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

Adrian Shields; Sian E Faustini; Marisol Perez-Toledo; Sian Jossi; Erin Aldera; Joel D Allen; Saly Al-Taei; Claire Backhouse; Andrew Bosworth; Lyndsey A Dunbar; Daniel Ebanks; Beena Emmanuel; Mark Garvey; Joanna Gray; I Michael Kidd; Golaleh McGinnell; Dee E McLoughlin; Gabriella Morley; Joanna O'Neill; Danai Papakonstantinou; Oliver Pickles; Charlotte Poxon; Megan Richter; Eloise M Walker; Kasun Wanigasooriya; Yasunori Watanabe; Celina Whalley; Agnieszka E Zielinska; Max Crispin; David C Wraith; Andrew D Beggs; Adam F Cunningham; Mark T Drayson; Alex G Richter

doi:10.1136/thoraxjnl-2020-215414

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

Adrian Shields, Sian E Faustini, Marisol Perez-Toledo, Sian Jossi, Erin Aldera, Joel D Allen, Saly Al-Taei, Claire Backhouse, Andrew Bosworth, Lyndsey A Dunbar, Daniel Ebanks, Beena Emmanuel, Mark Garvey, Joanna Gray, I Michael Kidd, Golaleh McGinnell, Dee E McLoughlin, Gabriella Morley, Joanna O'Neill, Danai PapakonstantinouOliver Pickles, Charlotte Poxon, Megan Richter, Eloise M Walker, Kasun Wanigasooriya, Yasunori Watanabe, Celina Whalley, Agnieszka E Zielinska, Max Crispin, David C Wraith, Andrew D Beggs, Adam F Cunningham, Mark T Drayson, Alex G Richter

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Abstract

OBJECTIVE: To determine the rates of asymptomatic viral carriage and seroprevalence of SARS-CoV-2 antibodies in healthcare workers.

DESIGN: A cross-sectional study of asymptomatic healthcare workers undertaken on 24/25 April 2020.

SETTING: University Hospitals Birmingham NHS Foundation Trust (UHBFT), UK.

PARTICIPANTS: 545 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.

INTERVENTION: Participants 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 MEASURE: Proportion of participants demonstrating infection and positive SARS-CoV-2 serology.

RESULTS: The 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 RELEVANCE: We 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.

Original language	English
Pages (from-to)	1089-1094
Number of pages	6
Journal	Thorax
Volume	75
Issue number	12
Early online date	11 Sept 2020
DOIs	https://doi.org/10.1136/thoraxjnl-2020-215414
Publication status	Published - 16 Nov 2020

Keywords

Adult
Antibodies, Viral/blood
Asymptomatic Diseases
COVID-19/diagnosis
Cross-Sectional Studies
Female
Health Personnel/statistics & numerical data
Humans
Male
Middle Aged
Pandemics
RNA, Viral/analysis
SARS-CoV-2/genetics
Seroepidemiologic Studies

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Shields_et_al_2020_SARS-CoV-2_seroprevalence_and_asymptomatic_viral_carriage_ThoraxFinal published version, 329 KBLicence: Creative Commons: Attribution (CC BY)

Understanding the molecular basis and consequences of chemoradiosensitivity in rectal cancer in order to improve tharapy (MOL-RSRC)
Middleton, G., Cazier, J. & Beggs, A.
Cancer Research Uk
3/04/17 → 31/03/22
Project: Research

Cite this

Shields, A., Faustini, S. E., Perez-Toledo, M., Jossi, S., Aldera, E., Allen, J. D., Al-Taei, S., Backhouse, C., Bosworth, A., Dunbar, L. A., Ebanks, D., Emmanuel, B., Garvey, M., Gray, J., Kidd, I. M., McGinnell, G., McLoughlin, D. E., Morley, G., O'Neill, J., ... Richter, A. G. (2020). SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers: a cross-sectional study. Thorax, 75(12), 1089-1094. https://doi.org/10.1136/thoraxjnl-2020-215414

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

abstract = "OBJECTIVE: To determine the rates of asymptomatic viral carriage and seroprevalence of SARS-CoV-2 antibodies in healthcare workers.DESIGN: A cross-sectional study of asymptomatic healthcare workers undertaken on 24/25 April 2020.SETTING: University Hospitals Birmingham NHS Foundation Trust (UHBFT), UK.PARTICIPANTS: 545 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.INTERVENTION: Participants 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 MEASURE: Proportion of participants demonstrating infection and positive SARS-CoV-2 serology.RESULTS: The 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 RELEVANCE: We 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.",

keywords = "Adult, Antibodies, Viral/blood, Asymptomatic Diseases, COVID-19/diagnosis, Cross-Sectional Studies, Female, Health Personnel/statistics & numerical data, Humans, Male, Middle Aged, Pandemics, RNA, Viral/analysis, SARS-CoV-2/genetics, Seroepidemiologic Studies",

author = "Adrian Shields and Faustini, {Sian E} and Marisol Perez-Toledo and Sian Jossi and Erin Aldera and Allen, {Joel D} and Saly Al-Taei and Claire Backhouse and Andrew Bosworth and Dunbar, {Lyndsey A} and Daniel Ebanks and Beena Emmanuel and Mark Garvey and Joanna Gray and Kidd, {I Michael} and Golaleh McGinnell and McLoughlin, {Dee E} and Gabriella Morley and Joanna O'Neill and Danai Papakonstantinou and Oliver Pickles and Charlotte Poxon and Megan Richter and Walker, {Eloise M} and Kasun Wanigasooriya and Yasunori Watanabe and Celina Whalley and Zielinska, {Agnieszka E} and Max Crispin and Wraith, {David C} and Beggs, {Andrew D} and Cunningham, {Adam F} and Drayson, {Mark T} and Richter, {Alex G}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2020",

month = nov,

day = "16",

doi = "10.1136/thoraxjnl-2020-215414",

language = "English",

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Shields, A , Faustini, SE , Perez-Toledo, M, Jossi, S, Aldera, E, Allen, JD, Al-Taei, S, Backhouse, C, Bosworth, A, Dunbar, LA, Ebanks, D, Emmanuel, B, Garvey, M, Gray, J, Kidd, IM, McGinnell, G, McLoughlin, DE, Morley, G, O'Neill, J, Papakonstantinou, D, Pickles, O, Poxon, C, Richter, M, Walker, EM, Wanigasooriya, K, Watanabe, Y, Whalley, C, Zielinska, AE, Crispin, M, Wraith, DC , Beggs, AD , Cunningham, AF , Drayson, MT & Richter, AG 2020, 'SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers: a cross-sectional study', Thorax, vol. 75, no. 12, pp. 1089-1094. https://doi.org/10.1136/thoraxjnl-2020-215414

TY - JOUR

T1 - SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers

T2 - a cross-sectional study

AU - Shields, Adrian

AU - Faustini, Sian E

AU - Perez-Toledo, Marisol

AU - Jossi, Sian

AU - Aldera, Erin

AU - Allen, Joel D

AU - Al-Taei, Saly

AU - Backhouse, Claire

AU - Bosworth, Andrew

AU - Dunbar, Lyndsey A

AU - Ebanks, Daniel

AU - Emmanuel, Beena

AU - Garvey, Mark

AU - Gray, Joanna

AU - Kidd, I Michael

AU - McGinnell, Golaleh

AU - McLoughlin, Dee E

AU - Morley, Gabriella

AU - O'Neill, Joanna

AU - Papakonstantinou, Danai

AU - Pickles, Oliver

AU - Poxon, Charlotte

AU - Richter, Megan

AU - Walker, Eloise M

AU - Wanigasooriya, Kasun

AU - Watanabe, Yasunori

AU - Whalley, Celina

AU - Zielinska, Agnieszka E

AU - Crispin, Max

AU - Wraith, David C

AU - Beggs, Andrew D

AU - Cunningham, Adam F

AU - Drayson, Mark T

AU - Richter, Alex G

PY - 2020/11/16

Y1 - 2020/11/16

N2 - OBJECTIVE: To determine the rates of asymptomatic viral carriage and seroprevalence of SARS-CoV-2 antibodies in healthcare workers.DESIGN: A cross-sectional study of asymptomatic healthcare workers undertaken on 24/25 April 2020.SETTING: University Hospitals Birmingham NHS Foundation Trust (UHBFT), UK.PARTICIPANTS: 545 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.INTERVENTION: Participants 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 MEASURE: Proportion of participants demonstrating infection and positive SARS-CoV-2 serology.RESULTS: The 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 RELEVANCE: We 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.

AB - OBJECTIVE: To determine the rates of asymptomatic viral carriage and seroprevalence of SARS-CoV-2 antibodies in healthcare workers.DESIGN: A cross-sectional study of asymptomatic healthcare workers undertaken on 24/25 April 2020.SETTING: University Hospitals Birmingham NHS Foundation Trust (UHBFT), UK.PARTICIPANTS: 545 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.INTERVENTION: Participants 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 MEASURE: Proportion of participants demonstrating infection and positive SARS-CoV-2 serology.RESULTS: The 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 RELEVANCE: We 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.

KW - Adult

KW - Antibodies, Viral/blood

KW - Asymptomatic Diseases

KW - COVID-19/diagnosis

KW - Cross-Sectional Studies

KW - Female

KW - Health Personnel/statistics & numerical data

KW - Humans

KW - Male

KW - Middle Aged

KW - Pandemics

KW - RNA, Viral/analysis

KW - SARS-CoV-2/genetics

KW - Seroepidemiologic Studies

UR - http://www.scopus.com/inward/record.url?scp=85091456207&partnerID=8YFLogxK

U2 - 10.1136/thoraxjnl-2020-215414

DO - 10.1136/thoraxjnl-2020-215414

M3 - Article

C2 - 32917840

SN - 0040-6376

VL - 75

SP - 1089

EP - 1094

JO - Thorax

JF - Thorax

IS - 12

ER -

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

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Understanding the molecular basis and consequences of chemoradiosensitivity in rectal cancer in order to improve tharapy (MOL-RSRC)

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