SARS-CoV-2 exposure, symptoms and seroprevalence in healthcare workers in Sweden

Ann-Sofie Rudberg, Sebastian Havervall, Anna Månberg, August Jernbom Falk, Katherina Aguilera, Henry Ng, Lena Gabrielsson, Ann-Christin Salomonsson, Leo Hanke, Ben Murrell, Gerald McInerney, Jennie Olofsson, Eni Andersson, Cecilia Hellström, Shaghayegh Bayati, Sofia Bergström, Elisa Pin, Ronald Sjöberg, Hanna Tegel, My Hedhammar, Mia Phillipson, Peter Nilsson, Sophia Hober, Charlotte Thålin, Ann-Sofie Rudberg, Sebastian Havervall, Anna Månberg, August Jernbom Falk, Katherina Aguilera, Henry Ng, Lena Gabrielsson, Ann-Christin Salomonsson, Leo Hanke, Ben Murrell, Gerald McInerney, Jennie Olofsson, Eni Andersson, Cecilia Hellström, Shaghayegh Bayati, Sofia Bergström, Elisa Pin, Ronald Sjöberg, Hanna Tegel, My Hedhammar, Mia Phillipson, Peter Nilsson, Sophia Hober, Charlotte Thålin

Abstract

SARS-CoV-2 may pose an occupational health risk to healthcare workers. Here, we report the seroprevalence of SARS-CoV-2 antibodies, self-reported symptoms and occupational exposure to SARS-CoV-2 among healthcare workers at a large acute care hospital in Sweden. The seroprevalence of IgG antibodies against SARS-CoV-2 was 19.1% among the 2149 healthcare workers recruited between April 14th and May 8th 2020, which was higher than the reported regional seroprevalence during the same time period. Symptoms associated with seroprevalence were anosmia (odds ratio (OR) 28.4, 95% CI 20.6-39.5) and ageusia (OR 19.2, 95% CI 14.3-26.1). Seroprevalence was also associated with patient contact (OR 2.9, 95% CI 1.9-4.5) and covid-19 patient contact (OR 3.3, 95% CI 2.2-5.3). These findings imply an occupational risk for SARS-CoV-2 infection among healthcare workers. Continued measures are warranted to assure healthcare workers safety and reduce transmission from healthcare workers to patients and to the community.

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1. Symptomatology.
Fig. 1. Symptomatology.
Symptomatology in seropositive (a; n = 410) and seronegative (b, n = 1739) individuals. Horizontal bars to the left represent the total number of participants in each group reporting the specifically denoted symptom. Vertical bars show the total number of participants in each group reporting symptoms symbolized with black dot(s) in the corresponding column. The percentage of participants reporting symptoms symbolized with black dot(s) in the corresponding column is presented above the bars. Source data are available as Source Data file.
Fig. 2. Associations between prior symptoms and…
Fig. 2. Associations between prior symptoms and seroprevalence of SARS-CoV 2 IgG antibodies.
Odds ratios of seropositivity for individually reported symptoms. Odds ratios were calculated using two-sided Fisher’s exact test with n = 2149 independent individuals. No adjustment for multiple comparisons was applied. Data are presented as odds ratios and 95% confidence intervals. Source data are available as Source Data file.
Fig. 3. Association between occupational exposure and…
Fig. 3. Association between occupational exposure and seroprevalence of SARS-CoV 2 IgG antibodies.
Odds ratios of seropositivity given patient contact, non-COVID-19 patient contact, or COVID-19 patient contact compared to no patient contact, and (under the horizontal black line) given COVID-19 patient contact compared to non-COVID-19 patient contact. Odds ratios were calculated using two-sided Fisher’s exact test with n = 2149 (patient contact vs no patient contact), n = 1107 (non-COVID-19 patient contact vs no patient contact), n = 1267 (COVID-19 patient contact vs no patient contact), and n = 1764 (COVID-19 patient contact vs non-COVID-19 patient contact) independent individuals. No adjustment for multiple comparisons was applied. Data are presented as odds ratios and 95% confidence intervals. Source data are available as Source Data file.
Fig. 4. Associations between occupations and seroprevalence…
Fig. 4. Associations between occupations and seroprevalence of SARS-CoV 2 IgG antibodies among HCW with patient contact.
Odds ratios of seropositivity for groups of HCW with patient contact, compared to personnel without patient contact. Odds ratios were calculated using two-sided Fisher’s exact test with n = 733 (assistant nurses vs no patient contact), n = 941 (nurses vs no patient contact), n = 744 (physicians vs no patient contact), and n = 559 (other medical staff vs no patient contact) independent plasma samples. No adjustment for multiple comparisons was applied. Data are presented as odds ratios and 95% confidence intervals. Source data are available as Source Data file.

References

    1. Organization WH. Coronavirus disease 2019 (COVID-19): situation report-63. (2020)
    1. Folkhälsomyndigheten. (2020)
    1. Salje, H. et al. Estimating the burden of SARS-CoV-2 in France. Science369, 208–211 (2020).
    1. Sood, N. Seroprevalence of SARS-CoV-2-specific antibodies among adults in Los Angeles County, California, on April 10-11, 2020. JAMA323, 2425–24270 (2020).
    1. Varia M, et al. Hospital Outbreak Investigation T. Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada. CMAJ. 2003;169:285–292.
    1. Masur H, Emanuel E, Lane HC. Severe acute respiratory syndrome: providing care in the face of uncertainty. JAMA. 2003;289:2861–2863. doi: 10.1001/jama.289.21.JED30036.
    1. Twu SJ, et al. Control measures for severe acute respiratory syndrome (SARS) in Taiwan. Emerg. Infect. Dis. 2003;9:718–720. doi: 10.3201/eid0906.030283.
    1. Xu, X. et al. Seroprevalence of immunoglobulin M and G antibodies against SARS-CoV-2 in China. Nat. Med.26, 1193–1195 (2020).
    1. Garcia-Basteiro, A. Seroprevalence of antibodies against SARS-CoV-2 among health care workers in a large Spanish reference hospital. Nat. Commun.11, 3500 (2020).
    1. Steensels, D. et al. Hospital-wide SARS-CoV-2 antibody screening in 3056 staff in a Tertiary Center in Belgium. JAMA324, 195–197 (2020).
    1. Eyre, D. W. et al. Differential occupational risks to healthcare workers from SARS-CoV2: a prospective observational study. medRxiv. 10.1101/2020.06.24.20135038 (2020).
    1. Korth J, et al. SARS-CoV-2-specific antibody detection in healthcare workers in Germany with direct contact to COVID-19 patients. J. Clin. Virol. 2020;128:104437. doi: 10.1016/j.jcv.2020.104437.
    1. Stubblefield, W. B. et al. Seroprevalence of SARS-CoV-2 Among Frontline Healthcare Personnel During the First Month of Caring for COVID-19 Patients—Nashville, Tennessee. Clinical infectious diseases (Infectious Diseases Society of America, 2020).
    1. Iversen, K. et al. Risk of COVID-19 in health-care workers in Denmark: an observational cohort study. Lancet Infect Dis.10.1016/S1473-3099(20)30652-6 (2020).
    1. Menni, C. et al. Real-time tracking of self-reported symptoms to predict potential COVID-19. Nat. Med.26, 1037–1040 (2020).
    1. Gudbjartsson, D. F. et al. Spread of SARS-CoV-2 in the Icelandic Population. N. Engl. J. Med.282, 2302–2315 (2020).
    1. Team CC-R. Characteristics of health care personnel with COVID-19—United States, February 12-April 9, 2020. MMWR Morb. Mortal. Wkly. Rep. 2020;69:477–481. doi: 10.15585/mmwr.mm6915e6.
    1. Prevention. CfDCa. Symptoms of coronavirus disease 2019 (COVID-19) (2020).
    1. Wang, M. Clinical diagnosis of 8274 samples with 2019-novel coronavirus in Wuhan. medRxiv 10.1101/2020.02.12.20022327 (2020).
    1. Chow, E. Symptom screening at illness onset of health care personnel with SARS-CoV-2 Infection in King County, Washington. JAMA323, 2087–2089 (2020).
    1. Fontanet, A. Cluster of COVID-19 in northern France: a retrospective closed cohort study. medRxiv10.1101/2020.04.18.20071134 (2020).
    1. Fowler RA, et al. Transmission of severe acute respiratory syndrome during intubation and mechanical ventilation. Am. J. Respir. Crit. Care Med. 2004;169:1198–1202. doi: 10.1164/rccm.200305-715OC.
    1. Reynolds MG, et al. Factors associated with nosocomial SARS-CoV transmission among healthcare workers in Hanoi, Vietnam, 2003. BMC Public Health. 2006;6:207. doi: 10.1186/1471-2458-6-207.
    1. Banik, R. K. & Ulrich, A. K. Evidence of short-range aerosol transmission of SARS-CoV-2 and call for universal airborne precautions for anesthesiologists during the COVID-19 pandemic. Anesth. Analg.10.1213/ANE.0000000000004933 (2020).
    1. Canova V, et al. Transmission risk of SARS-CoV-2 to healthcare workers -observational results of a primary care hospital contact tracing. Swiss Med. Wkly. 2020;150:w20257.
    1. Wilson, N. M., Norton, A., Young, F. P. & Collins, D. W. Airborne transmission of severe acute respiratory syndrome coronavirus-2 to healthcare workers: a narrative review. Anaesthesia75, 1086–1095 (2020).
    1. WHO. Infection Prevention and Control During Health Care When Novel Coronavirus (nCoV) Infection is Suspected (WHO, 2020).
    1. Ran, L. et al. Risk Factors of Healthcare Workers with Corona Virus Disease 2019: A Retrospective Cohort Study in a Designated Hospital of Wuhan in China (Infectious Diseases Society of America, 2020).
    1. McMichael, T. M. et al Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. N. Engl. J. Med.382, 2005–2011 (2020).
    1. Fennelly, K. P. Particle sizes of infectious aerosols: implications for infection control. Lancet Respir. Med.8, 914–924 (2020).
    1. Nguyen, L. H. et al. Risk of COVID-19 among frontline healthcare workers and the general community: a prospective cohort study. 10.1101/2020.04.29.20084111 (2020).
    1. Ye, G. et al. Environmental Contamination of SARS-CoV-2 in Healthcare Premises. J. Infect.81, e1–e5 (2020).
    1. Guo ZD, et al. Aerosol and surface distribution of severe acute respiratory syndrome Coronavirus 2 in hospital wards, Wuhan, China, 2020. Emerg. Infect. Dis. 2020;26:1583–1591. doi: 10.3201/eid2607.200885.
    1. Whitman, J. D. et al. Test performance evaluation of SARS-CoV-2 serological assays. medRxiv10.1101/2020.04.25.20074856 (2020).
    1. Wrapp D, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science. 2020;367:1260–1263. doi: 10.1126/science.abb2507.
    1. Pin E, et al. Array-based profiling of proteins and autoantibody repertoires in CSF. Methods Mol. Biol. 2019;2044:303–318. doi: 10.1007/978-1-4939-9706-0_19.

Source: PubMed

3
Prenumerera