Updated guidance addresses SARS-CoV-2 testing, use of PPE in vaccinated people, those with previous infection

Editor's note:AAP interim guidance is based on current evidence and best data at the time of publication. Updates are provided to reflect changes in knowledge about the impact of the disease on children and adolescents. For the latest news on COVID-19, visit http://bit.ly/AAPNewsCOVID19.

The AAP has updated its interim guidance on testing for SARS-CoV-2 to include new recommendations for people with previous infection and those who have received a COVID-19 vaccine.

Interim guidance on the use of personal protective equipment (PPE) for pediatric care in ambulatory care settings also has been updated to address the use of PPE by those who have been vaccinated and includes new information on the efficacy of face masks.

Interim guidance on the use of face masks was updated as well and calls for the universal use of face masks by children ages 2 years and older and adults as schools reopen.

Testing guidance

Circulation of several variant strains of SARS-CoV-2 throughout the United States has raised concerns that people may be reinfected with the virus. The AAP generally does not recommend testing for active SARS-CoV-2 infection with nucleic acid amplification tests (NAATs) or antigen-based tests for asymptomatic patients if they tested positive within the past three months or if they received Moderna, Pfizer-BioNTech or Janssen vaccine.

However, the guidance acknowledges that some SARS-CoV-2 variants may cause reinfections. “Therefore, in a child with known exposure and compatible symptoms, it may be reasonable to retest within the 3-month window. Results of such testing should be interpreted in the context of the knowledge that NAATs (particularly PCRs [polymerase chain reaction]) may continue to yield positive results for weeks or months after initial infection, so a positive test result within that 3-month period may reflect prior infection.”

Vaccinated children with known exposures and symptoms also should be tested, since the vaccines do not provide 100% protection against infection, the guidance states, adding that “Receipt of SARS-CoV-2 vaccine does not result in positive NAAT or antigen test results.”  

The AAP does not recommend antibody testing to determine a person’s immunity to COVID-19 following vaccination or to assess the need for vaccination.

The guidance points out the limitations of at-home antigen tests, which recently received emergency use authorization from the Food and Drug Administration for patients 2 years and older. “The role of such testing in children remains unclear, and issues such as adequacy of self- or parent-collected specimens may limit the utility of these tests for diagnosis of SARS-CoV-2 infection in children.”

The AAP continues to recommend testing for patients with symptoms consistent with COVID-19; patients who were in close contact with a person with confirmed or probable SARS-CoV-2 infection; and patients who require screening e.g., before a medical procedure or as a school or workplace requirement.

PPE guidance

The updated interim guidance addresses use of PPE by health care professionals who have been vaccinated, stating they should “continue to use all recommended precautions against spread of the SARS-CoV-2 virus, including universal masking, other appropriate PPE, hand hygiene and social distancing, since there is insufficient data on the possibility of a vaccinated individual being able to become infected and spread the virus.”

The guidance also highlights a study by the Centers for Disease Control and Prevention that showed mask efficacy can be improved by wearing two masks or ensuring a single mask fits well. In lab tests with dummies, both techniques protected the wearer and reduced the spread of SARS-CoV-2.

Face mask guidance

The AAP’s updated interim guidance on face masks (previously called cloth face coverings) continues to recommend the consistent and correct use of well-fitting face masks by children 2 years of age and older to help reduce the spread of SARS-CoV-2.

“During the COVID-19 pandemic, plans for the safe return of children to school, child care, and other group settings must include the universal use of face masks by children 2 years of age and older and the adults with whom they interact,” the guidance states.