The Susceptibility of School Contacts of SARS‐CoV‐2 and the Effectiveness of Non-Pharmaceutical Interventions in School Environments: A Meta-Analysis

Background: Little is known about the role of school contact in the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the effectiveness of non-pharmaceutical interventions (NPIs) in educational institutions remains controversial. This meta-analysis aims to clarify the secondary infections of SARS-CoV-2 and the effects of NPIs in schools so as to provide a basis for improving the decision-making of preventive measures in educational institutions. Methods: A literature search was conducted using the databases PubMed, Web of Science, and Cochrane through August 1, 2022. Data would be extracted in a standard form. Freeman-Tukey double arcsine24 transformed secondary attack rates (SARs) were used to assess the susceptibility of close contacts of SARS‐CoV‐2 in educational institutions. Subgroup analysis would be conducted to explore the potential source of heterogeneity. This review was registered with PROSPERO (CRD42022349917).Results: Thirty-four studies involving 226 727 school contacts and 2 216 secondary cases were included. The pooled SAR in educational institutions was 3·25% (95%CI: 1·97, 4·82) , with significant evidence of high between-study heterogeneity (Q=1420.21, tau2= 0.0127, I2 29 =98%, P<0.01). Twenty-one studies reported the SARs in staff contacts, the pooled SAR was 2.86% (95%CI: 0.54, 6.33), and twenty-four studies reported the SARs in student contacts, the pooled SAR was 3.02% (95%CI: 1.59, 4.83). The pooled relative risk (RR) for secondary infections of staff and student contacts was 1.31, with no significant difference (P>0.05). The results of subgroup analysis showed that implementation of multiple or specific combinations of NPIs was associated with lower SAR.Interpretation: The pooled SAR was higher than that in previous studies, which provided updated evidence of SARS-CoV-2 transmission in educational institutions. There was limited evidence to identify the high-risk group of SARS-CoV-2 transmission in schools. Adopting multiple prevention strategies could effectively reduce the secondary infection of SARS-CoV-2 in school.Study Registration: This review was registered with PROSPERO (CRD42022349917).Funding Information: None.Declaration of Interests: The authors declare no conflict of interest.Ethics Approval Statement: The meta-analysis is based on published research, and the original data are anonymous, so the study does not require ethical approval.