CoV-2 in primary and secondary schools, addressing school premises and all school-related activities, as well as routes to and from school.

Methods

This evidence- and consensus-based S3 guideline was registered with the AWMF and developed by guideline panelists representing a broad range of scientific societies across multiple disciplines, public health and educational institutions, as well as associations of those directly affected, notably teachers, students and parents.

Recommendations

This guideline contains recommendations on hybrid learning and cohorting of classes or students, wearing masks, measures on the way to school and in class, managing suspected cases and contact persons in schools, options for reducing aerosol concentrations in classrooms and testing strategies. In developing these, the guideline panel considered: balance of health benefits and harms, legal aspects, socio-cultural acceptability, health equity and non-discrimination, social and ecological consequences, financial and economic consequences and feasibility.

Zusammenfassung

Ziel

Diese Leitlinie befasst sich mit Maßnahmen zur Prävention und Kontrolle der Übertragung von SARS-CoV-2 in Grundschulen und weiterführenden Schulen. Sie berücksichtigt sowohl das Schulgelände und alle schulbezogenen Aktivitäten als auch die Wege von und zur Schule.

Methoden

Diese evidenz- und konsensbasierte S3-Leitlinie wurde bei der AWMF registriert und von einem Leitliniengremium erarbeitet, das ein breites Spektrum wissenschaftlicher Fachgesellschaften aus verschiedenen Disziplinen, Einrichtungen des öffentlichen Gesundheitswesens und des Bildungswesens sowie Verbände der direkt Betroffenen, insbesondere Lehrer, Schüler und Eltern, vertritt.

Empfehlungen

Die Leitlinie enthält Empfehlungen zu hybridem Lernen und Kohortenbildung von Klassen oder Schülern, dem Tragen von Masken, Maßnahmen auf dem Schulweg und im Unterricht, dem Umgang mit Verdachtsfällen und Kontaktpersonen in Schulen, Möglichkeiten zur Reduzierung der Aerosolkonzentration in Klassenzimmern und Teststrategien. Bei der Entwicklung dieser Empfehlungen berücksichtigte das Leitlinienteam das Gleichgewicht zwischen gesundheitlichem Nutzen und Schaden, rechtliche Aspekte, soziokulturelle Akzeptanz, gesundheitliche Chancengleichheit und Nichtdiskriminierung, soziale und ökologische Folgen, finanzielle und wirtschaftliche Auswirkungen sowie die Umsetzbarkeit.

Keywords

COVID-19 - children and adolescents - school - WHO-INTEGRATE - public - health - infection control

Schlüsselwörter

COVID-19 - Kinder und Jugendliche - Schule - WHO-INTEGRATE - Public - Health - Infektionskontrolle

Full Text

References

References
1 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) Ständige Kommission Leitlinien. AWMF-Regelwerk „Leitlinien“. Auflage 2.1 2023 https://www.awmf.org/regelwerk/ Accessed: 30.10.2024
2 Krishnaratne S, Littlecott H, Sell K. et al. Measures implemented in the school setting to contain the COVID-19 pandemic. Cochrane Database of Systematic Reviews 2022; 2022
3 Kratzer S, Pfadenhauer LM, Biallas RL. et al. Unintended consequences of measures implemented in the school setting to contain the COVID-19 pandemic: a scoping review. Cochrane Database of Systematic Reviews 2022;
4 Guyatt GH, Oxman AD, Vist GE. et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924-926
5 Rehfuess EA, Stratil JM, Scheel IB. et al. The WHO-INTEGRATE evidence to decision framework version 1.0: integrating WHO norms and values and a complexity perspective. BMJ Glob Health 2019; 4: e000844
6 Lessler J, Grabowski MK, Grantz KH. et al. Household COVID-19 risk and in-person schooling. Science 2021; 372: 1092-1097
7 Liu D, Lin G, Sun X. et al. Different School Reopening Plans on Coronavirus Disease 2019 Case Growth Rates in the School Setting in the United States. Journal of School Health 2021; 91: 370-375
8 Oster E, Jack R, Halloran C. et al. COVID-19 Mitigation Practices and COVID-19 Rates in Schools: Report on Data from Florida. New York and Massachusetts [forthcoming]
9 Reinbold GW. Effect of Fall 2020 K-12 instruction types on COVID-19 cases, hospital admissions, and deaths in Illinois counties. American Journal of Infection Control 2021; 49: 1146-1151
10 Chu DK, Akl EA, Duda S. et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. The Lancet 2020; 395: 1973-1987
11 Li Y, Liang M, Gao L. et al. Face masks to prevent transmission of COVID-19: A systematic review and meta-analysis. American Journal of Infection Control 2021; 49: 900-906
12 Bershteyn A, Kim H-Y, McGillen J. et al. Which policies most effectively reduce SARS-CoV-2 transmission in schools?. [forthcoming]
13 Budzyn SE, Panaggio MJ, Parks SE. et al. Pediatric COVID-19 Cases in Counties With and Without School Mask Requirements – United States, July 1–September 4, 2021. MMWR Morb Mortal Wkly Rep 2021; 70: 1377-1378
14 Cohen JA, Mistry D, Kerr CC. et al. Schools are not islands: Balancing COVID-19 risk and educational benefits using structural and temporal countermeasures [forthcoming].
15 Donovan CV, Rose C, Lewis KN. et al. SARS-CoV-2 Incidence in K–12 School Districts with Mask-Required Versus Mask-Optional Policies – Arkansas, August–October 2021. MMWR Morb Mortal Wkly Rep 2022; 71: 384-389
16 Gill BP, Goyal R, Hotchkiss J. Operating Schools in a Pandemic: Predicted Effects of Opening, Quarantining, and Closing Strategies. (September 2020 ) https://www.mathematica.org/publications/operating-schools-in-a-pandemic-predicted-effects-of-opening-and-quarantining-strategies Accessed: 30.10.2024
17 Sombetzki M, Lücker P, Ehmke M. et al. Impact of Changes in Infection Control Measures on the Dynamics of COVID-19 Infections in Schools and Pre-schools. Front Public Health 2021; 9: 780039
18 Sasser P, McGuine TA, Haraldsdottir K. et al. Reported COVID-19 Incidence in Wisconsin High School Athletes in Fall 2020. Journal of Athletic Training 2022; 57: 59-64
19 Heinrich J, Zhao T, Quartucci C. et al. SARS-CoV-2 Infektionen während Reisen mit Bahn und Bus. Ein systematisches Review epidemiologischer Studien. Gesundheitswesen 2021; 83: 581-592
20 Sun KS, Lau TSM, Yeoh EK. et al. Effectiveness of different types and levels of social distancing measures: a scoping review of global evidence from earlier stage of COVID-19 pandemic. BMJ Open 2022; 12: e053938
21 Becher L, Gena AW, Alsaad H. et al. The spread of breathing air from wind instruments and singers using schlieren techniques. Indoor Air 2021; 31: 1798-1814
22 Fleischer M, Schumann L, Hartmann A. et al. Pre-adolescent children exhibit lower aerosol particle volume emissions than adults for breathing, speaking, singing and shouting. J R Soc Interface 2022; 19: 20210833
23 Good N, Fedak KM, Goble D. et al. Respiratory Aerosol Emissions from Vocalization: Age and Sex Differences Are Explained by Volume and Exhaled CO2. Environ Sci Technol Lett 2021; 8: 1071-1076
24 McCarthy LP, Orton CM, Watson NA. et al. Aerosol and droplet generation from performing with woodwind and brass instruments. Aerosol Science and Technology 2021; 55: 1277-1287
25 Mürbe D, Kriegel M, Lange J. et al. Aerosol emission in professional singing of classical music. Sci Rep 2021; 11: 14861
26 Vance D, Shah P, Sataloff RT. COVID-19: Impact on the Musician and Returning to Singing; A Literature Review. Journal of Voice 2023; 37: 292.e1-292.e8
27 Exner M, Walger P, Gebel J. et al. Stellungnahme: Zum Einsatz von dezentralen mobilen Luftreinigungsgeräten im Rahmen der Prävention von COVID-19. (25. September 2020 ) https://www.krankenhaushygiene.de/pdfdata/2020_09_03_DGKH_Stellungnahme_Zum_Einsatz_von_dezentralen_Luftreinigern_zur_Praevention.pdf Accessed: 30.10.2024
28 Curtius J, Granzin M, Schrod J. Testing mobile air purifiers in a school classroom: Reducing the airborne transmission risk for SARS-CoV-2. Aerosol Science and Technology 2021; 55: 586-599
29 James C, Bernstein DI, Cox J. et al. HEPA filtration improves asthma control in children exposed to traffic-related airborne particles. Indoor Air 2020; 30: 235-243
30 Kähler CJ, Fuchs T, Hain R. Können mobile Raumluftreiniger eine indirekte SARS-CoV-2 Infektionsgefahr durch Aerosole wirksam reduzieren?. (05. Augustr 2020 ) https://www.unibw.de/lrt7/raumluftreiniger.pdf Accessed: 30.10.2024
31 Küpper M, Asbach C, Schneiderwind U. et al. Testing of an Indoor Air Cleaner for Particulate Pollutants under Realistic Conditions in an Office Room. Aerosol Air Qual Res 2019; 19: 1655-1665
32 Mousavi ES, Godri Pollitt KJ, Sherman J. et al. Performance analysis of portable HEPA filters and temporary plastic anterooms on the spread of surrogate coronavirus. Building and Environment 2020; 183: 107186
33 Siegel JA. Primary and secondary consequences of indoor air cleaners. Indoor Air 2016; 26: 88-96
34 Zacharias N, Haag A, Brang-Lamprecht R. et al. Air filtration as a tool for the reduction of viral aerosols. Science of The Total Environment 2021; 772: 144956
35 Blanchard AC, Desforges M, Labbé A-C. et al. Evaluation of Real-life Use of Point-of-care Rapid Antigen Testing for SARS-CoV-2 in Schools (EPOCRATES): a cohort study. cmajo 2022; 10: E1027-E1033
36 Campbell MM, Benjamin DK, Mann T. et al. Test-to-Stay After Exposure to SARS-CoV-2 in K–12 Schools. Pediatrics 2022; 149: e2021056045
37 Delaugerre C, Foissac F, Abdoul H. et al. Prevention of SARS-CoV-2 transmission during a large, live, indoor gathering (SPRING): a non-inferiority, randomised, controlled trial. The Lancet Infectious Diseases 2022; 22: 341-348
38 Dewald F, Suárez I, Johnen R. et al. Effective high-throughput RT-qPCR screening for SARS-CoV-2 infections in children. Nat Commun 2022; 13: 3640
39 Goldenfeld M, Cohen C, Gilboa M. et al. Rapid Antigen Tests For Safe School Opening in the COVID-19 Pandemic Era. Pediatric Infectious Disease Journal 2022; 41: e312-e317
40 Harris-McCoy K, Lee VC, Munna C. et al. Evaluation of a Test to Stay Strategy in Transitional Kindergarten Through Grade 12 Schools – Los Angeles County, California, August 16–October 31, 2021. MMWR Morb Mortal Wkly Rep 2021; 70: 1773-1777
41 Ma Q, Liu J, Liu Q. et al. Global Percentage of Asymptomatic SARS-CoV-2 Infections Among the Tested Population and Individuals With Confirmed COVID-19 Diagnosis: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4: e2137257
42 Pizarro AB, Persad E, Durao S. et al. Workplace interventions to reduce the risk of SARS-CoV-2 infection outside of healthcare settings. Cochrane Database of Systematic Reviews 2022; 2022
43 Schechter-Perkins EM, Doron S, Johnston R. et al. A Test-to-Stay Modified Quarantine Program for COVID-19 in Schools. Pediatrics 2022; 149: e2021055727
44 Walsh KA, Broderick N, Ahern S. et al. Effectiveness of rapid antigen testing for screening of asymptomatic individuals to limit the transmission of SARS-CoV-2: A rapid review. Reviews in Medical Virology 2022; 32: e2350
45 Young BC, Eyre DW, Kendrick S. et al. Daily testing for contacts of individuals with SARS-CoV-2 infection and attendance and SARS-CoV-2 transmission in English secondary schools and colleges: an open-label, cluster-randomised trial. The Lancet 2021; 398: 1217-1229
46 Joachim A, Dewald F, Suárez I. et al. Pooled RT-qPCR testing for SARS-CoV-2 surveillance in schools – a cluster randomised trial. EClinicalMedicine 2021; 39: 101082
47 Bischoff SC, Singer P, Koller M. et al. Standard operating procedures for ESPEN guidelines and consensus papers. Clinical Nutrition 2015; 34: 1043-1051

Supplementary Material

Supplementary Material