gms | German Medical Science

GMS Hygiene and Infection Control

Deutsche Gesellschaft für Krankenhaushygiene (DGKH)

ISSN 2196-5226

Measures to maintain regular operations and prevent outbreaks of SARS-CoV-2 in childcare facilities or schools under pandemic conditions and co-circulation of other respiratory pathogens

Maßnahmen zur Aufrechterhaltung eines Regelbetriebs und zur Prävention von SARS-CoV-2-Ausbrüchen in Einrichtungen der Kindertagesbetreuung oder Schulen unter Bedingungen der Pandemie und Kozirkulation weiterer Erreger von Atemwegserkrankungen


  • corresponding author Arne Simon - Pediatric Oncology and Hematology, Children’s Hospital Medical Center, University Clinics, Homburg, Germany
  • Johannes Huebner - Division of Pediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, Munich University Hospital, Munich, Germany
  • Reinhard Berner - Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
  • Alasdair P. S. Munro - NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
  • Martin Exner - Institute of Hygiene and Public Health, University of Bonn, Bonn, Germany
  • Hans-Iko Huppertz - Bremen, Germany
  • corresponding author Peter Walger - German Society of Hospital Hygiene, Berlin, Germany

GMS Hyg Infect Control 2020;15:Doc22

doi: 10.3205/dgkh000357, urn:nbn:de:0183-dgkh0003574

Veröffentlicht: 15. September 2020

© 2020 Simon et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe


After the lockdown and the end of the summer holidays, day-cares and schools need to be reopened and (despite the continued circulation of the new coronavirus SARS-CoV-2) kept open. The need for opening up arises from the right of children to education, participation, support and care. This is possible if appropriate hygiene measures are implemented and community transmission remains stable. In addition, the safety of educators, teachers and carers must be a priority and needs to be addressed by appropriate measures. Finally, the needs of families must also be taken into account. The following document describes in detail how these objectives can be achieved.


Nach dem Lockdown und dem Ende der großen Ferien sollen die Gemeinschaftseinrichtungen und Schulen für Kinder und Jugendliche wieder geöffnet und (trotz fortbestehender Zirkulation des neuen Coronavirus SARS-CoV-2) offen gehalten werden. Die Notwendigkeit zur Öffnung ergibt sich aus dem Recht der Kinder und Jugendlichen auf Bildung, Teilhabe, Förderung und Betreuung. Dies ist dann möglich, wenn angemessene Hygienemaßnahmen durchgeführt werden. Zudem muss die Sicherheit von Erziehern, Lehrern und Betreuern durch angemessene Maßnahmen gewährleistet werden. Schließlich ist auch den Bedürfnissen der Familien Rechnung zu tragen. Das folgende Dokument beschreibt detailliert, wie diese Ziele erreicht werden können.


Although new findings on this topic have been published continuously since the beginning of the pandemic, not all questions concerning the role of children and adolescents in the pandemic spread of SARS-CoV-2 (the pathogen causing COVID-19) have been conclusively clarified yet. All those involved are called upon to actively participate in scientific studies.

In comparison to adults, children and adolescents have, based on the findings to date

There is also evidence that children and adolescents (at least up to 14 years) [25] transmit SARS-CoV-2 to other people less frequently than adults [26], [27], [28], [29], [30], [31], [32]. The data for children up to the age of 10 seem to indicate that their role for transmission dynamics is less important than for adolescents aged 14 and more [25], [33].

The scientific publications since the end of May 2020 have confirmed the recommendations of the statement of several medical societies [34], even though discussions on the effectiveness of individual non-pharmaceutical measures continue [35]. According to the authors' current assessment, teachers in schools and staff in day-care facilities have only a low risk of infection through contact with potentially infected children if basic hygiene measures are adhered to [36], [37]. This risk is not increased compared to the risk of infection through contact with adult SARS-CoV-2-infected people in public or private settings [25].

The currently available data speak in favour of a strategy of future prevention concepts differentiated according to the age of the children and adolescents in order to minimise the risk of infection events, to limit them and to prevent the blanket closure of day-care centres and schools as a first measure [38], [39], [40]. Continuous attendance at a day-care centre [41] or school is not only essential for the sustainable educational success of the next generation, but also for healthy and successful development through social contacts, developmental tasks and challenges [42], [43], [44], [45]. In addition, it leads to a relief of the families and also to a release of the labour force of the persons having custody (compared to the continuous care of small children at home or the digital home-schooling of school children) [46], [47], [48], [49], [50], [51], [52].

In order to enable day-care centres and schools to operate on a regular basis as far as possible, in addition to the measures mentioned below it is necessary to develop a concept that allows [53], [54]

to distinguish respiratory infections caused by seasonal viral pathogens from those caused by SARS-CoV-2 using a risk-adapted testing strategy
to rapidly detect changes in the incidence of infection through a combination of tests based on specific risk factors (e.g. by taking into account holiday and travel risks, social history, membership of risk groups) and, if necessary, scientifically accompanied by sentinel examinations with involvement of carers and teachers;
to gain an overview of the developing epidemiological situation in small social niches (schools, day-care centres, districts) and to follow it regionally in order to be able to react in a timely and targeted (i.e. containment) manner;
making organisational arrangements to prevent the uncontrolled spread of infections within the facility. These concepts must be discussed in advance with the public health department. The possible contact persons in the event of an incident should be determined in advance. Parents, teachers, educators and carers should be informed in advance about the measures and their background;
to carry out structured outbreak investigations of clustered outbreaks in schools, day-care centres and municipalities in accordance with the general established principles of structured outbreak management by outbreak teams. The RKI has published guidelines for such a coordinated approach [55]. This guideline requires (as of 31.07.2020) a detailed update for the management of outbreaks in day-care centres and schools.

This concept must be regularly updated in the light of the continuing pandemic situation and adapted in line with new findings.

The overall objective is to enable children and young people to attend day-care centres and schools in the future and to avoid a complete lockdown situation. At the same time, a safe working environment and adequate protection against infection should be prioritized for educators and teachers (and other adult contact persons involved in the facilities). This also applies to the families of the children, teachers and care personnel.

Maintenance of regular operations and prevention of SARS-CoV-2 outbreaks in day-care centres and schools

Almost without exception, the complete closure of day-care centers and schools as part of pandemic management was justified as a preventive measure. Reports of outbreaks of SARS-CoV-2 in day-care centres or schools include lists of a few cases of infection in which mostly teachers or other personnel were the source of infection[40], [56]. Less frequently, individual children or students whose parents were also often sick and were considered vectors [31], [57]. Children have so far not appeared as so-called “superspreaders” in schools and day-care centres or within families [29], [58], [59], [60], [61]. A more detailed analysis of the transmission paths in terms of a structured outbreak analysis is missing.

Most of the so-called outbreaks are accumulations of infections with smaller numbers of cases, the cause of which was outside the day-care centres or schools. There is no well-founded scientific evidence of an increased risk of transmission at day-care centres and schools, although it should be noted that the majority of the cluster events reported were carried out in a lockdown situation and many reports only refer to reports in local media [40]. The re-opening of day-care centres and schools has not led to an increase in the number of infections among children and adolescents in any of the countries in which a general decline in infections in the general population has been observed and in which basic prevention measures in the general population have been further pursued (e.g. distance, cloth face masks, basic infection control rules). Accordingly, the risk for teachers and care personnel to become infected through contacts in day-care and school operations – despite appropriate preventive measures – remained low.

In countries in which outbreaks in schools were reported (e.g. Israel, Sweden or the USA), the number of infections in the general population was rising, in some cases significantly, so that the question of the causal relationships between infections in pupils through private or school transmissions and the cause of the infections in caregivers or staff remained unanswered [38], [40], [56]. Other aspects of specific risks in children and adolescents, such as the membership of families in population groups with religiously or ideologically motivated rejection of the hygiene measures [59], [62] or contradictory recommendations of the responsible health authorities with a simultaneously increased risk of mobility (USA) [63], [64] also make it difficult to draw general conclusions about the role of children and adolescents. The authors of a recent report on an outbreak at a secondary school in Israel emphasize that in the overcrowded school classes (>30 pupils), the wearing of mouth and nose covers and frequent airing were not consistently adhered to due to the high outside temperatures (40°C and more) (the air conditioning system was constantly in operation with no information on air exchange rates) [65].

Cases of SARS-CoV-2 infection also occur in community facilities or schools in Germany and other European countries. It can be assumed, however, that the incidence in day-care centres and schools is generally lower than the general incidence in the associated district.

Incidence data (Incidence here means the cumulative number [mean value] of new cases reported daily over the last 7 days per 100,000 inhabitants in the respective district; see Table 1 [Tab. 1]) apply to counties or municipalities. However, if a local outbreak can be controlled in a narrowly defined area, an increased incidence overall (in the district, the municipality) does not automatically mean that the prevention strategy in schools and day-care centres has to be adjusted (or that they have to be closed down completely). Through a timely and targeted adaptation (escalation) of preventive measures with separation of children and caregivers/teachers regarding location and time, ideally, when SARS-CoV-2 infections occur in day-care centres and schools, only the cluster directly affected (group/class, grade level) should be temporarily quarantined. However, this decision is the responsibility of the local health authority.

Maintenance of regular operation with risk-based protection of staff in day-care centres and schools

The aim of the measures described below is to minimize the transmission of SARS-CoV-2 in day-care centres and schools. In everyday life, the prevention of any infection would be desirable, but probably cannot succeed and is therefore not the overall strategic goal. Such events cannot be completely ruled out, just as the entry of these infections into the facilities by the adults working there cannot be ruled out. The prevention of every single SARS-CoV-2 infection is not a realistic goal of a prevention strategy in which social life (and the age- and development-appropriate participation of children and adolescents) is maintained.

The staff’s anxieties resulting from this situation must be taken seriously. It requires specific measures that are the responsibility of the respective institutions. The lower risk of disease and transmission in children is accompanied by a lower risk of infection for teaching and care personnel if the basic hygiene rules described below are observed [25].

The risk of infection can be considerably minimized by a bundle of prevention measures. With regard to their implementation in day-care centres, explicit reference is made to the current version of the DAKJ’s Early Care and Child Health Commission [66], [67].

Teachers and educators are of paramount importance for the unrestricted access of children and adolescents to age-appropriate education and developmental opportunities within groups, classes and courses. Their daily work is not only relevant to the system but also to the future of our society [52], [68], [69]. The vast majority of the educational and teaching staff in day-care centres and schools are well aware of this, and they strive to fulfil their tasks with commitment even in these difficult and stressful times.

Occupational health

Fears of infection among staff in day-care centres and schools should be addressed through professional education and advice. Fears should not lead to employees identifying as belonging to a “risk group” and withdrawing from their official duties without a definitive medical reason. This would expose children and adolescents and their families to the risk of considerable collateral damage [70], [71], [72]. An assessment by an occupational health physician [73] in consultation with the primary care physician is preferable to a self-assessment regarding the risk of increased vulnerability in the case of a SARS-CoV-2 infection.

Preventive measures of the staff

Based on the general (regional) and specific (within the institution) epidemiological situation, the following preventive measures must be taken by staff to protect themselves and others (prevention bundle) [74]:

  • Observance of the infection control rules also in the private setting
    • Keeping distance whenever possible, especially to other adults and adolescents (i.e. communal areas for teachers or educators).
    • Washing hands, in special situations also hand disinfection.
    • Wearing a cloth face mask mask if distance rules cannot be observed [75].
  • Regular airing at the end of each school hour (or hourly in day-care centres), if necessary with additional measurement of the CO2 content of the room air in special cases according to national recommendations (DGVU:; if necessary, critical assessment of rooms with air conditioning with regard to the proportion of fresh air or recirculated air (see footnote 4 in Table 1 [Tab. 1]).
  • Early recognition of relevant symptoms in oneself, in colleagues and in the children and adolescents. The necessary consequences should be drawn promptly.
  • Close communication (in strict compliance with the hygiene rules) among each other and cooperation of the institutional management with the local authorities.
  • Active involvement of children and adolescents [76], parents (guardians) and their representatives in the overall concept of the respective institution. Parents are responsible for their children and indirectly also for the safe operation of the institution visited by their children (see below).

Before the complete closure of an institution [40], the escalation of preventive measures (see Table 1 [Tab. 1]) is an essential prerequisite for maintaining unrestricted or partially restricted regular operation.

Outbreak prevention, management and measures

Due to the increasing evidence on the limited role of children (and probably also of adolescents up to 14 years of age) in the dynamics of the COVID-19 pandemic, the following advice should be taken into account and measures for day-care and school operation should be implemented:

An open, public discussion should lead to the acceptance of the fact that under pandemic conditions the elimination of any residual risk (the avoidance of every single SARS-CoV-2 infection without exception) is not possible in everyday life and therefore cannot be the overriding strategic goal. It is necessary to learn how to deal with SARS-CoV-2 infections and to minimize the risk of a local outbreak.
The normal operation of day-care centres and schools is possible in regions with a low incidence (Table 1 [Tab. 1]) of SARS-CoV-2 infections/COVID-19 cases while maintaining defined basic infection control standards.
Setting-specific conditions must receive special attention. Overall, the spectrum ranges from family-like structures in day-care to colleges with four-digit numbers of pupils.
Cancellation or restriction of regular operations requires a well-founded, structured and transparent political decision-making process, which focuses on safeguarding the educational, social and psychological interests of children and pupils while taking into account the risks of infection and illness. In particular, the interests of children and adolescents with special educational needs, special needs or supportive needs must be taken into account at least as much as those of other children and adolescents [42], [66], [67], [68], [74], [77]. This political process needs to be scientifically monitored. In most regions, it is possible to draw on the special expertise of paediatricians from various subdisciplines (including Paediatric Infectious Diseases) as well as infection control and environmental hygienists.
A complete closure of day-care centres or schools for reasons of preventive health protection or solely due to the accumulation of infections in the general population of a certain region without a definitive risk for the school or day-care centre is not justified.
Deviations from normal operation may become necessary due to an increasing incidence in a region or a defined outbreak. This planning should not happen at the time it becomes necessary but well in advance and these deviations must follow a step-by-step concept to be agreed upon with the responsible public health department. The complete closure of the entire facility should only be the last option if all other measured have failed.
When individual cases of infection occur in children, adolescents or persons of the care or teaching staff or in their immediate family or social environment, the primary goal is to limit the occurrence of infection to the defined area of a day-care group, a school class, or a course system. This is achieved by intensifying practised and previously established infection control rules, organising school operations according to constant group formation (cohorting) and prescribing defined quarantine measures or temporary closures of sub-areas.
In the higher class levels the fixed group formation may not be maintained due to requirements of course systems (i.e. no fixed classes or groups). On the other hand, these adolescents/young adults are quite capable of consistently implementing general infection prevention measures. Other forms of teaching can be offered here in addition to classroom teaching (e.g. digital learning).
Even in the event of infection clusters, cluster isolation should have priority over the closure of entire institutions. In cooperation with the responsible public health department, an infection control concept needs to be developed and agreed in advance, even before the facility is opened, to determine the procedures to be followed in individual cases of SARS-CoV-2 infections or outbreaks in an institution. A committee (outbreak and/or prevention team) of the school or day-care centre coordinated by the management of the facility is responsible for this.
When cases of infection occur, the ultimately responsible public health department, in cooperation with the institutional management, carries out a structured outbreak management. This involves an analysis of the transmission pathways according to established medical criteria (see RKI guidelines [55]) and the development of an adapted action plan for the specific case as well as testing the cohort regardless of symptoms to prevent subsequent asymptomatic transmission.
Complete day-care centre and school closures can only be a final step in the outbreak management if there has been an increase in transmission within the respective institution that cannot be contained by other measures.
While the institution management is an important partner, the local health authority is in charge. The involvement of representatives of educators, teachers, parents and children/adolescents should be part of the outbreak management.
The self-evaluation of teachers and other personnel as a risk group should be abandoned in favour of occupational health advice and assessment. The Committee for Occupational Medicine [78], considers the existence of defined pre-existing conditions without a defined age limit as a key criterion.
A general recommendation for teaching or care personnel to wear a daily mask during an outbreak should always be the most important step before a complete closure of a day-care centre or school. Irrespective of this, the rules of compulsory masks for older children and adolescents [75], [79], [80], [81], [82], [83], [84] as well as for teaching and care personnel in defined situations are part of preventive infection protection (see Table 1 [Tab. 1] and Table 2 [Tab. 2]).
The infection control concepts are based on the age of the pupils and the regional incidence of SARS-CoV-2 infections (see Table 1 [Tab. 1] and Table 2 [Tab. 2]). They are based on and supplement the institution-related hygiene plans of the respective federal states. An age limit of 10 years is considered reasonable, although this limit is blurred between a clearly low risk of transmission and illness in under 10-year-olds and an increasing risk behaviour and thus a growing transmission risk in the over-14-year-olds.
It is not possible for educators in day-care centres to adhere to distance rules and to wear a cloth face mask throughout the day when there is close contact with the children. Visors are no substitute for an MNB, but they can be used in different ways and should be preferred to not using a cloth face mask at all.

Further measures

Establishment of easily accessible SARS-CoV-2 testing facilities for children, adolescents, caregivers and teachers, in order to enable rapid return to care facilities and workplaces without restrictions in the event of negative results.
Provide opportunities for testing on an ad hoc basis depending on aspects of special risks associated with travel, regional cluster events, special risks from family or social environment of children and pupils or other anamnestic evidence of special risks.
Symptom-independent sentinel SARS-CoV-2 studies in specific populations (in the context of scientific or scientifically supervised studies) to detect and prevent increased virus spread pre-emptively before manifest cases of disease occur.
Testing of sentinel populations (e.g. hospitalised children) with respiratory tract infections for respiratory viruses using multiplex PCR to map the general epidemiology of respiratory infectious diseases in a region (see also:
Ensuring vaccination for pupils and teachers or carers through active counselling and low-threshold vaccination programmes. As a result, other (vaccine-preventable) infections, which are often clinically indistinguishable from SARS-CoV-2 infections, become less frequent [85].

Testing for SARS-CoV-2 in children in an outpatient treatment context

These instructions apply to children under 10 years of age. For older children and adolescents the relevant recommendations ( apply.

Sensitive methods for sample collection (e.g. saliva samples) [86] should be developed and validated as an alternative to the deep nasopharyngeal swab in children. Especially the deep nasal swab is very unpleasant for children and, depending on the age of the child, also traumatizing. In addition, the difficulties in obtaining material, especially for infants and toddlers, limit the validity of the results. In autumn and winter 2020, the usual significant (seasonal) increase in upper respiratory tract infections in children and adolescents can be expected. The seasonal occurrence of these infections can also be expected under the conditions of partial restriction of public life.

A distinction between a symptomatic SARS-CoV-2 infection and infections caused by other pathogens is not possible solely on the basis of clinical findings and examination.

A general testing of all symptomatic children and adolescents for SARS-CoV-2 is unrealistic for logistical and capacity reasons [87]. In addition, if the prevalence in the investigated group is low, false-positive results could outweigh the correct positive results, with the consequence of additional retesting or expensive sequencing, or even lockdowns or quarantine measures, which undermine the confidence in hygiene management.

The indication for a SARS-CoV-2 test should be individually justified based on the criteria listed below. Tests within the framework of scientific epidemiological studies or sentinel investigations as well as investigations within the framework of structured outbreak management should be evaluated separately. Early information of parents about this background is recommended.

Sick children or adolescents in a reduced general condition with fever, cough, sore throat or ear pain, severe abdominal pain, vomiting, diarrhoea or an unclear skin rash do not belong in either the day-care or school. Institutions are therefore entitled to have children or adolescents who have fallen ill being collected by their parents or guardians and to suggest a visit to a doctor.

The request for a SARS-CoV-2 test is made by a physician (according to the criteria below) or by the health authorities. Institutions (schools, day-care centres etc.) are not entitled to demand a test (or the presentation of a negative test result).

A medical certificate for readmission is only required if the child has been in quarantine due to COVID-19, a SARS-CoV-2 detection without symptoms or a Category 1 contact (according to RKI: with a SARS-CoV-2 positive person. Furthermore, institutions are not entitled to request a “negative test” as a condition for re-entry. Children with mild self-limiting signs of infection (mild cold without fever, only mild cough; these children mainly cough in the morning because the secretion runs down their throats at night) or after a short period of illness (less than 3 days) may be readmitted without a medical certificate if they are in good general condition and their symptoms have subsided. Some states have adopted the pragmatic solution whereby parents have to confirm in writing to the day-care centre that their child was free of symptoms for 24 hours before being readmitted. For the coming year, it is recommended that such procedural arrangements be included in the care agreement between parents and facilities, thereby achieving commitment and certainty of action.

A test for SARS-CoV-2 infection in an outpatient context should be carried out:

  • For children with reduced general condition and symptoms of infection, such as fever (sustained oral or rectal body temperature above 38°C or once above 38.5°C) or coughing for more than 2 days, children with gastrointestinal symptoms (persistent severe abdominal pain with or without diarrhoea and vomiting), unless there is no other explanation (as assessed by a physician).
  • By order of the local health authorities (e.g. for tracing chains of infection) children living in the same household with a person who is infected with SARS-CoV-2 do not have to be necessarily tested, but remain in quarantine. This is decided by the public health department [87].

Testing for SARS-CoV-2 infection in an outpatient context is not required in children in good general health with:

  • Rhinorrhoea (runny nose) or blocked nasal breathing with or without cough (without fever; yellowish or greenish secretion does not give a reliable indication as to whether the infection is bacterial or viral.)
  • Mild self-limiting infection of less than 3 days (see above)
  • clear diagnosis of a bacterial infection (e.g. tonsillopharyngitis caused by A-streptococci, urinary tract infection, skin and soft tissue infections) after clinical improvement and antibiotic therapy or other infection


The information on the test criteria corresponds to the status as of 03.08.2020 and may change depending on the epidemiological situation and new scientific findings.

This statement was prepared and coordinated by the German Society for Pediatric Infectious Disease (DGPI), the German Society for Pediatric and Adolescent Medicine (DGKJ), the German Society for Hospital Hygiene (DGKH) and the German Academy for Children and Youth Medicine (DAKJ).

Competing interests

This statement is supported by the German Society for Hygiene and Microbiology (DGHM), the Association of German Company and Works Doctors (VDBW e.V.) and the Society for Hygiene, Environmental Medicine and Preventive Medicine (GHUP).

The authors declare that they have no competing interests.


The authors would like to thank Prof. Dr. Walter Haas and Prof. Dr. Wieler (Robert Koch Institute, Berlin) for their critical comments and further constructive suggestions (this is not an official statement of the RKI). The authors would also like to thank Prof. Dr. Dr. Schmidt-Chanasit of the Bernhard-Nocht-Institute, Hamburg, for the critical commentary and for the constructive comments on the virological basis of the statement.


Centers for Disease Control and Prevention (CDC). Commercial Laboratory Seroprevalence Survey Data: Seroprevalence Detail for New York City Metro Area (March 2–April 1,2020). 2020 [last accessed 2020 Jul 25]. Available from: Externer Link
Debatin K, Henneke P, Hoffmann G, Kräusslich, HG, Renk H. Prevalence of COVID-19 in children in Baden-Württemberg – Preliminary study report. Heidelberg: UKHD; 2020. Available from: Externer Link
Pollán M, Pérez-Gómez B, Pastor-Barriuso R, et al. Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study. Lancet. 2020;396(10250):535-44. DOI: 10.1016/S0140-6736(20)31483-5 Externer Link
Pressemitteilung des Universitätsklinikums Hamburg-Eppendorf. C19.CHILD Hamburg: Ältere Kinder haben häufiger Antikörper gegen SARS-CoV-2. 2020 Jun 19 [last accessed 2020 Jul 25]. Available from: Externer Link
Su L, Ma X, Yu H, et al. The different clinical characteristics of corona virus disease cases between children and their families in China – the character of children with COVID-19. Emerg Microbes Infect. 2020;9(1):707-13. DOI: 10.1080/22221751.2020.1744483 Externer Link
Armann J, Diffloth N, Simon A, et al. Kurzmitteilung: Hospitalisierungen von Kindern und Jugendlichen mit COVID-19 – Erste Ergebnisse eines deutschlandweiten Surveys der Deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI). Dtsch Arztebl. 2020;117:373-4. DOI: 10.3238/arztebl.2020.0373 Externer Link
Bhopal S, Bagaria J, Bhopal R. Children’s mortality from COVID-19 compared with all-deaths and other relevant causes of death: epidemiological information for decision-making by parents, teachers, clinicians and policymakers. Public Health. 2020;185:19-20. DOI: 10.1016/j.puhe.2020.05.047 Externer Link
Brambilla I, Castagnoli R, Caimmi S, Ciprandi G, Luigi Marseglia G. COVID-19 in the Pediatric Population Admitted to a Tertiary Referral Hospital in Northern Italy: Preliminary Clinical Data. Pediatr Infect Dis J. 2020;39(7):e160. DOI: 10.1097/INF.0000000000002730 Externer Link
Cabrero-Hernández M, García-Salido A, Leoz-Gordillo I, et al. Severe SARS-CoV-2 Infection in Children With Suspected Acute Abdomen: A Case Series From a Tertiary Hospital in Spain. Pediatr Infect Dis J. 2020;39(8):e195-8. DOI: 10.1097/INF.0000000000002777 Externer Link
CDC COVID-19 Response Team. Coronavirus Disease 2019 in Children – United States, February 12–April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(14):422-6. DOI: 10.15585/mmwr.mm6914e4 Externer Link
Chidini G, Villa C, Calderini E, Marchisio P, De Luca D. SARS-CoV-2 Infection in a Pediatric Department in Milan: A Logistic Rather Than a Clinical Emergency. Pediatr Infect Dis J. 2020;39(6):e79-e80. DOI: 10.1097/INF.0000000000002687 Externer Link
Dufort EM, Koumans EH, Chow EJ, et al. Multisystem Inflammatory Syndrome in Children in New York State. N Engl J Med. 2020;383(4):347-58. DOI: 10.1056/NEJMoa2021756 Externer Link
Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020;383(4):334-46. DOI: 10.1056/NEJMoa2021680 Externer Link
Götzinger F, Santiago-García B, Noguera-Julián A, et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health. 2020;4(9):653-61. DOI: 10.1016/S2352-4642(20)30177-2 Externer Link
Gudbjartsson DF, Helgason A, Jonsson H, et al. Spread of SARS-CoV-2 in the Icelandic Population. N Engl J Med. 2020;382(24):2302-15. DOI: 10.1056/NEJMoa2006100 Externer Link
Liguoro I, Pilotto C, Bonanni M, et al. SARS-COV-2 infection in children and newborns: a systematic review. Eur J Pediatr. 2020;179(7):1029-46. DOI: 10.1007/s00431-020-03684-7 Externer Link
Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109(6):1088-95. DOI: 10.1111/apa.15270 Externer Link
Mithal LB, Machut KZ, Muller WJ, Kociolek LK. SARS-CoV-2 Infection in Infants Less than 90 Days Old. J Pediatr. 2020;224:150-2. DOI: 10.1016/j.jpeds.2020.06.047 Externer Link
Oberweis ML, Codreanu A, Boehm W, et al. Pediatric Life-Threatening Coronavirus Disease 2019 With Myocarditis. Pediatr Infect Dis J. 2020;39(7):e147-9. DOI: 10.1097/INF.0000000000002744 Externer Link
Parri N, Lenge M, Buonsenso D; Coronavirus Infection in Pediatric Emergency Departments (CONFIDENCE) Research Group. Children with Covid-19 in Pediatric Emergency Departments in Italy. N Engl J Med. 2020;383(2):187-90. DOI: 10.1056/NEJMc2007617 Externer Link
Parri N, Magistà AM, Marchetti F, et al. Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks. Eur J Pediatr. 2020;179(8):1315-23. DOI: 10.1007/s00431-020-03683-8 Externer Link
Streng A, Hartmann K, Armann J, Berner R, Liese JG. COVID-19 bei hospitalisierten Kindern und Jugendlichen: Ein systematischer Review zu publizierten Fallserien (Stand 31.03.2020) und erste Daten aus Deutschland [COVID-19 in hospitalized children and adolescents: A systematic review on published case series (as of 31.03.2020) and first data from Germany]. Monatsschr Kinderheilkd. 2020;168(7):615-27. DOI: 10.1007/s00112-020-00919-7 Externer Link
Tagarro A, Epalza C, Santos M, et al. Screening and Severity of Coronavirus Disease 2019 (COVID-19) in Children in Madrid, Spain. JAMA Pediatr. 2020 Apr 8;e201346. DOI: 10.1001/jamapediatrics.2020.1346 Externer Link
Zylka-Menhorn V, Grunert D. Kinder reagieren auf Viren anders als Erwachsene. Dtsch Arztebl. 2020;117(29-30):A1435-A40
Public Health Agency of Sweden; Finnish Institute for Health and Welfare THL. Covid-19 in schoolchildren: a comparison between Finland and Sweden. Östersund: Folkhälsomyndigheten; 2020 Jul 07 [last accessed 2020 Jul 29]. Available from: Externer Link
Bi Q, Wu Y, Mei S, et al. Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study [published correction appears in Lancet Infect Dis. 2020 Jul;20(7):e148]. Lancet Infect Dis. 2020;20(8):911-9. DOI: 10.1016/S1473-3099(20)30287-5 Externer Link
Fontanet A, Tondeur L, Madec Y, et al. Cluster of COVID-19 in northern France. A retrospective closed cohort study [Preprint]. medRxiv. 2020 April 23. DOI: 10.1101/2020.04.18.20071134 Externer Link
Posfay-Barbe KM, Wagner N, Gauthey M, et al. COVID-19 in Children and the Dynamics of Infection in Families. Pediatrics. 2020;146(2):e20201576. DOI: 10.1542/peds.2020-1576 Externer Link
Prazuck T, Giaché S, Gubavu C, et al. Investigation of a family outbreak of COVID-19 using systematic rapid diagnostic tests raises new questions about transmission. J Infect. 2020. DOI: 10.1016/j.jinf.2020.06.066 Externer Link
Sun D, Zhu F, Wang C, et al. Children Infected With SARS-CoV-2 From Family Clusters. Front Pediatr. 2020 Jun 23;8:386. DOI: 10.3389/fped.2020.00386 Externer Link
van der Hoek W, Backer JA, Bodewes R, et al. De rol van kinderen in de transmissie van SARS-CoV-2 [The role of children in the transmission of SARS-CoV-2]. Ned Tijdschr Geneeskd. 2020 Jun 3;164:D5140.
Zhu Y, Bloxham C, Home K, et al. Children are unlikely to have been the primary source of household SARS-CoV-2 infections [Preprint]. medRxiv. 2020 Mar 30. DOI: 10.1101/2020.03.26.20044826 Externer Link
Somekh E, Gleyzer A, Heller E, et al. The Role of Children in the Dynamics of Intra Family Coronavirus 2019 Spread in Densely Populated Area. Pediatr Infect Dis J. 2020;39(8):e202-4. DOI: 10.1097/INF.0000000000002783 Externer Link
Walger P, Heininger U, Knuf M, Exner M, Popp W, Fischbach T, Trapp S, Hübner J, Herr C, Simon A; German Society for Hospital Hygiene(DGKH); German Society for Pediatric Infectious Diseases (DGPI); German Academy for Pediatric and Adolescent Medicine (DAKJ); Society of Hygiene, Environmental and Public Health Sciences (GHUP); Professional Association of Pediatricians in Germany (bvkj e.V.). Children and adolescents in the CoVid-19 pandemic: Schools and daycarecenters are to be opened again without restrictions. The protection of teachers, educators, carers and parents and the general hygiene rules do not conflict with this. GMS Hyg Infect Control. 2020;15:Doc11. DOI: 10.3205/dgkh000346 Externer Link
Haug N, Geyrhofer L, Londei A, et al. Ranking the effectiveness of worldwide COVID-19 government interventions [Preprint]. medRxiv. 2020 Jul 08. DOI: 10.1101/2020.07.06.20147199 Externer Link
Heavey L, Casey G, Kelly C, Kelly D, McDarby G. No evidence of secondary transmission of COVID-19 from children attending school in Ireland, 2020. Euro Surveill. 2020;25(21):2000903. DOI: 10.2807/1560-7917.ES.2020.25.21.2000903 Externer Link
National Centre for Immunisation Research and Surveillance (NCIRS). COVID-19 in schools – the experience in NSW – Prepared by the National Centre for Immunisation Research and Surveillance (NCIRS). Westmead: NCIRS; 2020 Apr 26. Available from: Externer Link
Esposito S, Principi N. School Closure During the Coronavirus Disease 2019 (COVID-19) Pandemic: An Effective Intervention at the Global Level? JAMA Pediatr. 2020 May 13. DOI: 10.1001/jamapediatrics.2020.1892 Externer Link
Schober T, Rack-Hoch A, Kern A, von Both U, Hübner J. Coronakrise: Kinder haben das Recht auf Bildung. Dtsch Arztebl. 2020;117(19): A990-4. Available from: Externer Link
Viner RM, Russell SJ, Croker H, et al. School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review. Lancet Child Adolesc Health. 2020;4(5):397-404. DOI: 10.1016/S2352-4642(20)30095-X Externer Link
Knollmann C, Thyen U. Einfluss des Besuchs einer Kindertagesstätte (Kita) auf den Entwicklungsstand bei Vorschulkindern [Impact of Daycare Center Attendance on Children’s Development]. Gesundheitswesen. 2019;81(3):196-203. DOI: 10.1055/a-0652-5377 Externer Link
Deutsche Gesellschaft für Sozialpädiatrie und Jugendmedizin (DGSPJ). Denkanstöße für die Wiedereröffnung von außerfamiliärer und außerschulischer Betreuung von Kindern und Jugendlichen mit besonderen psychosozialen und gesundheitlichen Risiken während der Corona-Pandemie. 2020 May 25. Available from: Externer Link
Moore SA, Faulkner G, Rhodes RE, et al. Impact of the COVID-19 virus outbreak on movement and play behaviours of Canadian children and youth: a national survey. Int J Behav Nutr Phys Act. 2020;17(1):85. Published 2020 Jul 6. DOI: 10.1186/s12966-020-00987-8 Externer Link
Paedine Saar Netzwerk. Schrittweise Aufhebung des „Shutdowns“ im Rahmen der Eindämmung von SARS-CoV-2 Infektionen in Schulen und Kindertagesstätten. Stellungnahme des Paedine Saar Netzwerkes. 2020 Apr 24. Available from: Externer Link
Süddeutsche Gesellschaft für Kinder- und Jugendmedizin (SDKJ). Ad-Hoc Stellungnahme des Vorstandes der Süddeutschen Gesellschaft für Kinder- und Jugendmedizin zur anhaltenden Schließung von Grundschulen und Kindertagesstätten. 2020 Apr 22. Available from: Externer Link
Bayham J, Fenichel EP. Impact of school closures for COVID-19 on the US health-care workforce and net mortality: a modelling study. Lancet Public Health. 2020;5(5):e271-8. DOI: 10.1016/S2468-2667(20)30082-7 Externer Link
Cooper DM, Guay-Woodford L, Blazar BR, et al. Reopening Schools Safely: The Case for Collaboration, Constructive Disruption of Pre-Coronavirus 2019 Expectations, and Creative Solutions. J Pediatr. 2020;223:183-5. DOI: 10.1016/j.jpeds.2020.05.022 Externer Link
Patrick SW, Henkhaus LE, Zickafoose JS, et al. Well-being of Parents and Children During the COVID-19 Pandemic: A National Survey [published online ahead of print, 2020 Jul 24]. Pediatrics. 2020;e2020016824. DOI: 10.1542/peds.2020-016824 Externer Link
Royal College of Paediatrics and Child Health (RCPCH). COVID-19 – 'shielding' guidance for children and young people. London: RCPCH; 2020 [last accessed 2020 Jul 10]. Available from: Externer Link
Royal College of Paediatrics and Child Health (RCPCH). Open letter from UK paediatricians about the return of children to schools. London: RCPCH; 2020 Jun 17. Available from: Externer Link
Stein A, Funke A, Menne S. Factsheet – Kinderarmut: Eine unbearbeitete Großbaustelle. Gütersloh: Bertelsmann Stiftung; 2020 Jul 22. Available from: Externer Link
Van Lancker W, Parolin Z. COVID-19, school closures, and child poverty: a social crisis in the making. Lancet Public Health. 2020;5(5):e243-4. DOI: 10.1016/S2468-2667(20)30084-0 Externer Link
American Academy of Pediatrics. Critical Updates on COVID-19/Clinical Guidance/COVID-19 Planning Considerations: Guidance for School Re-entry. 2020 [last accessed 2020 Jun 25]. Available from: Externer Link
Johansen TB, Astrup E, Jore S, et al. Infection prevention guidelines and considerations for paediatric risk groups when reopening primary schools during COVID-19 pandemic, Norway, April 2020. Euro Surveill. 2020;25(22):2000921. DOI: 10.2807/1560-7917.ES.2020.25.22.2000921 Externer Link
Robert Koch-Institut. Leitfaden für den Öffentlichen Gesundheitsdienst zum Vorgehen bei Häufungen von COVID-19. Berlin: RKI; 2020 [last accessed 2020 Jul 27]. Available from: Externer Link
Viner R, Nicholls D, Bonell C, et al. How safe are our children? A review of the risks of COVID-19 and the harms of school closures for children and young people in the UK [submitted to BMJ Pediatrics]. 2020.
Rijksinstituut voor Volksgezondheid en Milieun. Children and schools (Modification date 2020 Jun 18). Bilthoven: RIVM; 2020 [last accessed 2020 Jun 21]. Available from: Externer Link
Berndt C. Kinder bremsen laut Studie das Virus aus. Ergebnisse aus Dresden zeigen, dass sich das Coronavirus unter Schülern und Lehrern in Sachsen kaum verbreitet hat. Sueddeutsche Zeitung. 2020 Jul 13. Available from: Externer Link
Dattner I, Goldberg Y, Katriel G, Yaari R, Gal N, Miron Y, Ziv A, Hamo Y, Huppert A. The role of children in the spread of COVID-19 – Using household data from Bnei Brak, Israel, to estimate the relative susceptibility and infectivity of children [Preprint]. medRxiv. 2020 Jun 5. DOI: 10.1101/2020.06.03.20121145 Externer Link
Davies NG, Klepac P, Liu Y, et al. Age-dependent effects in the transmission and control of COVID-19 epidemics. Nat Med. 2020;26(8):1205-11. DOI: 10.1038/s41591-020-0962-9 Externer Link
Schwierzeck V, König JC, Kühn J, et al. First reported nosocomial outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a pediatric dialysis unit. Clin Infect Dis. 2020;ciaa491. DOI: 10.1093/cid/ciaa491 Externer Link
Park YJ, Choe YJ, Park O, et al. Contact Tracing during Coronavirus Disease Outbreak, South Korea, 2020 [published online ahead of print, 2020 Jul 16]. Emerg Infect Dis. 2020;26(10). DOI:10.3201/eid2610.201315 Externer Link
Community Interventions and Critical Populations Task Force; CDC COVID-19 Emergency Response. CRAFT Schools Briefing Packet – For internal use only. New York: New York Times; 2019 Jul 8 (Updated July 24, 2020). Available from: Externer Link
Goodnough A, Mandavilli A. C.D.C. Calls on Schools to Reopen, Downplaying Health Risks: The agency's statement followed earlier criticism from President Trump that its guidelines for reopening were too “tough”. The New York Times. 2020 Jul 24. Available from: Externer Link
Stein-Zamir C, Abramson N, Shoob H, et al. A large COVID-19 outbreak in a high school 10 days after schools' reopening, Israel, May 2020. Euro Surveill. 2020;25(29):2001352. DOI: 10.2807/1560-7917.ES.2020.25.29.2001352 Externer Link
Kommission Frühe Betreuung und Kindergesundheit der DAKJ. Ergänzung zur Stellungnahme der Kommission Frühe Betreuung und Kindergesundheit der DAKJ vom 28.05.2020 zur Verminderung des COVID19 Infektionsrisikos nach § 34 IfSG in Kindertageseinrichtungen (Kinderkrippen, Kindertagesstätten und Kindergärten) und in Kinderhorten. Berlin: DAKJ; 2020 Jun 9. Available from: Externer Link
Kommission Frühe Betreuung und Kindergesundheit der DAKJ. Wiederaufnahme der Betreuung von Kindern im Vorschulalter: Stellungnahme der Kommission Frühe Betreuung und Kindergesundheit der DAKJ. Berlin: DAKJ; 2020 Mai 25. Available from: Externer Link
Kuper H, Krägeloh-Mann I, Dickhäuser O, et al. Für eine kontrollierte Öffnung der Erziehungs-, Bildungs- und Betreuungseinrichtungen im Vorschul- und Schulalter: Gemeinsame Stellungnahme der Deutschen Gesellschaft für Erziehungswissenschaft, Deutschen Gesellschaft für Kinder- und Jugendmedizin, Deutschen Gesellschaft für Psychologie, Gesellschaft für Empirische Bildungsforschung, des Vereins für Socialpolitik und der Stiftung Kindergesundheit. 2020 [last accessed 2020 Jul 29]. Available from: Externer Link
Thompson LA, Rasmussen SA. What Does the Coronavirus Disease 2019 (COVID-19) Mean for Families? JAMA Pediatr. 2020;174(6):628. DOI: 10.1001/jamapediatrics.2020.0828 Externer Link
Bhopal S, Buckland A, McCrone R, Villis AI, Owens S. Who has been missed? Dramatic decrease in numbers of children seen for child protection assessments during the pandemic. Arch Dis Child. 2020 Jun 18. DOI: 10.1136/archdischild-2020-319783 Externer Link
Cluver L, Lachman JM, Sherr L, et al. Parenting in a time of COVID-19 [published correction appears in Lancet. 2020 Apr 11;395(10231):1194]. Lancet. 2020;395(10231):e64. DOI: 10.1016/S0140-6736(20)30736-4 Externer Link
Lynn RM, Avis JL, Lenton S, Amin-Chowdhury Z, Ladhani SN. Delayed access to care and late presentations in children during the COVID-19 pandemic: a snapshot survey of 4075 paediatricians in the UK and Ireland. Arch Dis Child. 2020 Jun 25. DOI: 10.1136/archdischild-2020-319848 Externer Link
Bundesministerium für Arbeit und Soziales. Umgang mit aufgrund der SARS-CoV-2-Epidemie besonders schutzbedürftigen Beschäftigten. Arbeitsmedizinische Empfehlung. Bonn: BMAS; 2020 Jul [last accessed 2020 Aug 03]. Available from: Externer Link
Jung-Sendzik T, Hallsson LR, Böse-O'Reilly S, Thyen U, Renz-Polster H, De Bock F, Genuneit J; Kompetenznetz Public Health COVID-19. Maßnahmen zur SARS-CoV-2 Infektionseindämmung in Kitas – Balanceakt zwischen Transmission und kindlichen Entwicklungsbedürfnissen. Bremen: BIPS; 2020 Jun 15 [last accessed 2020 Jul 25]. Available from: Externer Link
Centers for Disease Control and Prevention (CDC). Use of Masks to Help Slow the Spread of COVID-19. 2020. Available from: Externer Link
Council of Europe. Protecting and empowering children during the Covid-19 pandemic. Strasbourg Cedex: Council of Europe; 2020 [last accessed 2020 Jul 29]. Available from: Externer Link
Deutsche Akademie für Kinder- und Jugendmedizin e.V. Maßnahmen zur Prävention einer SARS-CoV-2 Infektion bei Kindern mit besonderem Bedarf bei der Betreuung in Gemeinschaftseinrichtungen (GE). 2020 Mar 17. Available from: Externer Link
Bundesministerium für Arbeit und Soziales, Deutsche Gesetzlichen Unfallversicherung, Bundesanstalt für Arbeitsschutz und Arbeitsmedizin. SARS-CoV-2-Arbeitsschutzstandard. 2020 Apr 16 [last accessed 2020 Jul 25]. Available from: Externer Link
Brooks JT, Butler JC, Redfield RR. Universal Masking to Prevent SARS-CoV-2 Transmission – The Time Is Now. JAMA. 2020 Jul 14. DOI: 10.1001/jama.2020.13107 Externer Link
Chen A, Khumra S, Eaton V, Kong D. Snapshot of Barriers and Indicators for Antimcrobial Stewardship in Australian Hospitals. J P Pract Res. 2011;41(1):37-41. DOI: 10.1002/j.2055-2335.2011.tb00064.x Externer Link
Dbouk T, Drikakis D. On respiratory droplets and face masks. Phys Fluids (1994). 2020;32(6):063303. DOI: 10.1063/5.0015044 Externer Link
Esposito S, Principi N. Mask-wearing in pediatric age. Eur J Pediatr. 2020;179(8):1341-2. DOI: 10.1007/s00431-020-03725-1 Externer Link
Esposito S, Principi N. To mask or not to mask children to overcome COVID-19. Eur J Pediatr. 2020;179(8):1267-70. DOI: 10.1007/s00431-020-03674-9 Externer Link
Jin K, Min J, Jin X. Re: Esposito et al.: To mask or not to mask children to overcome COVID-19. Eur J Pediatr. 2020;179(8):1339-40. DOI: 10.1007/s00431-020-03720-6 Externer Link
Kommission für Infektionskrankheiten und Impffragen der Deutschen Akademie für Kinder- und Jugendmedizin. Covid-19: Impfungen und Früherkennungsuntersuchungen. Aufrechterhaltung von Impfungen und Früherkennungsuntersuchungen in der aktuellen SARS-CoV-2 Pandemie. Stellungnahme der Kommission für Infektionskrankheiten und Impffragen der Deutschen Akademie für Kinder- und Jugendmedizin (Stand 22.3.2020). Berlin: DAKJ; 2020 Mar 22. Available from: Externer Link
Fakheran O, Dehghannejad M, Khademi A. Saliva as a diagnostic specimen for detection of SARS-CoV-2 in suspected patients: a scoping review. Infect Dis Poverty. 2020;9(1):100. Published 2020 Jul 22. DOI: 10.1186/s40249-020-00728-w Externer Link
Bundesministerium für Gesundheit. Verordnung zum Anspruch auf bestimmte Testungen für den Nachweis des Vorliegens einer Infektion mit dem Coronavirus SARS-CoV-2. 2020. (Stand: 08.06.2020). Available from: Externer Link