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Risk Factors Associated With SARS-CoV-2 Seropositivity Among US Health Care Personnel

Educational Objective
To identify the key insights or developments described in this article
Key Points

Question  What risk factors are associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity among health care personnel (HCP) inside and outside the workplace?

Findings  In this cross-sectional study of 24 749 HCP in 3 US states, contact with an individual with known coronavirus disease 2019 (COVID-19) exposure outside the workplace was the strongest risk factor associated with SARS-CoV-2 seropositivity, along with living in a zip code with higher COVID-19 incidence. None of the assessed workplace factors were associated with seropositivity.

Meaning  In this study, most risk factors associated with SARS-CoV-2 infection among HCP were outside the workplace, suggesting that current infection prevention strategies in health care are effective in preventing patient-to-HCP transmission in the workplace.

Abstract

Importance  Risks for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among health care personnel (HCP) are unclear.

Objective  To evaluate the risk factors associated with SARS-CoV-2 seropositivity among HCP with the a priori hypothesis that community exposure but not health care exposure was associated with seropositivity.

Design, Setting, and Participants  This cross-sectional study was conducted among volunteer HCP at 4 large health care systems in 3 US states. Sites shared deidentified data sets, including previously collected serology results, questionnaire results on community and workplace exposures at the time of serology, and 3-digit residential zip code prefix of HCP. Site-specific responses were mapped to a common metadata set. Residential weekly coronavirus disease 2019 (COVID-19) cumulative incidence was calculated from state-based COVID-19 case and census data.

Exposures  Model variables included demographic (age, race, sex, ethnicity), community (known COVID-19 contact, COVID-19 cumulative incidence by 3-digit zip code prefix), and health care (workplace, job role, COVID-19 patient contact) factors.

Main Outcome and Measures  The main outcome was SARS-CoV-2 seropositivity. Risk factors for seropositivity were estimated using a mixed-effects logistic regression model with a random intercept to account for clustering by site.

Results  Among 24 749 HCP, most were younger than 50 years (17 233 [69.6%]), were women (19 361 [78.2%]), were White individuals (15 157 [61.2%]), and reported workplace contact with patients with COVID-19 (12 413 [50.2%]). Many HCP worked in the inpatient setting (8893 [35.9%]) and were nurses (7830 [31.6%]). Cumulative incidence of COVID-19 per 10 000 in the community up to 1 week prior to serology testing ranged from 8.2 to 275.6; 20 072 HCP (81.1%) reported no COVID-19 contact in the community. Seropositivity was 4.4% (95% CI, 4.1%-4.6%; 1080 HCP) overall. In multivariable analysis, community COVID-19 contact and community COVID-19 cumulative incidence were associated with seropositivity (community contact: adjusted odds ratio [aOR], 3.5; 95% CI, 2.9-4.1; community cumulative incidence: aOR, 1.8; 95% CI, 1.3-2.6). No assessed workplace factors were associated with seropositivity, including nurse job role (aOR, 1.1; 95% CI, 0.9-1.3), working in the emergency department (aOR, 1.0; 95% CI, 0.8-1.3), or workplace contact with patients with COVID-19 (aOR, 1.1; 95% CI, 0.9-1.3).

Conclusions and Relevance  In this cross-sectional study of US HCP in 3 states, community exposures were associated with seropositivity to SARS-CoV-2, but workplace factors, including workplace role, environment, or contact with patients with known COVID-19, were not. These findings provide reassurance that current infection prevention practices in diverse health care settings are effective in preventing transmission of SARS-CoV-2 from patients to HCP.

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Article Information

Accepted for Publication: January 19, 2021.

Published: March 10, 2021. doi:10.1001/jamanetworkopen.2021.1283

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Jacob JT et al. JAMA Network Open.

Corresponding Author: Jesse T. Jacob, MD, School of Medicine, Emory University, 550 Peachtree St NE, Orr Bldg #1018, Atlanta, GA 30308 (jtjacob@emory.edu).

Author Contributions: Drs Jacob and Baker had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Jacob and Baker contributed equally to this work.

Concept and design: Jacob, Baker, Fridkin, Lopman, Steinberg, Christenson, King, Schrank, Hayden, Lin, Milstone, C. Rock, Harris.

Acquisition, analysis, or interpretation of data: Jacob, Baker, Fridkin, Lopman, Steinberg, Leekha, O’Hara, P. Rock, Schrank, Hayden, Hota, Lin, Stein, Caturegli, Milstone, C. Rock, Voskertchian, Reddy, Harris.

Drafting of the manuscript: Jacob, Baker, Fridkin, Christenson, P. Rock, Harris.

Critical revision of the manuscript for important intellectual content: Jacob, Baker, Fridkin, Lopman, Steinberg, King, Leekha, O’Hara, Schrank, Hayden, Hota, Lin, Stein, Caturegli, Milstone, C. Rock, Voskertchian, Reddy, Harris.

Statistical analysis: Baker, O’Hara, Hota, Caturegli.

Obtained funding: Lopman, Hayden, Milstone, C. Rock, Harris.

Administrative, technical, or material support: Baker, Steinberg, Christenson, King, Leekha, O’Hara, P. Rock, Schrank, Hayden, Hota, Lin, Stein, C. Rock, Voskertchian, Reddy.

Supervision: Jacob, Fridkin, Lopman, Steinberg, Leekha, P. Rock, Stein, C. Rock.

Conflict of Interest Disclosures: Dr Jacob reported receiving grants from the National Institutes of Health outside the submitted work. Dr Baker reported receiving personal fees from the World Health Organization outside the submitted work. Dr Lopman reported receiving grants and personal fees from Takeda Pharmaceutical and receiving personal fees from the World Health Organization outside the submitted work. Dr Christenson reported receiving personal fees from Siemens Healthineers, Quidel, Roche Diagnostics, Beckman-Coulter, Sphingotech, PixCell Medical, and Becton Dickinson outside the submitted work. Dr King reported receiving personal fees from UpToDate outside the submitted work. Dr P. Rock reported receiving personal fees from the American Board of Anesthesiology and Johns Hopkins University and receiving grants from Zygood and the National Institutes of Health outside the submitted work. Dr Hayden reported serving on the clinical adjudication panel for Sanofi and receiving grants from Abbott Molecular outside the submitted work. Dr Milstone reported receiving grants from Merck, the Agency for Healthcare Research and Quality, and the National Institutes of Health outside the submitted work. No other disclosures were reported.

Funding/Support: This study was in part supported by the US Centers for Disease Control and Prevention Prevention Epicenters Program and grant number T32AI074492 from the National Institute of Allergy and Infectious Disease to Dr Baker.

Role of the Funder/Sponsor: The US Centers for Disease Control and Prevention was involved in the interpretation of the data; and preparation, review, and approval of the manuscript. It was not involved in design of the study; conduct of the study, collection, analysis or management of the data; or the decision to submit the manuscript for publication.

Disclaimer: The findings and conclusion in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.

Additional Contributions: We thank our colleagues in the state health departments for data acquisition of the zip code–based data on coronavirus disease 2019 cases: Chinyere Alu, MPH, and Dejan Jovanov, BS, Illinois; David Blythe, MD, MPH, Maryland; and Laura Edison, DVM, Georgia. For data management and analytics, we thank Carly Adams, MPH (Emory University); Elizabeth Overton, MSPH (Emory Healthcare); Ellen C. Benson, MPH, Jinal Makhija, MBBS, MPH, Lahari Thotapalli, MPH (Rush University Medical Center); and Avi Gadala, MS (Johns Hopkins University). For laboratory work and guidance, we thank John D. Roback, MD (Emory University), and Kristin Mullins, PhD (University of Maryland). For local study design, we thank Michael Schoeny, PhD, and Latania K. Logan, MD, MSPH (Rush University Medical Center). For manuscript review and local study design, we thank Robert A. Weinstein, MD (Rush University Medical Center). For study management and oversight, we thank Danielle Koontz, MAA, Emily Egbert, MPH, B. Mark Landrum, MD, Pooja U. Gupta, MD, Morgan Katz, MD, MHS, and Sarojini Qasba, MD, MPH (Johns Hopkins University). For helping to determine the infection prevention timeline, Kari Love, RN, MS (Emory Healthcare). None of these individuals were compensated for their work in this study. Finally, we thank all health care personnel, especially our study participants, who have been working tirelessly to deliver safe and compassionate care to patients during this pandemic.

References
1.
Steensels  D , Oris  E , Coninx  L ,  et al.  Hospital-wide SARS-CoV-2 antibody screening in 3056 staff in a tertiary center in Belgium.   JAMA. 2020;324(2):195-197. doi:10.1001/jama.2020.11160PubMedGoogle ScholarCrossref
2.
Iversen  K , Bundgaard  H , Hasselbalch  RB ,  et al.  Risk of COVID-19 in health-care workers in Denmark: an observational cohort study.   Lancet Infect Dis. 2020;20(12):1401-1408. doi:10.1016/S1473-3099(20)30589-2PubMedGoogle ScholarCrossref
3.
Jespersen  S , Mikkelsen  S , Greve  T ,  et al.  SARS-CoV-2 seroprevalence survey among 17,971 healthcare and administrative personnel at hospitals, pre-hospital services, and specialist practitioners in the Central Denmark Region.   Clin Infect Dis. 2020;ciaa1471. doi:10.1093/cid/ciaa1471PubMedGoogle Scholar
4.
Self  WH , Tenforde  MW , Stubblefield  WB ,  et al; CDC COVID-19 Response Team; IVY Network.  Seroprevalence of SARS-CoV-2 among frontline health care personnel in a multistate hospital network—13 academic medical centers, April-June 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(35):1221-1226. doi:10.15585/mmwr.mm6935e2PubMedGoogle ScholarCrossref
5.
Hunter  BR , Dbeibo  L , Weaver  CS ,  et al.  Seroprevalence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies among healthcare workers with differing levels of coronavirus disease 2019 (COVID-19) patient exposure.   Infect Control Hosp Epidemiol. 2020;41(12):1441-1442. doi:10.1017/ice.2020.390PubMedGoogle ScholarCrossref
6.
Moscola  J , Sembajwe  G , Jarrett  M ,  et al; Northwell Health COVID-19 Research Consortium.  Prevalence of SARS-CoV-2 antibodies in health care personnel in the New York City area.   JAMA. 2020;324(9):893-895. doi:10.1001/jama.2020.14765PubMedGoogle ScholarCrossref
7.
Baker  JM , Nelson  KN , Overton  E ,  et al.  Quantification of occupational and community risk factors for SARS-CoV-2 seropositivity among healthcare workers in a large U.S. healthcare system.   Ann Intern Med. 2021. doi:10.7326/M20-7145PubMedGoogle Scholar
8.
Muñoz-Price  LS , Nattinger  AB , Rivera  F ,  et al.  Racial disparities in incidence and outcomes among patients with COVID-19.   JAMA Netw Open. 2020;3(9):e2021892. doi:10.1001/jamanetworkopen.2020.21892PubMedGoogle Scholar
9.
Scannell Bryan  M , Sun  J , Jagai  J ,  et al.  Coronavirus disease 2019 (COVID-19) mortality and neighborhood characteristics in Chicago.   Ann Epidemiol. 2020;S1047-2797(20)30409-9. doi:10.1016/j.annepidem.2020.10.011PubMedGoogle Scholar
10.
US Food and Drug Administration. EUA authorized serology test performance. Published October 14, 2020. Accessed November 10, 2020. https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/eua-authorized-serology-test-performance
11.
Suthar  MS , Zimmerman  MG , Kauffman  RC ,  et al.  Rapid generation of neutralizing antibody responses in COVID-19 patients.   Cell Rep Med. 2020;1(3):100040. doi:10.1016/j.xcrm.2020.100040PubMedGoogle Scholar
12.
Caturegli  G , Materi  J , Howard  BM , Caturegli  P .  Clinical validity of serum antibodies to SARS-CoV-2 : a case-control study.   Ann Intern Med. 2020;173(8):614-622. doi:10.7326/M20-2889PubMedGoogle ScholarCrossref
13.
Lopman lab. Accessed February 3, 2021. https://github.com/lopmanlab
14.
Bajema  KL , Dahlgren  FS , Lim  TW ,  et al.  Comparison of estimated SARS-CoV-2 seroprevalence through commercial laboratory residual sera testing and a community survey.   Clin Infect Dis. 2020;ciaa1804. doi:10.1093/cid/ciaa1804PubMedGoogle Scholar
15.
Hughes  MM , Groenewold  MR , Lessem  SE ,  et al.  Update: characteristics of health care personnel with COVID-19—United States, February 12-July 16, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(38):1364-1368. doi:10.15585/mmwr.mm6938a3PubMedGoogle ScholarCrossref
16.
Kambhampati  AK , O’Halloran  AC , Whitaker  M ,  et al; COVID-NET Surveillance Team.  COVID-19-associated hospitalizations among health care personnel—COVID-NET, 13 states, March 1-May 31, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(43):1576-1583. doi:10.15585/mmwr.mm6943e3PubMedGoogle ScholarCrossref
17.
Boehmer  TK , DeVies  J , Caruso  E ,  et al.  Changing age distribution of the COVID-19 pandemic—United States, May-August 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(39):1404-1409. doi:10.15585/mmwr.mm6939e1PubMedGoogle ScholarCrossref
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