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SARS-CoV-2 seroconversion among 4040 Egyptian healthcare workers in 12 resource-limited healthcare facilities: A prospective cohort study.
Int J Infect Dis. 2021 Mar; 104:534-542.IJ

Abstract

BACKGROUND

We examined Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) seroconversion incidence and risk factors 21 days after baseline screening among healthcare workers (HCWs) in a resource-limited setting.

METHODS

A prospective cohort study of 4040 HCWs took place at 12 university healthcare facilities in Cairo, Egypt; April-June 2020. Follow-up exposure and clinical data were collected through online survey. SARS-CoV-2 testing was done using rapid IgM and IgG serological tests and reverse transcriptase-polymerase chain reaction (RT-PCR) for those with positive serology. Cox proportional hazards modelling was used to estimate adjusted hazard ratios (HR) of seroconversion.

RESULTS

3870/4040 (95.8%) HCWs tested negative for IgM, IgG and PCR at baseline; 2282 (59.0%) returned for 21-day follow-up. Seroconversion incidence (positive IgM and/or IgG) was 100/2282 (4.4%, 95% CI:3.6-5.3), majority asymptomatic (64.0%); daily hazard of 0.21% (95% CI:0.17-0.25)/48 746 person-days of follow-up. Seroconversion was: 4.0% (64/1596; 95% CI:3.1-5.1) among asymptomatic; 5.3% (36/686; 95% CI:3.7-7.2) among symptomatic HCWs. Seroconversion was independently associated with older age; lower education; contact with a confirmed case >15 min; chronic kidney disease; pregnancy; change/loss of smell; and negatively associated with workplace contact.

CONCLUSIONS

Most seroconversions were asymptomatic, emphasizing need for regular universal testing. Seropositivity was three-fold that observed at baseline. Cumulative infections increased nationally by a similar rate, suggesting HCW infections reflect community not nosocomial transmission.

Authors+Show Affiliations

Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Electronic address: aya.kamaleldin@med.asu.edu.eg.Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Clinical Research Center (MASRI-CRC), Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Ain Shams University Specialized Hospitals, Egypt.Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Ain Shams University Specialized Hospitals, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Clinical Research Center (MASRI-CRC), Faculty of Medicine, Ain Shams University, Cairo, Egypt.Ain Shams University Specialized Hospitals, Egypt; Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Hepatobiliary Surgery & Liver Transplantation, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33484863

Citation

Mostafa, Aya, et al. "SARS-CoV-2 Seroconversion Among 4040 Egyptian Healthcare Workers in 12 Resource-limited Healthcare Facilities: a Prospective Cohort Study." International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, vol. 104, 2021, pp. 534-542.
Mostafa A, Kandil S, El-Sayed MH, et al. SARS-CoV-2 seroconversion among 4040 Egyptian healthcare workers in 12 resource-limited healthcare facilities: A prospective cohort study. Int J Infect Dis. 2021;104:534-542.
Mostafa, A., Kandil, S., El-Sayed, M. H., Girgis, S., Hafez, H., Yosef, M., Saber, S., Ezzelarab, H., Ramadan, M., Algohary, E., Fahmy, G., Afifi, I., Hassan, F., Elsayed, S., Reda, A., Fattuh, D., Mahmoud, A., Mansour, A., Sabry, M., ... El-Meteini, M. (2021). SARS-CoV-2 seroconversion among 4040 Egyptian healthcare workers in 12 resource-limited healthcare facilities: A prospective cohort study. International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, 104, 534-542. https://doi.org/10.1016/j.ijid.2021.01.037
Mostafa A, et al. SARS-CoV-2 Seroconversion Among 4040 Egyptian Healthcare Workers in 12 Resource-limited Healthcare Facilities: a Prospective Cohort Study. Int J Infect Dis. 2021;104:534-542. PubMed PMID: 33484863.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - SARS-CoV-2 seroconversion among 4040 Egyptian healthcare workers in 12 resource-limited healthcare facilities: A prospective cohort study. AU - Mostafa,Aya, AU - Kandil,Sahar, AU - El-Sayed,Manal H, AU - Girgis,Samia, AU - Hafez,Hala, AU - Yosef,Mostafa, AU - Saber,Saly, AU - Ezzelarab,Hoda, AU - Ramadan,Marwa, AU - Algohary,Eman, AU - Fahmy,Gehan, AU - Afifi,Iman, AU - Hassan,Fatmaelzahra, AU - Elsayed,Shaimaa, AU - Reda,Amira, AU - Fattuh,Doaa, AU - Mahmoud,Asmaa, AU - Mansour,Amany, AU - Sabry,Moshira, AU - Habeb,Petra, AU - Ebeid,Fatma Se, AU - Elanwar,Ali, AU - Saleh,Ayman, AU - Mansour,Ossama, AU - Omar,Ashraf, AU - El-Meteini,Mahmoud, Y1 - 2021/01/20/ PY - 2020/12/09/received PY - 2020/12/31/revised PY - 2021/01/10/accepted PY - 2021/1/24/pubmed PY - 2021/4/24/medline PY - 2021/1/23/entrez KW - COVID-19 KW - SARS-CoV-2 KW - asymptomatic KW - cohort KW - healthcare workers KW - seroconversion SP - 534 EP - 542 JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JO - Int J Infect Dis VL - 104 N2 - BACKGROUND: We examined Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) seroconversion incidence and risk factors 21 days after baseline screening among healthcare workers (HCWs) in a resource-limited setting. METHODS: A prospective cohort study of 4040 HCWs took place at 12 university healthcare facilities in Cairo, Egypt; April-June 2020. Follow-up exposure and clinical data were collected through online survey. SARS-CoV-2 testing was done using rapid IgM and IgG serological tests and reverse transcriptase-polymerase chain reaction (RT-PCR) for those with positive serology. Cox proportional hazards modelling was used to estimate adjusted hazard ratios (HR) of seroconversion. RESULTS: 3870/4040 (95.8%) HCWs tested negative for IgM, IgG and PCR at baseline; 2282 (59.0%) returned for 21-day follow-up. Seroconversion incidence (positive IgM and/or IgG) was 100/2282 (4.4%, 95% CI:3.6-5.3), majority asymptomatic (64.0%); daily hazard of 0.21% (95% CI:0.17-0.25)/48 746 person-days of follow-up. Seroconversion was: 4.0% (64/1596; 95% CI:3.1-5.1) among asymptomatic; 5.3% (36/686; 95% CI:3.7-7.2) among symptomatic HCWs. Seroconversion was independently associated with older age; lower education; contact with a confirmed case >15 min; chronic kidney disease; pregnancy; change/loss of smell; and negatively associated with workplace contact. CONCLUSIONS: Most seroconversions were asymptomatic, emphasizing need for regular universal testing. Seropositivity was three-fold that observed at baseline. Cumulative infections increased nationally by a similar rate, suggesting HCW infections reflect community not nosocomial transmission. SN - 1878-3511 UR - https://www.unboundmedicine.com/medline/citation/33484863/SARS_CoV_2_seroconversion_among_4040_Egyptian_healthcare_workers_in_12_resource_limited_healthcare_facilities:_A_prospective_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1201-9712(21)00048-5 DB - PRIME DP - Unbound Medicine ER -