Factors associated with receipt of COVID-19 vaccination and SARS-CoV-2 seropositivity among healthcare workers in Albania (February 2021-June 2022): secondary analysis of a prospective cohort study

Pernille Jorgensen; Alexis Schmid; Jonilda Sulo; Iria Preza; Iris Hasibra; Esther Kissling; Albana Fico; Shela Sridhar; Julia E Rubin-Smith; Majlinda Kota; Adela Vasili; Rovena Daja; Miljana Nika; Richard Pebody; Kathryn E Lafond; Mark A Katz; Silvia Bino

doi:10.1016/j.lanepe.2023.100584

Factors associated with receipt of COVID-19 vaccination and SARS-CoV-2 seropositivity among healthcare workers in Albania (February 2021-June 2022): secondary analysis of a prospective cohort study

Lancet Reg Health Eur. 2023 Apr:27:100584. doi: 10.1016/j.lanepe.2023.100584. Epub 2023 Feb 27.

Authors

Pernille Jorgensen¹, Alexis Schmid², Jonilda Sulo³, Iria Preza⁴, Iris Hasibra⁴, Esther Kissling⁵, Albana Fico⁴, Shela Sridhar^{2

6}, Julia E Rubin-Smith², Majlinda Kota⁴, Adela Vasili⁴, Rovena Daja⁴, Miljana Nika⁷, Richard Pebody¹, Kathryn E Lafond⁸, Mark A Katz¹, Silvia Bino⁴

Affiliations

¹ World Health Organization, Regional Office for Europe, Marmorvej 51, 2100, Copenhagen, Denmark.
² Boston Children's Hospital Global Health Program, Boston, MA, USA.
³ Southeast European Center for Surveillance and Control of Infectious Diseases, Alexander Moisiut Street N.80, 1001, Tirana, Albania.
⁴ Institute of Public Health, Alexander Moisiut Street N.80, 1001, Tirana, Albania.
⁵ Epiconcept, 25 Rue Titon, 75011, Paris, France.
⁶ Brigham and Women's Hospital, Department of Global Health Equity, 651 Huntington Avenue FXB, Building, 7th Floor, Boston, MA, USA.
⁷ Tirana University Hospital "Mother Theresa", Dibra Street N.372, 1001, Tirana, Albania.
⁸ Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Abstract

Background: Healthcare workers (HCWs) have been disproportionally affected by COVID-19. We investigated factors associated with two- and three-dose COVID-19 vaccine uptake and SARS-CoV-2 seropositivity among 1504 HCWs enrolled (19 February-7 May 2021) in a prospective COVID-19 vaccine effectiveness cohort in Albania through a secondary analysis.

Methods: We collected sociodemographic, occupational, health, prior SARS-CoV-2 infection, and COVID-19 vaccination data from all HCWs at enrollment. Vaccination status was assessed weekly through June 2022. A serum sample was collected from all participants at enrollment and tested for anti-spike SARS-CoV-2 antibodies. We analyzed HCWs characteristics and outcomes using multivariable logistic regression.

Findings: By 11 June 2022, 1337 (88.9%) HCWs had received two COVID-19 vaccine doses, of whom 255 (19.1%) received a booster. Factors significantly associated with receiving three doses (adjusted odds ratio (aOR), 95% CIs) were being ≥35 years (35-44 years: 1.76 (1.05-2.97); 45-54 years: 3.11 (1.92-5.05); ≥55 years: 3.38 (2.04-5.59)) and vaccinated against influenza (1.78; 1.20-2.64). Booster dose receipt was lower among females (0.58; 0.41-0.81), previously infected (0.67; 0.48-0.93), nurses and midwives (0.31; 0.22-0.45), and support staff (0.19; 0.11-0.32). Overall 1076 (72%) were SARS-CoV-2 seropositive at enrollment. Nurses and midwifes (1.45; 1.05-2.02), support staff (1.57; 1.03-2.41), and HCWs performing aerosol-generating procedures (AGPs) (1.40; 1.01-1.94) had higher odds of being seropositive, while smokers had reduced odds (0.55; 0.40-0.75).

Interpretation: In a large cohort of Albanian HCWs, COVID-19 vaccine booster dose uptake was very low, particularly among younger, female, and non-physician HCWs, despite evidence demonstrating the added benefit of boosters in preventing infection and severe disease. Reasons behind these disparities should be explored to develop targeted strategies in order to promote uptake in this critical population. SARS-CoV-2 seroprevalence was higher among non-physicians and HCWs performing APGs. A better understanding of the factors contributing to these differences is needed to inform interventions that could reduce infections in the future.

Funding: This study was funded by the Task Force for Global Health (US Centers for Disease Control (CDC) cooperative agreement # NU51IP000873) and the World Health Organization, Regional Office for Europe.

Keywords: COVID-19; Health care workers; Risk; SARS-CoV-2; Seropositivity; Vaccination.

Abstract

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