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Jacobson MA, Blanc PD, Tulsky J, Tilly M, Meister R, Huen W, McNicholas JE. Risk of subsequent SARS-CoV-2 infection among vaccinated employees with or without hybrid immunity acquired early in the Omicron-predominant era of the COVID-19 pandemic. Am J Ind Med 2024; 67:334-340. [PMID: 38316635 DOI: 10.1002/ajim.23570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Hybrid immunity, from COVID-19 vaccination followed by SARS-CoV-2 infection acquired after its Omicron variant began predominating, has provided greater protection than vaccination alone against subsequent infection over 1-3 months of observation. Its longer-term protection is unknown. METHODS We conducted a retrospective cohort study of COVID-19 case incidence among healthcare personnel (HCP) mandated to be vaccinated and report on COVID-19-associated symptoms, high-risk exposures, or known-positive test results to an employee health hotline. We compared cases with hybrid immunity, defined as incident COVID-19 during the first 6 weeks of Omicron-variant predominance (run-in period), to those with immunity from vaccination alone during the run-in period. Time until COVID-19 infection over 13 subsequent months (observation period) was analyzed by standard survival analysis. RESULTS Of 5867 employees, 641 (10.9%, 95% confidence interval [CI]: 10.1%-11.8%) acquired hybrid immunity during the run-in period. Of these, 104 (16.2%, 95% CI: 13.5%-19.3%) experienced new SARS-CoV-2 infection during the 13-month observation period, compared to 2177 (41.7%, 95% CI: 40.3%-43.0%) of the 5226 HCP without hybrid immunity. Time until incident infection was shorter among the latter (hazard ratio: 3.09, 95% CI: 2.54-3.78). CONCLUSIONS In a cohort of vaccinated employees, Omicron-era acquired SARS-CoV-2 hybrid immunity was associated with significantly lower risk of subsequent infection over more than a year of observation-a time period far longer than previously reported and during which three, progressively more resistant, Omicron subvariants became predominant. These findings can inform institutional policy and planning for future COVID-19 additional vaccine dosing requirements for employees, for surveillance programs, and for risk modification efforts.
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Affiliation(s)
- Mark A Jacobson
- Department of Medicine, Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Paul D Blanc
- Department of Medicine, Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Jacqueline Tulsky
- Department of Medicine, Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Monica Tilly
- Department of Medicine, Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Raymond Meister
- Department of Medicine, Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Will Huen
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - James E McNicholas
- Department of Medicine, Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
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Abstract
BACKGROUND Health care workers (HCWs) experience increased occupational risk of contracting COVID-19, with temporal trends that might inform surveillance. METHODS We analyzed data from a Veterans Affairs hospital-based COVID-19 worker telephone hotline collected over 40 weeks (2020). We calculated the proportion of COVID-19+ cases among persons-under-investigation (PUIs) for illness compared to rates from a nearby large university-based health care institution. RESULTS We observed 740 PUIs, 65 (8.8%) COVID-19+. Time trends were similar at the study and comparison hospitals; only for the first of 10 four-week observation periods was the ratio for observed to expected COVID-19+ significant (P < 0.001). DISCUSSION These data suggest that employee health COVID-19+ to PUI ratios could be utilized as a barometer of community trends. Pooling experience among heath care facilities may yield insights into occupational infectious disease outbreaks.
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Affiliation(s)
- James E McNicholas
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, California (Dr McNicholas, Dr Kosnik, Dr Blanc, and Dr Guntur); Division of Occupational Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California (Dr McNicholas, Dr Blanc and Dr Guntur); Office of Population Health, UCSF Medical Center, University of California San Francisco, San Francisco, California (Dr Taylor)
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