医护人员中抗SARS-CoV-2抗体状态及感染发生率
Antibody Status and Incidence of SARS-CoV-2 Infection in Health Care Workers.
作者信息
Lumley Sheila F, O'Donnell Denise, Stoesser Nicole E, Matthews Philippa C, Howarth Alison, Hatch Stephanie B, Marsden Brian D, Cox Stuart, James Tim, Warren Fiona, Peck Liam J, Ritter Thomas G, de Toledo Zoe, Warren Laura, Axten David, Cornall Richard J, Jones E Yvonne, Stuart David I, Screaton Gavin, Ebner Daniel, Hoosdally Sarah, Chand Meera, Crook Derrick W, O'Donnell Anne-Marie, Conlon Christopher P, Pouwels Koen B, Walker A Sarah, Peto Tim E A, Hopkins Susan, Walker Timothy M, Jeffery Katie, Eyre David W
机构信息
From Oxford University Hospitals NHS Foundation Trust (S.F.L., N.E.S., P.C.M., S.C., T.J., F.W., L.W., D.A., A.-M.O., K.J.), Nuffield Department of Medicine (S.F.L., D.O., N.E.S., P.C.M., A.H., S.B.H., B.D.M., R.J.C., E.Y.J., D.I.S., G.S., D.E., S. Hoosdally, D.W.C., C.P.C., A.S.W., T.E.A.P., T.M.W.), the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (N.E.S., P.C.M., S. Hoosdally, D.W.C., A.S.W., T.E.A.P., D.W.E.), the Kennedy Institute of Rheumatology Research (B.D.M.), the Medical School, University of Oxford (L.J.P., T.G.R., Z.T.), Target Discovery Institute (D.E.), Nuffield Department of Population Health (A.-M.O., K.B.P., D.W.E.), and the Big Data Institute (D.W.E.), University of Oxford, and the NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England (N.E.S., P.C.M., S. Hoosdally, D.W.C., K.B.P., A.S.W., T.E.A.P., D.W.E.), Oxford, and the National Infection Service, Public Health England at Colindale, London (M.C., S. Hopkins) - all in the United Kingdom; and the Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.M.W.).
出版信息
N Engl J Med. 2021 Feb 11;384(6):533-540. doi: 10.1056/NEJMoa2034545. Epub 2020 Dec 23.
BACKGROUND
The relationship between the presence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the risk of subsequent reinfection remains unclear.
METHODS
We investigated the incidence of SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) in seropositive and seronegative health care workers attending testing of asymptomatic and symptomatic staff at Oxford University Hospitals in the United Kingdom. Baseline antibody status was determined by anti-spike (primary analysis) and anti-nucleocapsid IgG assays, and staff members were followed for up to 31 weeks. We estimated the relative incidence of PCR-positive test results and new symptomatic infection according to antibody status, adjusting for age, participant-reported gender, and changes in incidence over time.
RESULTS
A total of 12,541 health care workers participated and had anti-spike IgG measured; 11,364 were followed up after negative antibody results and 1265 after positive results, including 88 in whom seroconversion occurred during follow-up. A total of 223 anti-spike-seronegative health care workers had a positive PCR test (1.09 per 10,000 days at risk), 100 during screening while they were asymptomatic and 123 while symptomatic, whereas 2 anti-spike-seropositive health care workers had a positive PCR test (0.13 per 10,000 days at risk), and both workers were asymptomatic when tested (adjusted incidence rate ratio, 0.11; 95% confidence interval, 0.03 to 0.44; P = 0.002). There were no symptomatic infections in workers with anti-spike antibodies. Rate ratios were similar when the anti-nucleocapsid IgG assay was used alone or in combination with the anti-spike IgG assay to determine baseline status.
CONCLUSIONS
The presence of anti-spike or anti-nucleocapsid IgG antibodies was associated with a substantially reduced risk of SARS-CoV-2 reinfection in the ensuing 6 months. (Funded by the U.K. Government Department of Health and Social Care and others.).
背景
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）抗体的存在与后续再次感染风险之间的关系尚不清楚。
方法
我们调查了在英国牛津大学医院参加无症状和有症状工作人员检测的血清学阳性和血清学阴性医护人员中，通过聚合酶链反应（PCR）确诊的SARS-CoV-2感染发生率。通过抗刺突蛋白（主要分析）和抗核衣壳IgG检测确定基线抗体状态，并对工作人员进行长达31周的随访。我们根据抗体状态估计PCR阳性检测结果和新的有症状感染的相对发生率，并对年龄、参与者报告的性别以及随时间变化的发生率进行调整。
结果
共有12541名医护人员参与并检测了抗刺突蛋白IgG；抗体结果为阴性的11364人以及阳性的1265人接受了随访，其中88人在随访期间发生了血清转化。共有223名抗刺突蛋白血清学阴性的医护人员PCR检测呈阳性（每10000天风险期内1.09例），100例在筛查时无症状，123例有症状，而2名抗刺突蛋白血清学阳性的医护人员PCR检测呈阳性（每10000天风险期内0.13例），且两名工作人员检测时均无症状（调整后的发病率比为0.11；95%置信区间为0.03至0.44；P = 0.002）。有抗刺突蛋白抗体的工作人员中没有出现有症状感染。单独使用抗核衣壳IgG检测或与抗刺突蛋白IgG检测联合使用来确定基线状态时，发病率比相似。
结论
抗刺突蛋白或抗核衣壳IgG抗体的存在与随后6个月内SARS-CoV-2再次感染的风险大幅降低相关。（由英国政府卫生和社会保健部及其他机构资助。）
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