Disproportionate impact of SARS-CoV-2 on ethnic minority and frontline healthcare workers: A cross-sectional seroprevalence survey at a North London hospital

Martyn, Emily; Whitaker, Heather; Gil, Eliza; Ighomereho, Patricia; Lambe, Gerry; Conley, Ray; Saldiray, Janet; Ladhani, Shamez; Mirfenderesky, Mariyam

doi:10.1016/j.jinf.2021.02.027

Cited by 7 publications

(5 citation statements)

References 6 publications

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“…Those of Asian ethnicity had a higher risk of seropositivity in October 2020, but this finding was no longer significant in April 2021. Both of these ethnic groups, as well as other minority ethnic groups which were likely under-represented in our study, have been shown to have increased risk in other studies (39) (56) (57) (58). There are likely to be social factors contributing to these ethnicity-related findings in both hospitals that our study did not measure.…”

Section: Discussionsupporting

confidence: 52%

Prevalence of Antibodies to SARS-CoV-2 following natural infection and vaccination in Irish Hospital Healthcare Workers; changing epidemiology as the pandemic progresses

Allen¹,

Brady

Riain

et al. 2021

Preprint

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BackgroundIn October 2020 SARS-CoV-2 seroprevalence among hospital healthcare workers (HCW) of two Irish hospitals was 15% and 4.1% respectively. We compare seroprevalence in the same HCW population six months later, assess changes in risk factors for seropositivity with progression of the pandemic and serological response to vaccination.MethodsAll staff of both hospitals (N=9038) were invited to participate in an online questionnaire and SARS-CoV-2 antibody testing in April 2021. We measured anti-nucleocapsid and anti-spike antibodies. Frequencies and percentages for positive SARS-CoV-2 antibodies were calculated and adjusted relative risks for participant characteristics were calculated using multivariable regression analysis.Results5085 HCW participated. Seroprevalence increased to 21% and 13% respectively; 26% of infections were previously undiagnosed. Black ethnicity (aRR 1.7, 95% CI 1.3-2.2, p<.001), lower level of education (aRR 1.4 for secondary level education, 95% CI 1.1-1.8, p=0.002), living with other HCW (aRR 1.2, 95% CI 1.0-1.4, p=0.007) were significantly associated with seropositivity. Having direct patient contact also carried a significant risk (being a healthcare assistant (aRR 1.8, 95% CI 1.3-2.3, p<.001), being a nurse (aRR 1.4, 95% CI 1.1-1.5, p=0.022), daily contact with COVID-19 patients (aRR 1.4, 95% CI 1.1-1.7, p=0.002), daily contact with patients without suspected or confirmed COVID-19 (aRR 1.3, 95% CI 1.1- 1.5, p=0.013) Breakthrough infection occurred in 23/4111(0.6%) of fully vaccinated participants; all had anti-S antibodies.ConclusionThe increase in seroprevalence reflects the magnitude of the third wave of the pandemic in Ireland. Genomic sequencing is needed to apportion risk to the workplace versus the household/community. Concerted efforts are needed to mitigate risk factors due to ethnicity and lower level of education, even at this stage of the pandemic. The undiagnosed and breakthrough infections call for ongoing infection prevention and control measures and testing of HCW in the setting of close contact. Vaccinated HCW with confirmed infection should be actively assessed, including SARS-CoV-2 whole genome sequencing (WGS), serology testing and assessment of host determinants, to advance understanding of the reasons for breakthrough infection.

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Section: Discussionsupporting

confidence: 52%

Prevalence of Antibodies to SARS-CoV-2 following natural infection and vaccination in Irish Hospital Healthcare Workers; changing epidemiology as the pandemic progresses

Allen¹,

Brady

Riain

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Those of Asian ethnicity had a higher risk of seropositivity in October 2020, but this finding was no longer significant in April 2021. Both of these ethnic groups, as well as other minority ethnic groups which were likely underrepresented in our study, have been shown to have increased risk in other studies (37,(54)(55)(56). There are likely to be social factors contributing to these ethnicity-related findings in both hospitals that our study did not measure.…”

Section: Risk Factors For Antibody Positivitymentioning

confidence: 60%

Prevalence of Antibodies to SARS-CoV-2 Following Natural Infection and Vaccination in Irish Hospital Healthcare Workers: Changing Epidemiology as the Pandemic Progresses

et al. 2022

View full text Add to dashboard Cite

BackgroundIn October 2020 SARS-CoV-2 seroprevalence among hospital healthcare workers (HCW) of two Irish hospitals was 15 and 4. 1%, respectively. We compare seroprevalence in the same HCW population 6 months later, assess changes in risk factors for seropositivity with progression of the pandemic and serological response to vaccination.MethodsAll staff of both hospitals (N = 9,038) were invited to participate in an online questionnaire and SARS-CoV-2 antibody testing in April 2021. We measured anti-nucleocapsid and anti-spike antibodies. Frequencies and percentages for positive SARS-CoV-2 antibodies were calculated and adjusted relative risks for participant characteristics were calculated using multivariable regression analysis.ResultsFive thousand and eighty-five HCW participated. Seroprevalence increased to 21 and 13%, respectively; 26% of infections were previously undiagnosed. Black ethnicity (aRR 1.7, 95% CI 1.3–2.2, p < 0.001), lower level of education (aRR 1.4 for secondary level education, 95% CI 1.1–1.8, p = 0.002), living with other HCW (aRR 1.2, 95% CI 1.0–1.4, p = 0.007) were significantly associated with seropositivity. Having direct patient contact also carried a significant risk being a healthcare assistant (aRR 1.8, 95% CI 1.3–2.3, p < 0.001), being a nurse (aRR 1.4, 95% CI 1.0–1.8, p = 0.022), daily contact with COVID-19 patients (aRR 1.4, 95% CI 1.1–1.7, p = 0.002), daily contact with patients without suspected or confirmed COVID-19 (aRR 1.3, 95% CI 1.1–1.5, p = 0.013). Breakthrough infection occurred in 23/4,111(0.6%) of fully vaccinated participants; all had anti-S antibodies.ConclusionThe increase in seroprevalence reflects the magnitude of the third wave of the pandemic in Ireland. Genomic sequencing is needed to apportion risk to the workplace vs. the household/community. Concerted efforts are needed to mitigate risk factors due to ethnicity and lower level of education, even at this stage of the pandemic. The undiagnosed and breakthrough infections call for ongoing infection prevention and control measures and testing of HCW in the setting of close contact. Vaccinated HCW with confirmed infection should be actively assessed, including SARS-CoV-2 whole genome sequencing (WGS), serology testing and assessment of host determinants, to advance understanding of the reasons for breakthrough infection.

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“…That seroprevalence rates among staff and students were similar to local community infections rates, however, is reassuring because, if widespread silent transmission following asymptomatic infection was occurring in schools, then seropositivity and seroconversion rates would have been much higher than local community rates, as reported in up to two-thirds of residents and staff in care homes, irrespective of symptom status or PCR-positivity [28] . Other institutional settings including hospitals [29] , prisons [30] , and detention centres [31] have also reported much higher antibody seroprevalence rates during the current pandemic.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 infection, antibody positivity and seroconversion rates in staff and students following full reopening of secondary schools in England: A prospective cohort study, September–December 2020

Ladhani¹,

Ireland²,

Baawuah³

et al. 2021

eClinicalMedicine

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Background: Older children have higher SARS-CoV-2 infection rates than younger children. We investigated SARS-CoV-2 infection, seroprevalence and seroconversion rates in staff and students following the full reopening of all secondary schools in England. Methods: Public Health England (PHE) invited secondary schools in six regions (East and West London, Hertfordshire, Derbyshire, Manchester and Birmingham) to participate in SARS-CoV-2 surveillance during the 2020/21 academic year. Participants had nasal swabs for RT-PCR and blood samples for SARS-CoV-2 antibodies at the beginning (September 2020) and end (December 2020) of the autumn term. Multivariable logistic regression was used to assess independent risk factors for seropositivity and seroconversion. Findings: Eighteen schools in six regions enrolled 2,209 participants, including 1,189 (53.8%) students and 1,020 (46.2%) staff. SARS-CoV-2 infection rates were not significantly different between students and staff in round one (5/948; [0.53%] vs. 2/876 [0.23%]; p = 0.46) or round two (10/948 [1.05%] vs. 7/886 [0.79%]; p = 0.63), and similar to national prevalence. None of four and 7/15 (47%) sequenced strains in rounds 1 and 2 were the highly transmissible SARS-CoV-2 B.1.1.7 variant. In round 1, antibody seropositivity was higher in students than staff (114/893 [12.8%] vs. 79/861 [9.2%]; p = 0.016), but similar in round 2 (117/893 [13.1%] vs.117/872 [13.3%]; p = 0.85), comparable to local community seroprevalence. Between the two rounds, 8.7% (57/652) staff and 6.6% (36/549) students seroconverted (p = 0.16). Interpretation: In secondary schools, SARS-CoV-2 infection, seropositivity and seroconversion rates were similar in staff and students, and comparable to local community rates. Ongoing surveillance will be important for monitoring the impact of new variants in educational settings.

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Disproportionate impact of SARS-CoV-2 on ethnic minority and frontline healthcare workers: A cross-sectional seroprevalence survey at a North London hospital

Cited by 7 publications

References 6 publications

Prevalence of Antibodies to SARS-CoV-2 following natural infection and vaccination in Irish Hospital Healthcare Workers; changing epidemiology as the pandemic progresses

Prevalence of Antibodies to SARS-CoV-2 following natural infection and vaccination in Irish Hospital Healthcare Workers; changing epidemiology as the pandemic progresses

Prevalence of Antibodies to SARS-CoV-2 Following Natural Infection and Vaccination in Irish Hospital Healthcare Workers: Changing Epidemiology as the Pandemic Progresses

SARS-CoV-2 infection, antibody positivity and seroconversion rates in staff and students following full reopening of secondary schools in England: A prospective cohort study, September–December 2020

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