Table 1.
Risk Stratification for Pediatric SOT Recipients Returning to In-Person Education
| Potential Risk Category | Higher Potential Risk | Moderate Potential Risk | Lower Potential Risk |
|---|---|---|---|
| Patient factors | |||
| Level of immunosuppression | SOT recipients within early months post-transplant (ie, first 3-6 months), who are escalating or not yet tapering immunosuppression | SOT recipients on stable maintenance immunosuppression beyond the first 3-6 months following transplant or who are tapering immunosuppression | Low-level immunosuppressive monotherapy (eg, tacrolimus) or not receiving any immunosuppression |
| Stability of graft function and underlying disease indication for transplantation | Unstable graft function, increased likelihood of requiring augmented immunosuppression for rejection or other medical interventions to preserve graft function | Stable or improving graft function with low likelihood of requiring augmented immunosuppression for rejection or other medical interventions | Stable graft function |
| Comorbidities | Presence of comorbidities associated with risk of severe COVID-19, including: | Single medical comorbidity that is medically stable or improving and not requiring frequent adjustment of medical management; this may include a high-risk comorbidity that is well-controlled, if applicable | No potentially high-risk comorbidities |
| • Obesity | |||
| • Diabetes mellitus | |||
| • Chronic lung disease | |||
| • Cardiac dysfunction | |||
| • Neurologic disease | |||
| Presence of another concurrent condition leading to immunocompromise | |||
| Developmental and behavioral readiness to adhere to precautions in school setting | SOT recipient who would otherwise be categorized as “moderate potential risk” but due to developmental readiness, does not consistently demonstrate the ability to adhere to optimal hygiene, face covering, and physical distancing practices | SOT recipient who would otherwise be categorized as “low potential risk” but due to developmental readiness, does not consistently demonstrate the ability to adhere to optimal hygiene, face covering, and physical distancing practices | SOT recipient demonstrates the ability to adhere consistently to optimal hygiene, face covering, and physical distancing practices |
| AND | AND | OR | |
| Low likelihood that school personnel would be able to consistently support adherence to precautions | Low likelihood that school personnel would be able to consistently support adherence to precautions | SOT recipient has an individualized plan in place such that school personnel can consistently support adherence to optimal hygiene, face covering, and physical distancing practices | |
| Vaccination status of the SOT recipient | Unvaccinated or incomplete vaccine series | Completion of vaccine series | Based on uncertainty regarding vaccine effectiveness in SOT population, we would not consider any SOT recipients low risk strictly based on vaccine status |
| Community- and virus-related factors | |||
| Level of community transmissiona | Viral transmission in the community is substantial or high | Viral transmission in the community is moderate | Viral transmission in the community is low |
| Vaccine rates in the communityb | Community-level vaccination is low (<50% of vaccine-eligible individuals have completed vaccine series) | Community-level vaccination is moderate (50%-70% of vaccine-eligible individuals have completed vaccine series) | Community-level vaccination is high (>70% of vaccine-eligible individuals have completed vaccine series) |
| Contact tracing | No contact tracing is performed. | School relies on public health authority but cooperates to identify students who are close contacts of an infectious case | School/community performs contact tracing and school excludes students who are close contacts of an infectious case |
| School factors | |||
| Mask requirements for other students | Masks not required or worn by students or staff | Masks required indoors for all unvaccinated students and staff at all times | Masks required indoors for all students and staff at all times |
| Social distancing of other students | No minimum distancing requirements enforced | 3-6 feet social distancing required | 6 feet social distancing required |
| Cohorting | No cohorting performed | Students are kept in large cohorts (ie, grades) | Students are kept in small cohorts (ie, individual classes) and no mixing is permitted |
| Symptom screening | No symptom screening performed | School policy requires that symptomatic students stay home, but no formal procedures in place to screen | Students/staff are actively screened for symptoms and excluded from school if symptomatic |
| Ventilation | Rooms are unventilated | Standard ventilation is in place | Advanced ventilation is in place |
| Hand hygiene | Hand hygiene is at the discretion of the student | Hand hygiene is encouraged but not scheduled | Scheduled opportunities for hand hygiene are included in the day |
Abbreviation: SOT, solid organ transplant.
This table was developed to inform risk for an individual within each category (row). No single category should determine an individual’s risk. For example, a child who is unvaccinated is at higher risk than another child who has completed the full vaccine series, but this does not, in itself, make an unvaccinated child high risk. Information from all categories should be taken together to assess risk.
Low community transmission is defined as 0-9 cases per 100000 persons in the past 7 days; moderate transmission: 10-49 cases per 100000 persons in the past 7 days; substantial transmission: 50-99 cases per 100000 persons in the past 7 days; high transmission: ≥100 cases per 100000 persons in the past 7 days. Level of community transmission based on CDC COVID Data Tracker groupings, https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-fully-percent-pop12.
Low, moderate, and high designations based on CDC COVID Data Tracker groupings, https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-fully-percent-pop12.