What literature is there on respiratory outbreaks in residential care centres where children live? A rapid scoping review

Abstract Background and rationale: The SARS-CoV-2 virus which causes a respiratory illness called Covid-19 has now spread to all continents and is causing important disruptions. Foster care homes, also called residential units, children’s homes, sheltered care, childcare institutions or custodial facilities (among many other names) have not been spared by the pandemic and reports of unexpected new challenges are emerging, such as lack of protective equipment, increased violence within the facility, staff shortage, risk of burnout among staff working longer hours or quarantine procedures intentionally not followed by children. Although children and young people appear to develop relatively mild symptoms when contracting Covid-19 they are not immune from it, could act as vectors of transmission and children with weakened immune systems (for instance children living with HIV or taking chemotherapy) remain at risk. Residential care staff looking after children in care is also at risk of contracting Covid-19 and/or transmitting the disease outside of the foster home when caring for them, particularly given close contacts involved during daily activities. Objective: To investigate and map out the primary research literature on respiratory outbreaks in residential care centers where children live. Methods: Pubmed, ClinicalTrials.gov, CENTRAL, Cochrane Library, Swissbib, OpenGrey, bioRxiv and medRxiv were searched from inception to April 4, 2020. Additional citations were identified from the bibliographies of all included citations and the forward citations (Google Scholar) of 12 included studies were assessed. Ten searches were also done on Google Scholar. Primary research reports, published from 1 January 1910 to 4 April 2020 that referred to respiratory outbreaks in foster care homes were included. Results: 33 out of 37 articles reported data on respiratory outbreaks in residential care settings. The earliest respiratory outbreak occurred in 1957 and the latest in 2011. Three (n=3) studies documented outbreaks for the period 1950-1959, 12 studies for 1960-1969, 3 for 1970-1979, 8 for 1980-1989, 2 for 1990-1999, 4 for 2000-2009 and 1 for 2010-2019. Most articles were case studies or case series (n=19). A few articles were cohort studies (n=5), controlled before-after studies (n=4), cross-sectional studies (n=4) or diagnostic test studies (n=3). There was one (n=1) qualitative study, one (n=1) quasi-randomised controlled trial, one (n=1) randomized controlled trial and one (n=1) scoping review. In 21 studies the children looked after did not have handicaps (or no handicaps were reported). In 15 out of 37 studies the children looked after had either physical and/or mental handicaps. One (n=1) article [1] focused on residential care staff. 26 studies out reported data on foster care homes in the United States (US), 4 in the United Kingdom (UK) and one (n=1) each in Thailand, Spain, Slovenia, Jamaica, Canada and Australia. The most studied sources of respiratory outbreaks were influenza viruses (n=13 studies). The most commonly measured outcomes were: clinical prognosis (n=26 studies), virological data (n=24 studies), symptoms (n=23 studies), antibody data (n=11 studies) and side effects (n=6 studies). Sixteen (n=16) studies also reported infection control measures taken (most commonly medical treatments), with little details. Limitations: My searches may have missed relevant articles due to a lack of unique terminology, relatively simple searches and heterogeneous indexing of relevant articles. A number of additional potentially relevant studies were found but had to be excluded due to not being reported in French or English. Residential care settings are likely to differ from country to country and the generalizability of these findings could be questioned (although reports from children’s home in the 1960s and 1970s still had many things in common with my current work setting). Inclusion judgements involved a degree of subjectivity, particularly for mixed-populations (children and adults in a single facility, facility for children with and without medical needs) and other authors might differ on some articles to include or exclude. In general few details were provided about the facility (eg. hospital setting) or care staff (eg. medical or not) which made assessments challenging and misclassification is therefore a possibility. Sample size data extracted is to be read with caution given the complexity of data extraction for this outcome (for instance some studies report on the number of children in the whole facility, the number of children in specific wards affected, the number of children deemed at risk, the number of children + staff affected, etc.). Conclusions: Few studies on respiratory outbreaks in foster care homes were found. Most studies came from the United States and reported outbreak investigations from 1960-1969 and 1980-1989. Most studies had a medical focus, were of observational design and investigated the spread of diseases in care homes, symptoms of young people affected by the pathogen and their prognosis. Infection prevention and control measures were rarely reported in detail. Only one study focused on residential care staff. Experimental studies all measured the effectiveness and safety of medical treatments (typically vaccines or medicines). Recent outbreaks in residential facilities from non-US countries should be documented or perhaps indexed in a more structured way. Qualitative studies investigating the lived experiences, knowledge, practices, challenges and strategies of residential care staff facing respiratory outbreaks could be undertaken. Similarly, qualitative studies investigating needs, beliefs and experiences of young people living in care affected by respiratory outbreaks should be considered. There is a need for more experimental studies in this specific setting. Study authors should consider reporting more details about the residential facility and residential care staff and a reporting guideline could be developed on the matter. Funding: No funding was received for this work. Registration: See previous versions of this work on the Open Science Framework. Data and materials: Available at https://osf.io/nt8ek/ or included within this manuscript. Keywords: Disease outbreak, infection control, scoping review, residential care, children Suggested citation: Vuillème, M. (April 4, 2020). What literature is there on respiratory outbreaks in residential care centers where children live? A rapid scoping review. Retrieved from https://doi.org/10.17605/OSF.IO/XDFUJ

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.