Risk factors for SARS-CoV-2 seropositivity in a health care worker population during the early pandemic

Sebastian D Schubl; Cesar Figueroa; Anton M Palma; Rafael R de Assis; Aarti Jain; Rie Nakajima; Algimantas Jasinskas; Danielle Brabender; Sina Hosseinian; Ariana Naaseh; Oscar Hernandez Dominguez; Ava Runge; Shannon Skochko; Justine Chinn; Adam J Kelsey; Kieu T Lai; Weian Zhao; Peter Horvath; Delia Tifrea; Areg Grigorian; Abran Gonzales; Suzanne Adelsohn; Frank Zaldivar; Robert Edwards; Alpesh N Amin; Michael J Stamos; Philip S Barie; Philip L Felgner; Saahir Khan

doi:10.1186/s12879-023-08284-y

Risk factors for SARS-CoV-2 seropositivity in a health care worker population during the early pandemic

BMC Infect Dis. 2023 May 16;23(1):330. doi: 10.1186/s12879-023-08284-y.

Authors

Sebastian D Schubl¹, Cesar Figueroa¹, Anton M Palma², Rafael R de Assis³, Aarti Jain³, Rie Nakajima³, Algimantas Jasinskas³, Danielle Brabender⁴, Sina Hosseinian⁵, Ariana Naaseh⁵, Oscar Hernandez Dominguez⁵, Ava Runge⁵, Shannon Skochko⁵, Justine Chinn⁵, Adam J Kelsey⁶, Kieu T Lai⁶, Weian Zhao⁶, Peter Horvath², Delia Tifrea⁷, Areg Grigorian⁴, Abran Gonzales¹, Suzanne Adelsohn⁷, Frank Zaldivar², Robert Edwards⁷, Alpesh N Amin⁸, Michael J Stamos⁵, Philip S Barie⁹, Philip L Felgner³, Saahir Khan¹⁰

Affiliations

¹ Department of Surgery, School of Medicine, University of California Irvine, Irvine, CA, USA.
² Institute for Clinical and Translational Sciences, University of California Irvine, Irvine, CA, USA.
³ Department of Physiology and Biophysics, University of California Irvine, Irvine, CA, USA.
⁴ Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁵ School of Medicine, University of California Irvine, Irvine, CA, USA.
⁶ Department of Pharmaceutical Sciences, School of Medicine, University of California Irvine, Irvine, CA, USA.
⁷ Department of Pathology, School of Medicine, University of California Irvine, Irvine, CA, USA.
⁸ Department of Medicine, School of Medicine, University of California Irvine, Irvine, CA, USA.
⁹ Department of Surgery, Weill Cornell Medicine, New York, NY, USA.
¹⁰ Division of Infectious Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, 1520 San Pablo St., Los Angeles, CA, 90033, USA. saahirkh@usc.edu.

Abstract

Background: While others have reported severe acute respiratory syndrome-related coronavirus 2(SARS-CoV-2) seroprevalence studies in health care workers (HCWs), we leverage the use of a highly sensitive coronavirus antigen microarray to identify a group of seropositive health care workers who were missed by daily symptom screening that was instituted prior to any epidemiologically significant local outbreak. Given that most health care facilities rely on daily symptom screening as the primary method to identify SARS-CoV-2 among health care workers, here, we aim to determine how demographic, occupational, and clinical variables influence SARS-CoV-2 seropositivity among health care workers.

Methods: We designed a cross-sectional survey of HCWs for SARS-CoV-2 seropositivity conducted from May 15th to June 30th 2020 at a 418-bed academic hospital in Orange County, California. From an eligible population of 5,349 HCWs, study participants were recruited in two ways: an open cohort, and a targeted cohort. The open cohort was open to anyone, whereas the targeted cohort that recruited HCWs previously screened for COVID-19 or work in high-risk units. A total of 1,557 HCWs completed the survey and provided specimens, including 1,044 in the open cohort and 513 in the targeted cohort. Demographic, occupational, and clinical variables were surveyed electronically. SARS-CoV-2 seropositivity was assessed using a coronavirus antigen microarray (CoVAM), which measures antibodies against eleven viral antigens to identify prior infection with 98% specificity and 93% sensitivity.

Results: Among tested HCWs (n = 1,557), SARS-CoV-2 seropositivity was 10.8%, and risk factors included male gender (OR 1.48, 95% CI 1.05-2.06), exposure to COVID-19 outside of work (2.29, 1.14-4.29), working in food or environmental services (4.85, 1.51-14.85), and working in COVID-19 units (ICU: 2.28, 1.29-3.96; ward: 1.59, 1.01-2.48). Amongst 1,103 HCWs not previously screened, seropositivity was 8.0%, and additional risk factors included younger age (1.57, 1.00-2.45) and working in administration (2.69, 1.10-7.10).

Conclusion: SARS-CoV-2 seropositivity is significantly higher than reported case counts even among HCWs who are meticulously screened. Seropositive HCWs missed by screening were more likely to be younger, work outside direct patient care, or have exposure outside of work.

Keywords: Healthcare workers; Risk analysis; SARS-CoV-2; Serology.

MeSH terms

Antibodies, Viral
COVID-19* / epidemiology
Cross-Sectional Studies
Health Personnel
Humans
Male
Pandemics
SARS-CoV-2*
Seroepidemiologic Studies

Substances

Antibodies, Viral

Abstract

MeSH terms

Substances

Grants and funding