The association between SARS-CoV-2 infections in English primary and secondary school children and staff, and infections in members of their household in the schoolyear 2020-2021: a self-controlled case-series analysis

BackgroundThe role of children and staff in SARS-CoV-2 transmission outside and within households is still not fully understood when large numbers are in regular, frequent contact in schools. MethodsWe used the self-controlled case-series method during the alpha- and delta-dominant periods to explore the incidence of infection in periods around a household member infection, relative to periods without household infection, in a cohort of primary and secondary English school children and staff from November 2020 to July 2021. ResultsWe found the relative incidence of infection in students and staff was highest in the 1-7 days following household infection, remaining high up to 14 days after, with risk also elevated in the 6-12 days before household infection. Younger students had a higher relative incidence following household infection, suggesting household transmission may play a more prominent role compared with older students. The relative incidence was also higher amongst students in the alpha variant dominant period. ConclusionsThis analysis suggests SARS-CoV2 infection in children, young people and staff at English schools were more likely to be associated with within-household transmission than from outside the household, but that a small increased risk of seeding from outside is observed. Key messagesO_LIQuestion: With respect to incidence of SARS-CoV-2 infection before and after household member infection, is within-household transmission more likely than community transmission amongst school children and staff? C_LIO_LIFindings: In this self-controlled case-series analysis, the relative incidence of infection in students and staff was highest in the 1-7 days following household infection, remaining high up to 14 days after, with the highest relative incidence found in younger, primary school-aged children. C_LIO_LIImportance: Within-household transmission is more likely than from outside the household, but a small increased risk of seeding from outside the household is observed as well as variation by age and variant dominant period. C_LI