Abstract:
BACKGROUND : In low- and middle-income countries (LMICs) such as South Africa, there is paucity of data on SARS-CoV-2
infections among children attending school, including seroprevalence and transmission dynamics.
OBJECTIVE : This pilot study aims to assess (1) 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, (2) longitudinal changes in SARS-CoV-2 seroprevalence, and (3) SARS-CoV-2 acute infections, immune responses, transmission
dynamics, and symptomatic versus asymptomatic contacts in a unique cohort of unvaccinated primary school learners, their
parents, teachers, and close contacts in semirural primary school settings.
METHODS : Learners (grades 1-7) from primary schools in KwaZulu-Natal, South Africa, their parents, and teachers will be
invited to enroll into the COVID kids school study (CoKiDSS). CoKiDSS comprises 3 parts: a cross-sectional survey (N=640),
a follow-up survey (n=300), and a nested case-cohort substudy. Finger-prick blood and saliva samples will be collected for
serological and future testing, respectively, in the cross-sectional (451 learners:147 parents:42 teachers) and follow-up (210
learners:70 parents:20 teachers) surveys. The nested case-cohort substudy will include cases from the cross-sectional survey 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 substudy 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,
intracluster correlation, descriptive analysis, and graphical techniques.
RESULTS : A total of 645 participants were enrolled into the cross-sectional survey between May and August 2023. A subset of
300 participants were followed up in the follow-up survey in October 2023. Screening of the participants into the nested case-cohort
substudy is planned between November 2023 and September 2024. Data cleanup and analysis for the cross-sectional survey is
complete, while those for the follow-up survey and nested case substudy will be completed by the third quarter of 2024. The
dissemination and publication of results is anticipated for the fourth quarter of 2024.
CONCLUSIONS : This study provides data from an 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 21-24 months after resumption of normal school
attendance. In particular, this study will provide data on the 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, and symptoms of long COVID and mental health among a triad of learners, their parents, and teachers.
International Registered Report Identifier (IRRID): DERR1-10.2196/52713
