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Prevalence of Sars-Cov-2 Infection in Health Workers (HWs) and Diagnostic Test Performance: The Experience of a Teaching Hospital in Central Italy.
Int J Environ Res Public Health. 2020 06 19; 17(12)IJ

Abstract

(1)

Background:

Health workers (HWs) are at high risk of acquiring SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infections. Therefore, health authorities further recommend screening strategies for SARS-CoV-2 infection in exposed or high-risk HWs. Nevertheless, to date, the best/optimal method to screen HWs for SARS-CoV-2 infection is still under debate, and data on the prevalence of SARS-CoV-2 infection in HWs are still scarce. The present study aims to assess the SARS-CoV-2 infection rate amongst HWs in a teaching hospital in Central Italy and the diagnostic performance of SARS-CoV-2 serology (index test) in comparison with the SARS-CoV-2 RNA PCR assay (reference standard). (2)

Methods:

A cross-sectional study on the retrospective data of HWs tested for SARS-CoV-2 by RNA-RT-PCR on nasopharyngeal swabs and by an IgM/IgG serology assay on venous blood samples, irrespective of exposure and/or symptoms, was carried out. (3)

Results:

A total of 2057 HWs (median age 46, 19-69 years, females 60.2%) were assessed by the RNA RT-PCR assay and 58 (2.7%) tested positive for SARS-CoV-2 infection. Compared with negative HWs, SARS-CoV-2-positives were younger (mean age 41.7 versus 45.2, p < 0.01; 50% versus 31% under or equal to 40 years old, p < 0.002) and had a shorter duration of employment (64 versus 125 months, p = 0.02). Exposure to SARS-CoV-2 was more frequent in positive HWs than in negatives (55.2% versus 27.5%, p < 0.0001). In 44.8% of positive HWs, no exposure was traced. None of the positive HWs had a fatal outcome, none of them had acute respiratory distress syndrome, and only one required hospitalization for mild/moderate pneumonia. In 1084 (51.2%) HWs, nasopharyngeal swabs and an IgM/IgG serology assay were performed. With regard to IgM serology, sensitivity was 0% at a specificity of 98.99% (positive predictive value, PPV 0%, negative predictive value, NPV 99.2%). Concerning IgG serology and irrespective of the time interval between nasopharyngeal swab and serology, sensitivity was 50% at a specificity of 99.1% (PPV 28.6%, NPV 99.6%). IgG serology showed a higher diagnostic performance when performed at least two weeks after testing SARS-CoV-2-positive at the RNA RT-PCR assay by a nasopharyngeal swab. (4)

Conclusions:

Our experience in Central Italy demonstrated a low prevalence of SARS-CoV-2 infection amongst HWs, but higher than in the general population. Nearly half of the positive HWs reported no previous exposure to SARS-CoV-2-infected subjects and were diagnosed thanks to the proactive screening strategy implemented. IgG serology seems useful when performed at least two weeks after an RNA RT-PCR assay. IgM serology does not seem to be a useful test for the diagnosis of active SARS-CoV-2 infection. High awareness of SARS-CoV-2 infection is mandatory for all people, but especially for HWs, irrespective of symptoms, to safeguard their health and that of patients.

Authors+Show Affiliations

Department of Medical Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy. Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.Department of Medical Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy. Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.Department of Medical Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy. Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy. Department of Neurosciences, Mental Health, and Sensory Organs, "Sapienza" University of Rome, via di Grottarossa 1035-1039, 00189 Rome, Italy.Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy. Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, via di Grottarossa 1035-1039, 00189 Rome, Italy.Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy. Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy.Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.Department of Medical Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy. Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.Department of Medical Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy. Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

32575505

Citation

Lahner, Edith, et al. "Prevalence of Sars-Cov-2 Infection in Health Workers (HWs) and Diagnostic Test Performance: the Experience of a Teaching Hospital in Central Italy." International Journal of Environmental Research and Public Health, vol. 17, no. 12, 2020.
Lahner E, Dilaghi E, Prestigiacomo C, et al. Prevalence of Sars-Cov-2 Infection in Health Workers (HWs) and Diagnostic Test Performance: The Experience of a Teaching Hospital in Central Italy. Int J Environ Res Public Health. 2020;17(12).
Lahner, E., Dilaghi, E., Prestigiacomo, C., Alessio, G., Marcellini, L., Simmaco, M., Santino, I., Orsi, G. B., Anibaldi, P., Marcolongo, A., Annibale, B., & Napoli, C. (2020). Prevalence of Sars-Cov-2 Infection in Health Workers (HWs) and Diagnostic Test Performance: The Experience of a Teaching Hospital in Central Italy. International Journal of Environmental Research and Public Health, 17(12). https://doi.org/10.3390/ijerph17124417
Lahner E, et al. Prevalence of Sars-Cov-2 Infection in Health Workers (HWs) and Diagnostic Test Performance: the Experience of a Teaching Hospital in Central Italy. Int J Environ Res Public Health. 2020 06 19;17(12) PubMed PMID: 32575505.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence of Sars-Cov-2 Infection in Health Workers (HWs) and Diagnostic Test Performance: The Experience of a Teaching Hospital in Central Italy. AU - Lahner,Edith, AU - Dilaghi,Emanuele, AU - Prestigiacomo,Claudio, AU - Alessio,Giuliano, AU - Marcellini,Laura, AU - Simmaco,Maurizio, AU - Santino,Iolanda, AU - Orsi,Giovanni Battista, AU - Anibaldi,Paolo, AU - Marcolongo,Adriano, AU - Annibale,Bruno, AU - Napoli,Christian, Y1 - 2020/06/19/ PY - 2020/05/27/received PY - 2020/06/15/revised PY - 2020/06/17/accepted PY - 2020/6/25/entrez PY - 2020/6/25/pubmed PY - 2020/7/3/medline KW - CoViD-19 KW - health workers (HWs), screening JF - International journal of environmental research and public health JO - Int J Environ Res Public Health VL - 17 IS - 12 N2 - (1) Background: Health workers (HWs) are at high risk of acquiring SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infections. Therefore, health authorities further recommend screening strategies for SARS-CoV-2 infection in exposed or high-risk HWs. Nevertheless, to date, the best/optimal method to screen HWs for SARS-CoV-2 infection is still under debate, and data on the prevalence of SARS-CoV-2 infection in HWs are still scarce. The present study aims to assess the SARS-CoV-2 infection rate amongst HWs in a teaching hospital in Central Italy and the diagnostic performance of SARS-CoV-2 serology (index test) in comparison with the SARS-CoV-2 RNA PCR assay (reference standard). (2) Methods: A cross-sectional study on the retrospective data of HWs tested for SARS-CoV-2 by RNA-RT-PCR on nasopharyngeal swabs and by an IgM/IgG serology assay on venous blood samples, irrespective of exposure and/or symptoms, was carried out. (3) Results: A total of 2057 HWs (median age 46, 19-69 years, females 60.2%) were assessed by the RNA RT-PCR assay and 58 (2.7%) tested positive for SARS-CoV-2 infection. Compared with negative HWs, SARS-CoV-2-positives were younger (mean age 41.7 versus 45.2, p < 0.01; 50% versus 31% under or equal to 40 years old, p < 0.002) and had a shorter duration of employment (64 versus 125 months, p = 0.02). Exposure to SARS-CoV-2 was more frequent in positive HWs than in negatives (55.2% versus 27.5%, p < 0.0001). In 44.8% of positive HWs, no exposure was traced. None of the positive HWs had a fatal outcome, none of them had acute respiratory distress syndrome, and only one required hospitalization for mild/moderate pneumonia. In 1084 (51.2%) HWs, nasopharyngeal swabs and an IgM/IgG serology assay were performed. With regard to IgM serology, sensitivity was 0% at a specificity of 98.99% (positive predictive value, PPV 0%, negative predictive value, NPV 99.2%). Concerning IgG serology and irrespective of the time interval between nasopharyngeal swab and serology, sensitivity was 50% at a specificity of 99.1% (PPV 28.6%, NPV 99.6%). IgG serology showed a higher diagnostic performance when performed at least two weeks after testing SARS-CoV-2-positive at the RNA RT-PCR assay by a nasopharyngeal swab. (4) Conclusions: Our experience in Central Italy demonstrated a low prevalence of SARS-CoV-2 infection amongst HWs, but higher than in the general population. Nearly half of the positive HWs reported no previous exposure to SARS-CoV-2-infected subjects and were diagnosed thanks to the proactive screening strategy implemented. IgG serology seems useful when performed at least two weeks after an RNA RT-PCR assay. IgM serology does not seem to be a useful test for the diagnosis of active SARS-CoV-2 infection. High awareness of SARS-CoV-2 infection is mandatory for all people, but especially for HWs, irrespective of symptoms, to safeguard their health and that of patients. SN - 1660-4601 UR - https://www.unboundmedicine.com/medline/citation/32575505/Prevalence_of_Sars_Cov_2_Infection_in_Health_Workers__HWs__and_Diagnostic_Test_Performance:_The_Experience_of_a_Teaching_Hospital_in_Central_Italy_ L2 - https://www.mdpi.com/resolver?pii=ijerph17124417 DB - PRIME DP - Unbound Medicine ER -