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SARS-CoV-2 infection in schools in a northern French city: a retrospective serological cohort study in an area of high transmission, France, January to April 2020
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Arnaud Fontanet1,2
,
Laura Tondeur1
,
Rebecca Grant1
, Sarah Temmam3
, Yoann Madec1 , Thomas Bigot4 , Ludivine Grzelak5,6,7 , Isabelle Cailleau8 , Camille Besombes1 , Marie-Noëlle Ungeheuer9 , Charlotte Renaudat9 , Blanca Liliana Perlaza9 , Laurence Arowas9 , Nathalie Jolly10 , Sandrine Fernandes Pellerin10 , Lucie Kuhmel11 , Isabelle Staropoli5,6,12 , Christèle Huon3 , Kuang-Yu Chen13 , Bernadette Crescenzo-Chaigne6,7,14 , Sandie Munier6,7,14 , Pierre Charneau15,16 , Caroline Demeret14 , Timothée Bruel5,6,12 , Marc Eloit3,17
, Olivier Schwartz5,6,12 , Bruno Hoen1,8
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View Affiliations Hide AffiliationsAffiliations: 1 Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France 2 PACRI Unit, Conservatoire National des Arts et Métiers, Paris, France 3 Pathogen Discovery Laboratory, Department of Virology, Institut Pasteur, Paris, France 4 Bioinformatic and Biostatistic Hub – Computational Biology Department, Institut Pasteur, Paris, France 5 Virus and Immunity Unit, Department of Virology, Institut Pasteur, Paris, France 6 UMR 3569, Centre National de la Recherche Scientifique, Paris, France 7 Université de Paris, Sorbonne Paris Cité, Paris, France 8 Direction de la recherche médicale, Institut Pasteur, Paris, France 9 ICAReB platform (Clinical Investigation & Access to Research Bioresources) of the Center for Translational Science, Institut Pasteur, Paris, France 10 Center for Translational Sciences, Institut Pasteur, Paris, France 11 Medical Center of the Institut Pasteur, Institut Pasteur, Paris, France 12 Vaccine Research Institute, Creteil, France 13 RNA Biology of Influenza Virus, Department of Virology, Institut Pasteur, Paris, France 14 Molecular Genetics of RNA Viruses, Institut Pasteur, Paris, France 15 Laboratoire Commun Pasteur/TheraVectys, Institut Pasteur, Paris, France 16 Unité de Virologie Moléculaire et Vaccinologie, Institut Pasteur, Paris, France 17 National Veterinary School of Alfort, Maisons-Alfort, FranceArnaud Fontanetfontanet pasteur.fr
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Citation style for this article: Fontanet Arnaud, Tondeur Laura, Grant Rebecca, Temmam Sarah, Madec Yoann, Bigot Thomas, Grzelak Ludivine, Cailleau Isabelle, Besombes Camille, Ungeheuer Marie-Noëlle, Renaudat Charlotte, Perlaza Blanca Liliana, Arowas Laurence, Jolly Nathalie, Pellerin Sandrine Fernandes, Kuhmel Lucie, Staropoli Isabelle, Huon Christèle, Chen Kuang-Yu, Crescenzo-Chaigne Bernadette, Munier Sandie, Charneau Pierre, Demeret Caroline, Bruel Timothée, Eloit Marc, Schwartz Olivier, Hoen Bruno. SARS-CoV-2 infection in schools in a northern French city: a retrospective serological cohort study in an area of high transmission, France, January to April 2020. Euro Surveill. 2021;26(15):pii=2001695. https://doi.org/10.2807/1560-7917.ES.2021.26.15.2001695 Received: 17 Sept 2020; Accepted: 16 Feb 2021
Abstract
Children’s role in SARS-CoV-2 epidemiology remains unclear. We investigated an initially unnoticed SARS-CoV-2 outbreak linked to schools in northern France, beginning as early as mid-January 2020.
This retrospective observational study documents the extent of SARS-CoV-2 transmission, linked to an affected high school (n = 664 participants) and primary schools (n = 1,340 study participants), in the context of unsuspected SARS-CoV-2 circulation and limited control measures.
Between 30 March and 30 April 2020, all school staff, as well as pupils and their parents and relatives were invited for SARS-CoV-2 antibody testing and to complete a questionnaire covering symptom history since 13 January 2020.
In the high school, infection attack rates were 38.1% (91/239), 43.4% (23/53), and 59.3% (16/27), in pupils, teachers, and non-teaching staff respectively vs 10.1% (23/228) and 12.0% (14/117) in the pupils’ parents and relatives (p < 0.001). Among the six primary schools, three children attending separate schools at the outbreak start, while symptomatic, might have introduced SARS-CoV-2 there, but symptomatic secondary cases related to them could not be definitely identified. In the primary schools overall, antibody prevalence in pupils sharing classes with symptomatic cases was higher than in pupils from other classes: 15/65 (23.1%) vs 30/445 (6.7%) (p < 0.001). Among 46 SARS-CoV-2 seropositive pupils < 12 years old, 20 were asymptomatic. Whether past HKU1 and OC43 seasonal coronavirus infection protected against SARS-CoV-2 infection in 6–11 year olds could not be inferred.
Viral circulation can occur in high and primary schools so keeping them open requires consideration of appropriate control measures and enhanced surveillance.

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