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Chea N, Eure T, Alkis Ramirez R, Zlotorzynska M, Blazek GT, Nadle J, Lee J, Czaja CA, Johnston H, Barter D, Kellogg M, Emanuel C, Meek J, Brackney M, Carswell S, Thomas S, Fridkin SK, Wilson LE, Perlmutter R, Marceaux-Galli K, Fell A, Lovett S, Lim S, Lynfield R, Shrum Davis S, Phipps EC, Sievers M, Dumyati G, Myers C, Hurley C, Licherdell E, Pierce R, Ocampo VLS, Hall EW, Wilson C, Adre C, Kirtz E, Markus TM, Billings K, Plumb ID, Abedi GR, James-Gist J, Magill SS, Grigg CT. Characteristics of healthcare personnel with SARS-CoV-2 infection: 10 emerging infections program sites in the United States, April 2020-December 2021. Infect Control Hosp Epidemiol 2024:1-9. [PMID: 38770586 DOI: 10.1017/ice.2024.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Understanding characteristics of healthcare personnel (HCP) with SARS-CoV-2 infection supports the development and prioritization of interventions to protect this important workforce. We report detailed characteristics of HCP who tested positive for SARS-CoV-2 from April 20, 2020 through December 31, 2021. METHODS CDC collaborated with Emerging Infections Program sites in 10 states to interview HCP with SARS-CoV-2 infection (case-HCP) about their demographics, underlying medical conditions, healthcare roles, exposures, personal protective equipment (PPE) use, and COVID-19 vaccination status. We grouped case-HCP by healthcare role. To describe residential social vulnerability, we merged geocoded HCP residential addresses with CDC/ATSDR Social Vulnerability Index (SVI) values at the census tract level. We defined highest and lowest SVI quartiles as high and low social vulnerability, respectively. RESULTS Our analysis included 7,531 case-HCP. Most case-HCP with roles as certified nursing assistant (CNA) (444, 61.3%), medical assistant (252, 65.3%), or home healthcare worker (HHW) (225, 59.5%) reported their race and ethnicity as either non-Hispanic Black or Hispanic. More than one third of HHWs (166, 45.2%), CNAs (283, 41.7%), and medical assistants (138, 37.9%) reported a residential address in the high social vulnerability category. The proportion of case-HCP who reported using recommended PPE at all times when caring for patients with COVID-19 was lowest among HHWs compared with other roles. CONCLUSIONS To mitigate SARS-CoV-2 infection risk in healthcare settings, infection prevention, and control interventions should be specific to HCP roles and educational backgrounds. Additional interventions are needed to address high social vulnerability among HHWs, CNAs, and medical assistants.
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Affiliation(s)
- Nora Chea
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Taniece Eure
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca Alkis Ramirez
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Zlotorzynska
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gregory T Blazek
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Chenega Enterprise Systems and Solutions, LLC, Chesapeake, VA, USA
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, CA, USA
| | - Jane Lee
- California Emerging Infections Program, Oakland, CA, USA
| | | | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Melissa Kellogg
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Catherine Emanuel
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
| | - Monica Brackney
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
| | - Stacy Carswell
- Georgia Emerging Infections Program, Atlanta Veterans Affairs Medical Center, Foundation for Atlanta Veterans Education and Research, Atlanta, GA, USA
| | - Stepy Thomas
- Georgia Emerging Infections Program, Atlanta Veterans Affairs Medical Center, Foundation for Atlanta Veterans Education and Research, Atlanta, GA, USA
| | - Scott K Fridkin
- Georgia Emerging Infections Program, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Ashley Fell
- Minnesota Department of Health, St. Paul, MN, USA
| | - Sara Lovett
- Minnesota Department of Health, St. Paul, MN, USA
| | - Sarah Lim
- Minnesota Department of Health, St. Paul, MN, USA
| | | | - Sarah Shrum Davis
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, NM, USA
| | - Erin C Phipps
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, NM, USA
- New Mexico Department of Health, Santa Fe, NM, USA
| | | | - Ghinwa Dumyati
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Christopher Myers
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Christine Hurley
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Erin Licherdell
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Rebecca Pierce
- Public Health Division, Oregon Health Authority, Portland, OR, USA
| | | | - Eric W Hall
- Oregon Health and Science University and Portland State University School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | | | - Cullen Adre
- Tennessee Department of Health, Nashville, TN, USA
| | - Erika Kirtz
- Tennessee Department of Health, Nashville, TN, USA
| | | | | | - Ian D Plumb
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Glen R Abedi
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jade James-Gist
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shelley S Magill
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cheri T Grigg
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Collis B, Tacey M, McGrath C, Madigan V, Kainer M, Tramontana A, Aboltins C. P2/N95 fit testing and the risk of COVID-19 in Healthcare Workers. Infect Dis Health 2024; 29:8-14. [PMID: 37573216 DOI: 10.1016/j.idh.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/23/2023] [Accepted: 07/23/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Guidelines recommend healthcare workers (HCWs) undertake fit testing of P2/N95 respirators to mitigate the risk of infectious aerosols, however few studies have assessed whether fit testing reduces COVID-19 infection. METHODS A retrospective cohort study was conducted amongst HCWs across two tertiary health services in Melbourne, Australia during a period of low community transmission. Institution-wide quantitative fit testing and detailed questionnaires assessing COVID-19 acquisition risk factors were undertaken from September 2020. HCWs diagnosed with COVID-19 in the period prior to the fit testing program (February 1st - August 31st 2020) were matched on a 1:3 ratio to HCWs who had not been diagnosed with COVID-19. Risk factors for COVID-19 acquisition, including fit testing outcome, were compared between groups. RESULTS A total of 1571 HCWs took part in fit testing programs. Seventy-two (4.6%) were diagnosed with COVID-19 within the study period. Younger age, nursing staff, close contact with a COVID-19 case, and working longer periods in wards with COVID-19 patients, were associated with COVID-19 infection. After matching for intensity of occupational exposure to infectious aerosols, close contact was the only independent variable associated with COVID-19 infection (OR 3.50, 95% CI:1.65-7.44, p = 0.001). Adequate fit test for the respirator predominately worn before the fit testing period was not associated with COVID-19 (OR 1.08, 95% CI:0.59-1.98, p = 0.815). CONCLUSION After controlling for intensity of occupational exposure to infectious aerosols, P2/N95 respirator fit testing was not associated with reduced risk of COVID-19 infection. The utility of widespread fit testing to reduce HCW COVID-19 infections should be reconsidered.
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Affiliation(s)
- Brennan Collis
- Department of Infectious Diseases, The Northern Hospital, 185 Cooper Street, Epping, Victoria, 3076, Australia.
| | - Mark Tacey
- Department of Infectious Diseases, The Northern Hospital, 185 Cooper Street, Epping, Victoria, 3076, Australia; Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria, 3053, Australia
| | - Christian McGrath
- Department of Infectious Diseases, The Northern Hospital, 185 Cooper Street, Epping, Victoria, 3076, Australia
| | - Victoria Madigan
- Department of Infectious Diseases, The Northern Hospital, 185 Cooper Street, Epping, Victoria, 3076, Australia
| | - Marion Kainer
- Department of Infectious Diseases, Western Health, 176 Furlong Road, St. Albans, Victoria, 3021, Australia
| | - Adrian Tramontana
- Department of Infectious Diseases, Western Health, 176 Furlong Road, St. Albans, Victoria, 3021, Australia
| | - Craig Aboltins
- Department of Infectious Diseases, The Northern Hospital, 185 Cooper Street, Epping, Victoria, 3076, Australia; Northern Clinical School, The University of Melbourne, 185 Cooper Street, Epping, Victoria, 3076, Australia
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Bansal A, Trieu MC, Mohn KGI, Madsen A, Olofsson JS, Sandnes HH, Sævik M, Søyland H, Hansen L, Onyango TB, Tøndel C, Brokstad KA, Syre H, Riis ÅG, Langeland N, Cox RJ. Risk assessment and antibody responses to SARS-CoV-2 in healthcare workers. Front Public Health 2023; 11:1164326. [PMID: 37546332 PMCID: PMC10402899 DOI: 10.3389/fpubh.2023.1164326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/22/2023] [Indexed: 08/08/2023] Open
Abstract
Background Preventing infection in healthcare workers (HCWs) is crucial for protecting healthcare systems during the COVID-19 pandemic. Here, we investigated the seroepidemiology of SARS-CoV-2 in HCWs in Norway with low-transmission settings. Methods From March 2020, we recruited HCWs at four medical centres. We determined infection by SARS-CoV-2 RT-PCR and serological testing and evaluated the association between infection and exposure variables, comparing our findings with global data in a meta-analysis. Anti-spike IgG antibodies were measured after infection and/or vaccination in a longitudinal cohort until June 2021. Results We identified a prevalence of 10.5% (95% confidence interval, CI: 8.8-12.3) in 2020 and an incidence rate of 15.0 cases per 100 person-years (95% CI: 12.5-17.8) among 1,214 HCWs with 848 person-years of follow-up time. Following infection, HCWs (n = 63) mounted durable anti-spike IgG antibodies with a half-life of 4.3 months since their seropositivity. HCWs infected with SARS-CoV-2 in 2020 (n = 46) had higher anti-spike IgG titres than naive HCWs (n = 186) throughout the 5 months after vaccination with BNT162b2 and/or ChAdOx1-S COVID-19 vaccines in 2021. In a meta-analysis including 20 studies, the odds ratio (OR) for SARS-CoV-2 seropositivity was significantly higher with household contact (OR 12.6; 95% CI: 4.5-35.1) and occupational exposure (OR 2.2; 95% CI: 1.4-3.2). Conclusion We found high and modest risks of SARS-CoV-2 infection with household and occupational exposure, respectively, in HCWs, suggesting the need to strengthen infection prevention strategies within households and medical centres. Infection generated long-lasting antibodies in most HCWs; therefore, we support delaying COVID-19 vaccination in primed HCWs, prioritising the non-infected high-risk HCWs amid vaccine shortage.
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Affiliation(s)
- Amit Bansal
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
| | - Mai-Chi Trieu
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
| | - Kristin G. I. Mohn
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Anders Madsen
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
| | - Jan Stefan Olofsson
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
| | | | - Marianne Sævik
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Hanne Søyland
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Lena Hansen
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
| | | | - Camilla Tøndel
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
| | - Karl Albert Brokstad
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
- Department of Safety, Chemistry and Biomedical Laboratory Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Heidi Syre
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Åse Garløv Riis
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Nina Langeland
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Rebecca Jane Cox
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
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Gigot C, Pisanic N, Kruczynski K, Gregory Rivera M, Spicer K, Kurowski KM, Randad P, Koehler K, Clarke WA, Holmes P, Hall DJ, Hall DJ, Heaney CD. SARS-CoV-2 Antibody Prevalence among Industrial Livestock Operation Workers and Nearby Community Residents, North Carolina, 2021 to 2022. mSphere 2023; 8:e0052222. [PMID: 36656002 PMCID: PMC9942583 DOI: 10.1128/msphere.00522-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/06/2022] [Indexed: 01/20/2023] Open
Abstract
Industrial livestock operations (ILOs), particularly processing facilities, emerged as centers of coronavirus disease 2019 (COVID-19) outbreaks in spring 2020. Confirmed cases of COVID-19 underestimate true prevalence. To investigate the prevalence of antibodies against SARS-CoV-2, we enrolled 279 participants in North Carolina from February 2021 to July 2022: 90 from households with at least one ILO worker (ILO), 97 from high-ILO intensity areas (ILO neighbors [ILON]), and 92 from metropolitan areas (metro). More metro (55.4%) compared to ILO (51.6%) and ILON participants (48.4%) completed the COVID-19 primary vaccination series; the median completion date was more than 4 months later for ILO compared to ILON and metro participants, although neither difference was statistically significant. Participants provided a saliva swab we analyzed for SARS-CoV-2 IgG using a multiplex immunoassay. The prevalence of infection-induced IgG (positive for nucleocapsid and receptor binding domain) was higher among ILO (63%) than ILON (42.9%) and metro (48.7%) participants (prevalence ratio [PR], 1.38; 95% confidence interval [CI], 1.06 to 1.80; reference category ILON and metro combined). The prevalence of infection-induced IgG was also higher among ILO participants than among an Atlanta health care worker cohort (PR, 2.45; 95% CI, 1.80 to 3.33) and a general population cohort in North Carolina (PRs, 6.37 to 10.67). The infection-induced IgG prevalence increased over the study period. Participants reporting not masking in public in the past 2 weeks had higher infection-induced IgG prevalence (78.6%) than participants reporting masking (49.3%) (PR, 1.59; 95% CI, 1.19 to 2.13). Lower education, more people per bedroom, Hispanic/Latino ethnicity, and more contact with people outside the home were also associated with higher infection-induced IgG prevalence. IMPORTANCE Few studies have measured COVID-19 seroprevalence in North Carolina, especially among rural, Black, and Hispanic/Latino communities that have been heavily affected. Antibody results show high rates of COVID-19 among industrial livestock operation workers and their household members. Antibody results add to evidence of health disparities related to COVID-19 by socioeconomic status and ethnicity. Associations between masking and physical distancing with antibody results also add to evidence of the effectiveness of these prevention strategies. Delays in the timing of receipt of COVID-19 vaccination reinforce the importance of dismantling vaccination barriers, especially for industrial livestock operation workers and their household members.
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Affiliation(s)
- Carolyn Gigot
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nora Pisanic
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kate Kruczynski
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Magdielis Gregory Rivera
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kristoffer Spicer
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kathleen M. Kurowski
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Pranay Randad
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - William A. Clarke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Phyla Holmes
- Rural Empowerment Association for Community Help, Warsaw, North Carolina, USA
| | - D. J. Hall
- Rural Empowerment Association for Community Help, Warsaw, North Carolina, USA
| | - Devon J. Hall
- Rural Empowerment Association for Community Help, Warsaw, North Carolina, USA
| | - Christopher D. Heaney
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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5
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Cooper DJ, Lear S, Sithole N, Shaw A, Stark H, Ferris M, Bradley J, Maxwell P, Goodfellow I, Weekes MP, Seaman S, Baker S. Demographic, behavioural and occupational risk factors associated with SARS-CoV-2 infection in UK healthcare workers: a retrospective observational study. BMJ Open 2022; 12:e063159. [PMID: 36343994 PMCID: PMC9644078 DOI: 10.1136/bmjopen-2022-063159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Healthcare workers (HCWs) are at higher risk of SARS-CoV-2 infection than the general population. This group is pivotal to healthcare system resilience during the COVID-19, and future, pandemics. We investigated demographic, social, behavioural and occupational risk factors for SARS-CoV-2 infection among HCWs. DESIGN/SETTING/PARTICIPANTS HCWs enrolled in a large-scale sero-epidemiological study at a UK university teaching hospital were sent questionnaires spanning a 5-month period from March to July 2020. In a retrospective observational cohort study, univariate logistic regression was used to assess factors associated with SARS-CoV-2 infection. A Least Absolute Shrinkage Selection Operator regression model was used to identify variables to include in a multivariate logistic regression model. RESULTS Among 2258 HCWs, highest ORs associated with SARS-CoV-2 antibody seropositivity on multivariate analysis were having a household member previously testing positive for SARS-CoV-2 antibodies (OR 6.94 (95% CI 4.15 to 11.6); p<0.0001) and being of black ethnicity (6.21 (95% CI 2.69 to 14.3); p<0.0001). Occupational factors associated with a higher risk of seropositivity included working as a physiotherapist (OR 2.78 (95% CI 1.21 to 6.36); p=0.015) and working predominantly in acute medicine (OR 2.72 (95% CI 1.57 to 4.69); p<0.0001) or medical subspecialties (not including infectious diseases) (OR 2.33 (95% CI 1.4 to 3.88); p=0.001). Reporting that adequate personal protective equipment (PPE) was 'rarely' available had an OR of 2.83 (95% CI 1.29 to 6.25; p=0.01). Reporting attending a handover where social distancing was not possible had an OR of 1.39 (95% CI 1.02 to 1.9; p=0.038). CONCLUSIONS The emergence of SARS-CoV-2 variants and potential vaccine escape continue to threaten stability of healthcare systems worldwide, and sustained vigilance against HCW infection remains a priority. Enhanced risk assessments should be considered for HCWs of black ethnicity, physiotherapists and those working in acute medicine or medical subspecialties. Workplace risk reduction measures include ongoing access to high-quality PPE and effective social distancing measures.
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Affiliation(s)
- Daniel James Cooper
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sara Lear
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nyarie Sithole
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ashley Shaw
- Medical Director's Office, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hannah Stark
- NIHR Bioresource, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Mark Ferris
- Occupational Health, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - John Bradley
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Patrick Maxwell
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ian Goodfellow
- Department of Pathology, Division of Virology, University of Cambridge, Cambridge, UK
| | - Michael P Weekes
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Shaun Seaman
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Stephen Baker
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, UK
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SARS-CoV-2 Exposures of Healthcare Workers from Primary Care, Long-Term Care Facilities and Hospitals: A Nationwide Matched Case-Control Study. Clin Microbiol Infect 2022; 28:1471-1476. [PMID: 35777605 PMCID: PMC9239704 DOI: 10.1016/j.cmi.2022.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study assessed the roles of various exposures and personal protective equipment (PPE) use on healthcare workers'risk (HCWs) of COVID-19 working in primary care, long-term-care facilities or hospitals. METHODS We conducted a matched case-control (1:1) study (10 April-9 July 2021). Cases (HCWs with confirmed COVID-19) and controls (HCWs without any COVID-19-positive test or symptoms) were invited by email to complete an online questionnaire on their exposures and PPE use over the 10-day period preceding inclusion. Risk factors were analyzed using multivariable conditional logistic regression. RESULTS A total of 2076 cases and 2076 matched controls were included. The analysis retained exposure to an infected person outside work (adjusted odd ratio, 19.9 [95% confidence intervaI, 12.4-31.9]), an infected colleague (2.26 [1.53-3.33]) or COVID-19 patients (2.37 [1.66-3.40]), as independent predictors of COVID-19 in HCWs, while partial (0.30 [0.22-0.40]) or complete (0.19 [0.14-0.27]) immunization was protective. Eye protection (0.57 [0.37-0.87]) and wearing a gown (0.58 [0.34-0.97]) for COVID-19 patient care were protective, while wearing an apron slightly increased the risk of infection (1.47 [1.00-2.18]). Protection of N95 respirators and surgical facemasks did not differ. Compared to medical professions, being a nurse (3.79 [2.50-5.76]) or a nurse's aide (9.08 [5.30-15.5]) was associated with COVID-19. Results were consistent across all healthcare settings. CONCLUSIONS HCWs were more likely to get COVID-19 in their personal sphere than during occupational activities. Our results suggest that eye protection for HCWs during patient care should be actively promoted.
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7
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Occupational risk factors for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among healthcare personnel: A 6-month prospective analysis of the COVID-19 Prevention in Emory Healthcare Personnel (COPE) Study. Infect Control Hosp Epidemiol 2022; 43:1664-1671. [PMID: 35156597 PMCID: PMC8886081 DOI: 10.1017/ice.2021.518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: To determine the incidence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among healthcare personnel (HCP) and to assess occupational risks for SARS-CoV-2 infection. Design: Prospective cohort of healthcare personnel (HCP) followed for 6 months from May through December 2020. Setting: Large academic healthcare system including 4 hospitals and affiliated clinics in Atlanta, Georgia. Participants: HCP, including those with and without direct patient-care activities, working during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Incident SARS-CoV-2 infections were determined through serologic testing for SARS-CoV-2 IgG at enrollment, at 3 months, and at 6 months. HCP completed monthly surveys regarding occupational activities. Multivariable logistic regression was used to identify occupational factors that increased the risk of SARS-CoV-2 infection. Results: Of the 304 evaluable HCP that were seronegative at enrollment, 26 (9%) seroconverted for SARS-CoV-2 IgG by 6 months. Overall, 219 participants (73%) self-identified as White race, 119 (40%) were nurses, and 121 (40%) worked on inpatient medical-surgical floors. In a multivariable analysis, HCP who identified as Black race were more likely to seroconvert than HCP who identified as White (odds ratio, 4.5; 95% confidence interval, 1.3–14.2). Increased risk for SARS-CoV-2 infection was not identified for any occupational activity, including spending >50% of a typical shift at a patient’s bedside, working in a COVID-19 unit, or performing or being present for aerosol-generating procedures (AGPs). Conclusions: In our study cohort of HCP working in an academic healthcare system, <10% had evidence of SARS-CoV-2 infection over 6 months. No specific occupational activities were identified as increasing risk for SARS-CoV-2 infection.
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8
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Sherman AC, Smith T, Zhu Y, Taibl K, Howard-Anderson J, Landay T, Pisanic N, Kleinhenz J, Simon TW, Espinoza D, Edupuganti N, Hammond S, Rouphael N, Shen H, Fairley JK, Edupuganti S, Cardona-Ospina JA, Rodriguez-Morales AJ, Premkumar L, Wrammert J, Tarleton R, Fridkin S, Heaney CD, Scherer EM, Collins MH. Application of SARS-CoV-2 Serology to Address Public Health Priorities. Front Public Health 2021; 9:744535. [PMID: 34888282 PMCID: PMC8650110 DOI: 10.3389/fpubh.2021.744535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Antibodies against SARS-CoV-2 can be detected by various testing platforms, but a detailed understanding of assay performance is critical. Methods: We developed and validated a simple enzyme-linked immunosorbent assay (ELISA) to detect IgG binding to the receptor-binding domain (RBD) of SARS-CoV-2, which was then applied for surveillance. ELISA results were compared to a set of complimentary serologic assays using a large panel of clinical research samples. Results: The RBD ELISA exhibited robust performance in ROC curve analysis (AUC> 0.99; Se = 89%, Sp = 99.3%). Antibodies were detected in 23/353 (6.5%) healthcare workers, 6/9 RT-PCR-confirmed mild COVID-19 cases, and 0/30 non-COVID-19 cases from an ambulatory site. RBD ELISA showed a positive correlation with neutralizing activity (p = <0.0001, R2 = 0.26). Conclusions: We applied a validated SARS-CoV-2-specific IgG ELISA in multiple contexts and performed orthogonal testing on samples. This study demonstrates the utility of a simple serologic assay for detecting prior SARS-CoV-2 infection, particularly as a tool for efficiently testing large numbers of samples as in population surveillance. Our work also highlights that precise understanding of SARS-CoV-2 infection and immunity at the individual level, particularly with wide availability of vaccination, may be improved by orthogonal testing and/or more complex assays such as multiplex bead assays.
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Affiliation(s)
- Amy C. Sherman
- Division of Infectious Diseases, The Hope Clinic of the Emory Vaccine Center, Emory University, Atlanta, GA, United States
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, United States
| | - Teresa Smith
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Yerun Zhu
- Division of Infectious Diseases, The Hope Clinic of the Emory Vaccine Center, Emory University, Atlanta, GA, United States
| | - Kaitlin Taibl
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - Taylor Landay
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Nora Pisanic
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jennifer Kleinhenz
- Division of Infectious Diseases, The Hope Clinic of the Emory Vaccine Center, Emory University, Atlanta, GA, United States
- Division of Infectious, Diseases, Department of Pediatrics, Emory University, Atlanta, GA, United States
| | - Trevor W. Simon
- Division of Infectious Diseases, The Hope Clinic of the Emory Vaccine Center, Emory University, Atlanta, GA, United States
| | - Daniel Espinoza
- Division of Infectious Diseases, The Hope Clinic of the Emory Vaccine Center, Emory University, Atlanta, GA, United States
| | - Neena Edupuganti
- Division of Infectious Diseases, The Hope Clinic of the Emory Vaccine Center, Emory University, Atlanta, GA, United States
| | - Skyler Hammond
- Department of Anthropology, Emory University, Atlanta, GA, United States
| | - Nadine Rouphael
- Division of Infectious Diseases, The Hope Clinic of the Emory Vaccine Center, Emory University, Atlanta, GA, United States
| | - Huifeng Shen
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States
| | - Jessica K. Fairley
- Division of Infectious Diseases, Emory University, Atlanta, GA, United States
| | - Srilatha Edupuganti
- Division of Infectious Diseases, The Hope Clinic of the Emory Vaccine Center, Emory University, Atlanta, GA, United States
| | - Jaime A. Cardona-Ospina
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
- Emerging Infectious Diseases and Tropical Medicine Research Group, Sci-Help, Pereira, Colombia
| | - Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
- Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru
| | - Lakshmanane Premkumar
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Jens Wrammert
- Emory Vaccine Center, Yerkes National Primate Research Center, Atlanta, GA, United States
| | - Rick Tarleton
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States
| | - Scott Fridkin
- Division of Infectious Diseases, Emory University, Atlanta, GA, United States
- Georgia Emerging Infections Program, Atlanta, GA, United States
| | | | - Erin M. Scherer
- Division of Infectious Diseases, The Hope Clinic of the Emory Vaccine Center, Emory University, Atlanta, GA, United States
| | - Matthew H. Collins
- Division of Infectious Diseases, The Hope Clinic of the Emory Vaccine Center, Emory University, Atlanta, GA, United States
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He S, Hecimovic A, Matijasevic V, Mai HT, Heslop L, Foster J, Alexander KE, Pal N, Alexandrou E, Davidson PM, Frost SA. Prevalence of SARS-CoV-2 antibodies among nurses: A systematic review and meta-analysis. J Clin Nurs 2021; 31:1557-1569. [PMID: 34570947 PMCID: PMC8661824 DOI: 10.1111/jocn.16009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/10/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022]
Abstract
Aims and Objectives This systematic review and meta‐analysis reports the seroprevalence of SARS‐CoV‐2 antibodies among nurses. Background With a growing body of literature reporting the positive serology for SARS‐CoV‐2 antibodies among healthcare workers, it remains unclear whether staff at the point of direct patient care are more prone to developing and transmitting the virus. Given nurses make up the majority of the global health workforce, outbreaks among these workers could severely undermine a health system’s capability to manage the pandemic. We aimed to summarise and report the seroprevalence of SARS‐CoV‐2 antibodies among nurses globally. Design Systematic review and meta‐analyses. Methods This systematic review was developed, undertaken and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guideline. We searched the electronic medical literature databases: MEDLINE; CINAHL; and EMBASE for studies reporting the seroprevalence of SARS‐CoV‐2 antibodies among nursing staff. Studies that reported nursing specific data were included in this review. Study quality was evaluated using the Joanna Briggs Institute checklist for studies reporting prevalence data. Studies were stratified according to the World Health Organisation region classifications, and results were presented using forest plots and summary prevalence and variance was estimated using a random effects model. Results Our electronic search identified 1687 potential studies, of which 1148 were screened for eligibility after duplicates were removed, and 51 of the studies were included in our meta‐analysis. The overall seroprevalence of SARS‐CoV‐2 antibodies among nurses was estimated to be 8.1% (95% CI 6.9%–9.4%) among the 60,571 participants included in the studies. Seropositivity was highest in the African region (48.2%, 95% CI 39.2%–57.3%), followed by the European region (10.3%, 95% CI 8.0%–12.5%), the Region of the Americas (8.4%, 95% CI 6.0%–10.7%), the South‐East Asia region (3.0%, 95% CI 0.00%–6.5%) and the Western Pacific region (0.5%, 95% CI 0.0%–1.0%). Pooled estimates were unable to be calculated in the Eastern Mediterranean region due to insufficient studies. Conclusion The seroprevalence of SARS‐CoV‐2 antibodies among nurses is comparable to other healthcare workers, and possibly similar to the general population. Early adoption and adherence to personal protective equipment and social distancing measures could explain these similarities, meaning the majority of staff contracted the virus through community transmission and not in a healthcare setting. Relevance to clinical practice Fear and uncertainty have been features of this pandemic, including among nurses. This meta‐analysis should provide some comfort to nurses that risks are similar to community exposure when adequate PPE is available and there is an adherence to infection control measures.
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Affiliation(s)
- Steven He
- South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,Western Sydney University, Sydney, New South Wales, Australia
| | - Anthony Hecimovic
- South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Local Health District Primary and Community Health, Sydney, New South Wales, Australia
| | - Vesna Matijasevic
- South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Local Health District Primary and Community Health, Sydney, New South Wales, Australia
| | - Ha Thi Mai
- South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,Western Sydney University, Sydney, New South Wales, Australia
| | - Linda Heslop
- Ken Merten Library, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Jann Foster
- South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,Western Sydney University, Sydney, New South Wales, Australia.,NSW Centre for Evidence Based Health Care: A JBI Affiliated Group, Sydney, New South Wales, Australia
| | - Kate E Alexander
- South Western Sydney Local Health District Public Health Unit, Sydney, New South Wales, Australia
| | - Naru Pal
- South Western Sydney Local Health District Public Health Unit, Sydney, New South Wales, Australia
| | - Evan Alexandrou
- South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,Western Sydney University, Sydney, New South Wales, Australia.,Department of Intensive Care, Liverpool Hospital, Sydney, New South Wales, Australia.,Griffith University, Brisbane, Queensland, Australia
| | | | - Steven A Frost
- South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,Western Sydney University, Sydney, New South Wales, Australia.,Department of Intensive Care, Liverpool Hospital, Sydney, New South Wales, Australia
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