Respiratory Virus Detection and Acute Respiratory Illness Rates in Students and Staff in Schools

Schools are an important setting for infectious disease transmission. Baseline rates of respiratory virus detections and acute respiratory illnesses (ARIs) in schools are lacking and needed to inform transmission risks and prevention strategies. This investigation sought to determine the incidence of respiratory virus detections and ARIs in pre-kindergarten (pre-K) to 12th-grade students and staff. Knowledge of Infectious Diseases in Schools (School KIDS) is a longitudinal prospective surveillance study conducted in a large (>20 000 students) Kansas City, Missouri public school district. Students and staff self-collected nasal swabs and reported respiratory symptoms from November 2022 to May 2023. Primary outcomes were respiratory virus detection by polymerase chain reaction and ARI rates by school level. The 816 participants were enrolled for a median of 24.5 weeks (IQR, 23.5-25.0) and submitted a median of 7 (6-8) specimens. Participants included 590 (72.3%) students and 226 (27.7%) staff, providing 5981 specimens and 5198 symptom surveys with 698 (85.5%) participants having at least 1 virus detected and 656 (80.4%) at least 1 ARI episode. Adjusted virus detection rates per 100 enrollment days were highest in pre-K (1.46) and elementary (1.51) followed by middle (1.19), high school (0.90), and staff (0.87). Adjusted ARI rates per 100 enrollment days were 1.66 (pre-K), 1.19 (elementary), 1.17 (middle), 0.76 (high), and 1.45 (staff). Pre-K and elementary students had the highest virus detection rates, and pre-K students and school staff had the highest ARI episode rates. These findings provide estimated rates of virus detections and ARIs in school populations and may provide useful data when determining effectiveness of prevention strategies in schools. Future studies are needed to determine the location of viral acquisition and correlation with ARI.