Pediatric experts outline back-to-school safety guidelines for solid organ transplant recipients

As school districts look ahead to a very different school year, pediatric infectious disease experts from across the United States convened to outline back-to-school safety guidelines for solid organ transplant (SOT) recipients.

The group, led by Kevin J. Downes, MD, attending physician in the Division of Pediatric Infectious Diseases at Children's Hospital of Philadelphia (CHOP), published their recommendations today in the Journal of the Pediatric Infectious Diseases Society.

Throughout the COVID-19 pandemic, pediatric SOT patients have been categorized as high-risk due to their use of immunosuppressive medications, frequent presence of additional medical issues, and elevated risk for more severe outcomes from other viral respiratory infections.

While there is no specific evidence that pediatric SOT recipients fare worse from COVID-19, parents of SOT patients are undoubtedly nervous to send their children back to school in the fall.

As a result, parents of transplant recipients need clear guidance regarding return to school decisions and what approaches, if any, they or their schools should take to protect their immunocompromised child. In addition to these health-related considerations, many are also weighing the notable academic, social, and emotional benefits of school attendance.

"We listened to the questions families brought to us, and to their transplant providers, and drafted a set of recommendations around their concerns," said Dr. Downes.

For the majority of pediatric SOT recipients, the benefits of attending school will probably outweigh the risks. However, the final decision is a matter of shared decision-making among families, transplant professionals, and educators, and depends on many factors, including the child's clinical risk, COVID-19 cases in the community, and preparedness of both the child and the school to adhere to recommended precautions to prevent viral transmission."

Kevin J. Downes, MD, Attending Physician, Division of Pediatric Infectious Diseases, Children's Hospital of Philadelphia

The consensus statements are grouped in three areas: 1) SOT patient-specific risk factors, 2) community transmission and public health responses, and 3) school-related interventions. Only questions pertaining to school attendance in kindergarten through 12th grade in U.S. schools were considered. Questions include topics related to masking, virtual learning, and infection prevention measures.

The COVID-19 pandemic has created unprecedented circumstances and unique challenges for vulnerable children around the world.

While caregivers are grappling with difficult decisions regarding returning to schools, public health officials, local health departments, and school administrators are working hard to make returning to school as safe as possible. Dr. Downes and his colleagues fully support efforts to allow all children to safely return to in-person education this academic year and have provided recommendations for transplant patients, families, and providers to help meet this goal.