scholarly journals “Scuola Sicura”: a school screening program to prevent the spread of COVID-19 among students in Piedmont, Italy

2021 ◽  
Author(s):  
Elena Farina ◽  
Ilenia Eboli ◽  
Teresa Spadea ◽  
Carlo Saugo ◽  
Lorenzo Richiardi ◽  
...  
Keyword(s):  
Secondary Schools ◽  
Large Scale ◽  
Screening Program ◽  
Transmission Rate ◽  
Outcome Evaluation ◽  
Mitigation Strategies ◽  
Contact Tracing ◽  
Local Health ◽  
Regional Government ◽  
School Screening

Abstract ObjectivesThe regional government of Piedmont approved an experimental screening testing program entitled “Scuola Sicura” with the aim to: rapidly contain thes spread of COVID-19 in the school population together with general mitigation strategies such as contact tracing, and case isolation, and to monitor the transmission rate in this population. In this paper we report the initial process and outcome evaluation results and the criticalities encountered during program rollout.DesignDescriptive study of the trend in the period Janaury-March 2021.The evaluation of the preventive capacity of the program is limited to the period of in-class learning. The data sources used are the COVID-19 platform Piedmont, the archives of the local health Departments and the CedAP-SDO archive. Setting and participantsThe screening program targeted second and third grade students in first level secondary schools throughout Piedmont. Each class was subdivided into four groups; one group each week underwent screening, yielding one test per student per month.Main outcome measuresThe following indices were calculated with a 95% confidence interval: 1. number of positive cases detected vs. total number of students tested in the “Scuola Sicura” program;2. number of positive cases detected outside the “Scuola Sicura” program vs total number of students enrolled in the 2nd and 3rd grades of first-level secondary schools in Piedmont.To evaluate the preventive capacity, quarantines were detected. In order to investigate the spread of COVID-19 in households, the mother-child pair was tracked and cases of positivity among mothers were identified. Results69% of schools in Piedmont participated in the program; the actual participation was 19.5% of the total number of students enrolled in second and third grades of first-level secondary schools. SS detected 114 positives cases for SARS-CoV-2, yielding a prevalence of 0.52% (95%CI 0.42-0.61) when calculated for the total number of students tested by the program. Starting from 08.03.2021, the target classes have started distance learning: 69 of the 114 positive students were identified before that date, leading to the activation of 67 quarantine measures. For 61 of the 69 cases (88%) identified by SS before 8 March, the mother-child couple was reconstruncted through record linkage between the CedAP and SDO archives. Forty-six mothers perfomed a swab test after that of the child with a positive result in 24% of cases (n=11). Asymptomatic cases identified at screening accounted for 26.5% of the total number of cases occurred in the participating classes.ConclusionsThis is one of the few studies (and the first in Italy) to describe the functioning and predictive capacity of school screening testing for COVID-19 in a real-world situation. Our findings provide data-driven suggestions for government agencies when planning large-scale school screening testing programs. When well organized and implemented jointly with other transmission prevention measures and contact tracing, school screening may be a viable strategy to keep schools open when high levels of the virus are circulating in the community.

scholarly journals “Scuola Sicura”: a school screening program to prevent the spread of COVID-19 among students in Piedmont, Italy

2021 ◽  
Author(s):  
Elena Farina ◽  
Ilenia Eboli ◽  
Teresa Spadea ◽  
Carlo Saugo ◽  
Lorenzo Richiardi ◽  
...  
Keyword(s):  
Large Scale ◽  
Screening Program ◽  
Outcome Evaluation ◽  
Birth Certificates ◽  
Local Health ◽  
Predictive Capacity ◽  
School Screening ◽  
Case Identification ◽  
Third Grade Students ◽  
Early Case

Abstract ObjectivesAims of “Scuola Sicura” (SS) were to monitor the rate of COVID-19 and to contain its spread within the school population through early case isolation. We report the initial process and outcome evaluation results.DesignDescriptive study of an experimental screening testing program in children in Piedmont in the period January-March 2021. We used data from the COVID-19 platform and the Local Health Units, the archives of birth certificates (CedAP) and hospital discharge files (SDO).Setting and participantsThe screening program targeted second and third grade students in first level secondary schools. Participants were subdivided into four groups; one group each week underwent screening, yielding one test per student per month.Main outcome measuresWe calculated:1. number of positive cases detected vs. total number of students tested in the SS program;2. number of positive cases detected outside the SS program vs. total number of students in the target population.We detected the number of quarantines due to SS and no-SS case identification. To investigate the spread of COVID-19 in households, the mother-child pairs were identified through record linkage between the CedAP and SDO archives, and positive mothers were identified.ResultsSixty-nine percent of schools and 19.5% of the students participated in the program. SS detected 114 positives cases for SARS-CoV-2. On 08.03.2021, the target classes started distance learning: 69 of the 114 positive students were identified before that date, leading to the activation of 67 quarantine measures. We were able to identify the mothers of 61 out of 69 of those students (88%); 46 mothers had performed a swab test after the positivity of their child with a positive result in 11 cases. Asymptomatic cases identified at screening during in-class learning period accounted for 26.5% of the total number of cases occurred in the participating classes.ConclusionsThis is one of the few studies (and the first in Italy) to describe the functioning and predictive capacity of school screening testing for SARS-CoV-2 in a real-world situation. Our findings provide data-driven suggestions for government agencies when planning large-scale school screening testing programs.

scholarly journals Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Transmission Dynamics Should Inform Policy

2020 ◽  
Author(s):  
Muge Cevik ◽  
Julia L Marcus ◽  
Caroline Buckee ◽  
Tara C Smith
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Large Scale ◽  
Mitigation Strategies ◽  
Transmission Dynamics ◽  
Contact Tracing ◽  
Reproductive Number ◽  
Targeted Interventions ◽  
Risk Environments ◽  
Preventative Measures ◽  
Nonpharmaceutical Interventions

Abstract It is generally agreed that striking a balance between resuming economic and social activities and keeping the effective reproductive number (R0) below 1 using nonpharmaceutical interventions is an important goal until and even after effective vaccines become available. Therefore, the need remains to understand how the virus is transmitted in order to identify high-risk environments and activities that disproportionately contribute to its spread so that effective preventative measures could be put in place. Contact tracing and household studies, in particular, provide robust evidence about the parameters of transmission. In this Viewpoint, we discuss the available evidence from large-scale, well-conducted contact-tracing studies from across the world and argue that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission dynamics should inform policy decisions about mitigation strategies for targeted interventions according to the needs of the society by directing attention to the settings, activities, and socioeconomic factors associated with the highest risks of transmission.

scholarly journals Detection of asymptomatic SARS-CoV-2 infections among healthcare workers: results from a large-scale screening program based on rapid serological testing.

2020 ◽  
Author(s):  
Francesca Maria Carozzi ◽  
Maria Grazia Cusi ◽  
Mauro Pistello ◽  
Luisa Galli ◽  
Alessandro Bartoloni ◽  
...  
Keyword(s):  
Large Scale ◽  
Screening Program ◽  
Serological Test ◽  
Contact Tracing ◽  
Winter Period ◽  
Serological Tests ◽  
Diagnostic Pcr ◽  
Predictive Values ◽  
The Individual

Abstract Objective: To evaluate the performance of two available rapid immunological tests for identification of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) antibodies and their subsequent application to a regional screening of health care workers (HCW) in Tuscany (Italy). Design: measures of accuracy and HCW serological surveillance Setting: 6 major health facilities in Tuscany, Italy. Participants: 17,098 HCW of the Tuscany Region. Measures of accuracy were estimated to assess sensitivity in 176 hospitalized Covid-19 clinical subjects at least 14 days after a diagnostic PCR-positive assay result. Specificity was assessed in 295 sera biobanked in the pre-Covid-19 era in winter or summer 2013-14 Main outcome measures: Sensitivity and specificity, and 95% confidence intervals, were measured using two serological tests, named T-1 and T-2. Positive and Negative predictive values were estimated at different levels of prevalence. HCW of the health centers were tested using the serological tests, with a follow- up nasopharyngeal PCR-test swab in positive tested cases. Results: Sensitivity was estimated as 99% (95%CI: 95%-100%) and 97% (95% CI: 90%-100%), whereas specificity was the 95% and 92%, for Test T-1 and T-2 respectively. In the historical samples IgM cross-reactions were detected in sera collected during the winter period, probably linked to other human coronaviruses. Out of the 17,098 tested, 3.1% have shown the presence of SARS-CoV-2 IgG antibodies, among them 6.8% were positive at PCR follow-up test on nasopharyngeal swabs. Conclusion Based on the low prevalence estimate observed in this survey, the use of serological test as a stand-alone test is not justified to assess the individual immunity status. Serological tests showed good performance and might be useful in an integrated surveillance, for identification of infected subjects and their contacts as required by the policy of contact tracing, with the aim to reduce the risk of dissemination, especially in health service facilities.

scholarly journals Evolution of SARS-CoV-2 Key Mutations in Vienna Detected by Large Scale Screening Program

Viruses ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2014
Author(s):  
Jakob Thannesberger ◽  
Anna Edermayr ◽  
Alireza Karimi ◽  
Mathias Mueller ◽  
Ursula Karnthaler ◽  
...  
Keyword(s):  
Large Scale ◽  
Screening Program ◽  
Relative Proportion ◽  
Capital City ◽  
Contact Tracing ◽  
Pcr Analysis ◽  
Specific Pcr ◽  
Unbiased Manner ◽  
Surveillance Programs ◽  
The Government

Currently countries across the globe are preparing for the fourth wave of SARS-CoV-2 infections, which is mainly driven by the rapid spread of novel SARS-CoV-2 variants. Austria and, in particular, the capital city of Vienna, witnessed a disproportionally steep rise in SARS-CoV-2 infection rates during the last wave of infections. By the end of January 2021, the government of Vienna launched an innovative, state-wide SARS-CoV-2 screening program based on PCR analysis of self-collected mouthwash samples. More than 400,000 mouthwash samples were collected in Vienna during the third wave of infection from January to March 2021. All preanalytical and analytical steps were carried out in a highly standardized manner at a single certified testing center. SARS-CoV-2 specific PCR analysis revealed in these samples a positivity rate of 0.43%. The relative proportion of N501Y positive virus samples increased continually to 68% of weekly samples. Mutation K417N was detected only in three samples. With this study, we were able to map the temporal occurrence of SARS-CoV-2 variants in a highly unbiased manner. Positivity rates and variant prevalence rates in this study were lower than in other nationwide programs. The results presented in this study indicate that actual virus prevalence tends to be overestimated by surveillance programs such as results of cluster analysis or contact tracing programs.

scholarly journals Subsequent attendance in a breast cancer screening program after a false-positive result in the Local Health Authority of Bologna (Italy)

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lorena Squillace ◽  
Lorenzo Pizzi ◽  
Flavia Rallo ◽  
Carmen Bazzani ◽  
Gianni Saguatti ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Positive Result ◽  
Breast Cancer Screening ◽  
Health Authority ◽  
False Positive ◽  
Screening Program ◽  
Local Health Authority ◽  
Local Health ◽  
False Positive Result

AbstractWe conducted a cross-sectional study to assess the likelihood of returning for routine breast cancer screening among women who have experienced a false-positive result (FPR) and to describe the possible individual and organizational factors that could influence subsequent attendance to the screening program. Several information were collected on demographic and clinical characteristics data. Electronic data from 2014 to 2016 related to breast screening program of the Local Health Authority (LHA) of Bologna (Italy) of women between 45 and 74 years old were reviewed. A total of 4847 women experienced an FPR during mammographic screening and were recalled to subsequent round; 80.2% adhered to the screening. Mean age was 54.2 ± 8.4 years old. Women resulted to be less likely to adhere to screening if they were not-Italian (p = 0.001), if they lived in the Bologna district (p < 0.001), if they had to wait more than 5 days from II level test to end of diagnostic procedures (p = 0.001), if the diagnostic tests were performed in a hospital with the less volume of activity and higher recall rate (RR) (p < 0.001) and if they had no previous participation to screening tests (p < 0.001). Our results are consistent with previous studies, and encourages the implementation and innovation of the organizational characteristics for breast cancer screening. The success of screening programs requires an efficient indicators monitoring strategy to develop and evaluate continuous improvement processes.

scholarly journals Estimating asymptomatic, undetected and total cases for the COVID-19 outbreak in Wuhan: a mathematical modeling study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xi Huo ◽  
Jing Chen ◽  
Shigui Ruan
Keyword(s):  
Disease Transmission ◽  
Large Scale ◽  
Transmission Rate ◽  
Control Strategies ◽  
Herd Immunity ◽  
Antibody Prevalence ◽  
Screening Process ◽  
Vaccination Programs ◽  
Prevalence Level ◽  
The Impact

Abstract Background The COVID-19 outbreak in Wuhan started in December 2019 and was under control by the end of March 2020 with a total of 50,006 confirmed cases by the implementation of a series of nonpharmaceutical interventions (NPIs) including unprecedented lockdown of the city. This study analyzes the complete outbreak data from Wuhan, assesses the impact of these public health interventions, and estimates the asymptomatic, undetected and total cases for the COVID-19 outbreak in Wuhan. Methods By taking different stages of the outbreak into account, we developed a time-dependent compartmental model to describe the dynamics of disease transmission and case detection and reporting. Model coefficients were parameterized by using the reported cases and following key events and escalated control strategies. Then the model was used to calibrate the complete outbreak data by using the Monte Carlo Markov Chain (MCMC) method. Finally we used the model to estimate asymptomatic and undetected cases and approximate the overall antibody prevalence level. Results We found that the transmission rate between Jan 24 and Feb 1, 2020, was twice as large as that before the lockdown on Jan 23 and 67.6% (95% CI [0.584,0.759]) of detectable infections occurred during this period. Based on the reported estimates that around 20% of infections were asymptomatic and their transmission ability was about 70% of symptomatic ones, we estimated that there were about 14,448 asymptomatic and undetected cases (95% CI [12,364,23,254]), which yields an estimate of a total of 64,454 infected cases (95% CI [62,370,73,260]), and the overall antibody prevalence level in the population of Wuhan was 0.745% (95% CI [0.693%,0.814%]) by March 31, 2020. Conclusions We conclude that the control of the COVID-19 outbreak in Wuhan was achieved via the enforcement of a combination of multiple NPIs: the lockdown on Jan 23, the stay-at-home order on Feb 2, the massive isolation of all symptomatic individuals via newly constructed special shelter hospitals on Feb 6, and the large scale screening process on Feb 18. Our results indicate that the population in Wuhan is far away from establishing herd immunity and provide insights for other affected countries and regions in designing control strategies and planing vaccination programs.

scholarly journals Use of Antiplatelet Agents Decreases the Positive Predictive Value of Fecal Immunochemical Tests for Colorectal Cancer but Does Not Affect Their Sensitivity

2021 ◽  
Vol 11 (6) ◽  
pp. 497
Author(s):  
Yoonsuk Jung ◽  
Eui Im ◽  
Jinhee Lee ◽  
Hyeah Lee ◽  
Changmo Moon
Keyword(s):  
Colorectal Cancer ◽  
Large Scale ◽  
Screening Program ◽  
Antiplatelet Agents ◽  
Population Based ◽  
Small Sample ◽  
Antithrombotic Agents ◽  
Predictive Values ◽  
Prescription Rates ◽  
Small Sample Sizes

Previous studies have evaluated the effects of antithrombotic agents on the performance of fecal immunochemical tests (FITs) for the detection of colorectal cancer (CRC), but the results were inconsistent and based on small sample sizes. We studied this topic using a large-scale population-based database. Using the Korean National Cancer Screening Program Database, we compared the performance of FITs for CRC detection between users and non-users of antiplatelet agents and warfarin. Non-users were matched according to age and sex. Among 5,426,469 eligible participants, 768,733 used antiplatelet agents (mono/dual/triple therapy, n = 701,683/63,211/3839), and 19,569 used warfarin, while 4,638,167 were non-users. Among antiplatelet agents, aspirin, clopidogrel, and cilostazol ranked first, second, and third, respectively, in terms of prescription rates. Users of antiplatelet agents (3.62% vs. 4.45%; relative risk (RR): 0.83; 95% confidence interval (CI): 0.78–0.88), aspirin (3.66% vs. 4.13%; RR: 0.90; 95% CI: 0.83–0.97), and clopidogrel (3.48% vs. 4.88%; RR: 0.72; 95% CI: 0.61–0.86) had lower positive predictive values (PPVs) for CRC detection than non-users. However, there were no significant differences in PPV between cilostazol vs. non-users and warfarin users vs. non-users. For PPV, the RR (users vs. non-users) for antiplatelet monotherapy was 0.86, while the RRs for dual and triple antiplatelet therapies (excluding cilostazol) were 0.67 and 0.22, respectively. For all antithrombotic agents, the sensitivity for CRC detection was not different between users and non-users. Use of antiplatelet agents, except cilostazol, may increase the false positives without improving the sensitivity of FITs for CRC detection.

scholarly journals Tuberculosis contact investigation results among paediatric contacts in low-incidence settings in Finland

2021 ◽  
Author(s):  
Antti Kontturi ◽  
Satu Kekomäki ◽  
Eeva Ruotsalainen ◽  
Eeva Salo
Keyword(s):  
Early Diagnosis ◽  
Young Children ◽  
Large Scale ◽  
Index Case ◽  
Contact Tracing ◽  
Sputum Smear ◽  
Endemic Country ◽  
Household Contacts ◽  
Contact Investigation ◽  
Positive Index

AbstractTuberculosis (TB) risk is highest immediately after primary infection, and young children are vulnerable to rapid and severe TB disease. Contact tracing should identify infected children rapidly and simultaneously target resources effectively. We conducted a retrospective review of the paediatric TB contact tracing results in the Hospital District of Helsinki and Uusimaa from 2012 to 2016 and identified risk factors for TB disease or infection. Altogether, 121 index cases had 526 paediatric contacts of whom 34 were diagnosed with TB disease or infection. The maximum delay until first contact investigation visit among the household contacts under 5 years of age with either TB disease or infection was 7 days. The yield for TB disease or infection was 4.6% and 12.8% for household contacts, 0.5% and 0% for contacts exposed in a congregate setting and 1.4% and 5.0% for other contacts, respectively. Contacts born in a TB endemic country (aOR 3.07, 95% CI 1.10–8.57), with household exposure (aOR 2.96, 95% CI 1.33–6.58) or a sputum smear positive index case (aOR 3.96, 95% CI 1.20–13.03) were more likely to have TB disease or infection.Conclusions: Prompt TB investigations and early diagnosis can be achieved with a well-organised contact tracing structure. The risk for TB infection or disease was higher among contacts with household exposure, a sputum smear positive index case or born in a TB endemic country. Large-scale investigations among children exposed in congregate settings can result in a very low yield and should be cautiously targeted. What is Known:• Vulnerable young children are a high priority in contact tracing and should be evaluated as soon as possible after TB exposure What is New:• Prompt investigations for paediatric TB contacts and early diagnosis of infected children can be achieved with a well-organised contact tracing structure• Large-scale investigations among children exposed in congregate settings can result in a very low yield and should be cautiously targeted

scholarly journals Digital proximity tracing on empirical contact networks for pandemic control

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
G. Cencetti ◽  
G. Santin ◽  
A. Longa ◽  
E. Pigani ◽  
A. Barrat ◽  
...  
Keyword(s):  
Large Scale ◽  
Disease Outbreaks ◽  
Physical Distance ◽  
Contact Tracing ◽  
Reproductive Number ◽  
Modeling Framework ◽  
Infectious Disease Outbreaks ◽  
Contact Patterns ◽  
Contact Data ◽  
The Impact

AbstractDigital contact tracing is a relevant tool to control infectious disease outbreaks, including the COVID-19 epidemic. Early work evaluating digital contact tracing omitted important features and heterogeneities of real-world contact patterns influencing contagion dynamics. We fill this gap with a modeling framework informed by empirical high-resolution contact data to analyze the impact of digital contact tracing in the COVID-19 pandemic. We investigate how well contact tracing apps, coupled with the quarantine of identified contacts, can mitigate the spread in real environments. We find that restrictive policies are more effective in containing the epidemic but come at the cost of unnecessary large-scale quarantines. Policy evaluation through their efficiency and cost results in optimized solutions which only consider contacts longer than 15–20 minutes and closer than 2–3 meters to be at risk. Our results show that isolation and tracing can help control re-emerging outbreaks when some conditions are met: (i) a reduction of the reproductive number through masks and physical distance; (ii) a low-delay isolation of infected individuals; (iii) a high compliance. Finally, we observe the inefficacy of a less privacy-preserving tracing involving second order contacts. Our results may inform digital contact tracing efforts currently being implemented across several countries worldwide.

scholarly journals Threat of arsenic contamination, salinity and water pollution in agricultural practices of Sundarban Delta, India, and mitigation strategies

2021 ◽  
Vol 3 (5) ◽  
Author(s):  
Anirban Nath ◽  
Sourav Samanta ◽  
Saon Banerjee ◽  
Anamitra Anurag Danda ◽  
Sugata Hazra
Keyword(s):  
Plant Breeding ◽  
Rural Population ◽  
Large Scale ◽  
Local Population ◽  
Agricultural Practices ◽  
Mitigation Strategies ◽  
Saline Stress ◽  
Freshwater Resources ◽  
Catchment Areas ◽  
The Sundarbans

AbstractThe paper through a critical appraisal of the agricultural practices in the Indian Sundarban deltaic region explores the tripartite problems of arsenic biomagnification, salinity of arable lands and ingress of agrochemical pollutants into the freshwater resources, which endanger the health, livelihood and food security of the rural population inhabiting the delta. The threefold problem has rendered a severe blow to the agrarian economy consequently triggering large-scale outmigration of the rural population from the region. Although recent studies have addressed these issues separately, the inter-connectivity among these elements and their possible long-term impact upon sustainability in the Sundarbans are yet to be elucidated. In the current scenario, the study emphasizes that the depleting freshwater resources is at the heart of the threefold problems affecting the Sundarbans. Owing to the heavy siltation of the local river systems, freshwater resources from the local ravines have salinized beyond the point of being used for agricultural purposes. At the same time, increasing salinity levels resulting from fluctuation of pre- and post-monsoon rainfall, frequent cyclones and capillary movement of salinized groundwater (primarily during the Rabi season) have severely hampered the agricultural practices. Salinization of above groundwater reserves has forced the farmers toward utilization of groundwater, which are lifted using STWs, especially for rice and other cultivations in the Rabi season. The Holocene aquifers of the region retain toxic levels of arsenic which are lifted during the irrigation process and are deposited on to the agricultural fields, resulting in bioaccumulation of As in the food products resourced from the area. The compound effect of consuming arsenic-contaminated food and drinking water has resulted in severe health issues recorded among the local population in the delta. Furthermore, due to the sub-optimal conditions for sustaining agriculture under saline stress, farmers often opt for the cultivation of post-green revolution high-yielding varieties, which require additional inputs of nitrogen-based fertilizers, organophosphate herbicides and pesticides that are frequently washed away by runoff from the watershed into the low-lying catchment areas of the biosphere reserve. Such practices have endangered the vulnerable conditions of local flora and fauna. In the present situation, the study proposes mitigation strategies which necessitate the smart use of locally obtainable resources like water, adaptable cultivars and sustainable agronomic practices like organic farming. The study also suggests engaging of conventional plant breeding strategies such as “Evolutionary plant breeding” for obtaining cultivars adapted to the shifting ecological conditions of the delta in the long run.

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