{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:33:00Z","timestamp":1760059980430,"version":"build-2065373602"},"reference-count":34,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Center for Disease Control and Prevention","award":["D19C20000250001"],"award-info":[{"award-number":["D19C20000250001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>During the COVID-19 pandemic, some studies suggested that transmission events could originate from schools. This study aimed to evaluate early-warning methods for identifying asymptomatic COVID-19 cases by implementing screening programs in schools. This study was conducted between September 2021 and May 2023, employing a rotation-screening plan for COVID-19 detection on a sample of students aged 14 to 19 years attending secondary schools in the regions of Tuscany, Veneto, Apulia and Friuli-Venezia Giulia. The schools were divided into two groups: experimental and control, with a ratio of 1:2. Two types of molecular salivary tests for SARS-CoV-2 were used to conduct the screening. This study included 16 experimental schools and 32 control schools. Out of 2527 subjects, 11,475 swabs were administrated, with 9177 tests deemed valid for analysis (a 20% loss of tests). Among these, 89 subjects (3.5%) tested positive. In control schools, 1895 subjects (6.5%) tested positive for SARS-CoV-2. This study recorded peaks in infections during the winter and autumn months, consistent with patterns observed in the general population. Beginning in September 2022, a shift occurred, with 2.6% of positive cases reported in the case schools compared to 0.3% in the control schools. Initially, most cases of COVID-19 were detected in the control schools; however, as the pandemic emergency phase concluded, cases were primarily identified through active screening in experimental schools. Although student participation in the active screening campaign was low during the project\u2019s extension phase, this approach was efficacious in the early identification of positive cases.<\/jats:p>","DOI":"10.3390\/microorganisms13081775","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T10:55:37Z","timestamp":1753872937000},"page":"1775","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Warning Approach to Identify Positive Cases of SARS-CoV-2 in School Settings in Italy"],"prefix":"10.3390","volume":"13","author":[{"given":"Caterina","family":"Milli","sequence":"first","affiliation":[{"name":"Epidemiology Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9146-9968","authenticated-orcid":false,"given":"Cristina","family":"Stasi","sequence":"additional","affiliation":[{"name":"Epidemiology Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy"},{"name":"Department of Life Science, Health and Health Professions, Link Campus University, 00165 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6168-6200","authenticated-orcid":false,"given":"Francesco","family":"Profili","sequence":"additional","affiliation":[{"name":"Epidemiology Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caterina","family":"Silvestri","sequence":"additional","affiliation":[{"name":"Epidemiology Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Pacifici","sequence":"additional","affiliation":[{"name":"Epidemiology Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2619-2130","authenticated-orcid":false,"given":"Michela","family":"Baccini","sequence":"additional","affiliation":[{"name":"Department of Statistics, Computer Science, Applications (DISIA), University of Florence, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9386-0434","authenticated-orcid":false,"given":"Gian Maria","family":"Rossolini","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"},{"name":"Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizia","family":"Mealli","sequence":"additional","affiliation":[{"name":"Department of Economics, European University Institute, 50014 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0295-6877","authenticated-orcid":false,"given":"Alberto","family":"Antonelli","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"},{"name":"Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Chilleri","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"},{"name":"Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3785-0554","authenticated-orcid":false,"given":"Fabio","family":"Morecchiato","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicla","family":"Giovacchini","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"},{"name":"Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6012-9453","authenticated-orcid":false,"given":"Vincenzo","family":"Baldo","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy"},{"name":"Preventive Medicine and Risk Assessment Unit, Azienda Ospedale Universit\u00e0 Padova, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3446-6613","authenticated-orcid":false,"given":"Maurizio","family":"Ruscio","sequence":"additional","affiliation":[{"name":"Division of Laboratory Medicine, University Hospital Giuliano Isontina (ASU GI), 34128 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Malacarne","sequence":"additional","affiliation":[{"name":"Public Health Department, University Health Agency Giuliano-Isontina (ASU GI), 34128 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Martin","sequence":"additional","affiliation":[{"name":"Division of Laboratory Medicine, University Hospital Giuliano Isontina (ASU GI), 34128 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuela","family":"Occoni","sequence":"additional","affiliation":[{"name":"Public Health Department, University Health Agency Giuliano-Isontina (ASU GI), 34128 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosa","family":"Prato","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Science, University of Foggia, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domenico","family":"Martinelli","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Science, University of Foggia, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonardo","family":"Ascatigno","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Science, University of Foggia, 71122 Foggia, 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