SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers: a cross-sectional study

• Published in: Thorax Vol. 75; no. 12; pp. 1089 - 1094
• Main Authors: Shields, Adrian, Faustini, Sian E, Perez-Toledo, Marisol, Jossi, Sian, Aldera, Erin, Allen, Joel D, Al-Taei, Saly, Backhouse, Claire, Bosworth, Andrew, Dunbar, Lyndsey A, Ebanks, Daniel, Emmanuel, Beena, Garvey, Mark, Gray, Joanna, Kidd, I Michael, McGinnell, Golaleh, McLoughlin, Dee E, Morley, Gabriella, O'Neill, Joanna, Papakonstantinou, Danai, Pickles, Oliver, Poxon, Charlotte, Richter, Megan, Walker, Eloise M, Wanigasooriya, Kasun, Watanabe, Yasunori, Whalley, Celina, Zielinska, Agnieszka E, Crispin, Max, Wraith, David C, Beggs, Andrew D, Cunningham, Adam F, Drayson, Mark T, Richter, Alex G
• Format: Journal Article Web Resource
• Language: English
• Published: England BMJ Publishing Group LTD 01.12.2020; BMJ Publishing Group
• Series: Original research
• Subjects: Adult; Age; Antibodies; Antibodies, Viral - blood; Asymptomatic; Asymptomatic Diseases; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 - virology; Cross-Sectional Studies; Departments; Disease control; Ethnicity; Female; Health Personnel - statistics & numerical data; Humans; Illnesses; Immunology; Infections; Intensive care; Male; Medical personnel; Middle Aged; Mortality; Pandemics; Respiratory Infection; RNA, Viral - analysis; SARS-CoV-2 - genetics; SARS-CoV-2 - immunology; Seroepidemiologic Studies; Serology; Severe acute respiratory syndrome coronavirus 2; Variables; Workers; United Kingdom > UK; infection control; viral infection; clinical epidemiology; respiratory infection
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thoraxjnl-2020-215414

ObjectiveTo determine the rates of asymptomatic viral carriage and seroprevalence of SARS-CoV-2 antibodies in healthcare workers.DesignA cross-sectional study of asymptomatic healthcare workers undertaken on 24/25 April 2020.SettingUniversity Hospitals Birmingham NHS Foundation Trust (UHBFT), UK.Participants545 asymptomatic healthcare workers were recruited while at work. Participants were invited to participate via the UHBFT social media. Exclusion criteria included current symptoms consistent with COVID-19. No potential participants were excluded.InterventionParticipants volunteered a nasopharyngeal swab and a venous blood sample that were tested for SARS-CoV-2 RNA and anti-SARS-CoV-2 spike glycoprotein antibodies, respectively. Results were interpreted in the context of prior illnesses and the hospital departments in which participants worked.Main outcome measureProportion of participants demonstrating infection and positive SARS-CoV-2 serology.ResultsThe point prevalence of SARS-CoV-2 viral carriage was 2.4% (n=13/545). The overall seroprevalence of SARS-CoV-2 antibodies was 24.4% (n=126/516). Participants who reported prior symptomatic illness had higher seroprevalence (37.5% vs 17.1%, χ2=21.1034, p<0.0001) and quantitatively greater antibody responses than those who had remained asymptomatic. Seroprevalence was greatest among those working in housekeeping (34.5%), acute medicine (33.3%) and general internal medicine (30.3%), with lower rates observed in participants working in intensive care (14.8%). BAME (Black, Asian and minority ethnic) ethnicity was associated with a significantly increased risk of seropositivity (OR: 1.92, 95% CI 1.14 to 3.23, p=0.01). Working on the intensive care unit was associated with a significantly lower risk of seropositivity compared with working in other areas of the hospital (OR: 0.28, 95% CI 0.09 to 0.78, p=0.02).Conclusions and relevanceWe identify differences in the occupational risk of exposure to SARS-CoV-2 between hospital departments and confirm asymptomatic seroconversion occurs in healthcare workers. Further investigation of these observations is required to inform future infection control and occupational health practices.