Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Int J Infect Dis. 2021 Mar;104:534-542. doi: 10.1016/j.ijid.2021.01.037. Epub 2021 Jan 20.
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.
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.
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.
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.
我们在埃及开罗的 12 所大学医疗机构中，对资源有限环境下的医护人员（HCW）进行了基线筛查后 21 天的严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）血清转换发生率和危险因素研究。
这是一项前瞻性队列研究，共纳入 4040 名 HCW，于 2020 年 4 月至 6 月在埃及开罗的 12 所大学医疗机构进行。通过在线调查收集随访暴露和临床数据。使用快速 IgM 和 IgG 血清学检测以及对阳性血清学的逆转录-聚合酶链反应（RT-PCR）对 SARS-CoV-2 进行检测。使用 Cox 比例风险模型估计血清转换的调整后风险比（HR）。
基线时，4040 名 HCW 中有 3870 名（95.8%）IgM、IgG 和 PCR 均为阴性；2282 名（59.0%）返回进行 21 天随访。血清转换发生率（IgM 和/或 IgG 阳性）为 100/2282（4.4%，95%CI：3.6-5.3%），多数为无症状（64.0%）；每天的风险为 0.21%（95%CI：0.17-0.25）/48746 人-日的随访。无症状 HCW 中血清转换率为 4.0%（64/1596；95%CI：3.1-5.1）；有症状的 HCW 中血清转换率为 5.3%（36/686；95%CI：3.7-7.2）。血清转换与年龄较大、受教育程度较低、与确诊病例接触时间＞15 分钟、慢性肾脏疾病、妊娠、嗅觉改变或丧失有关，与工作场所接触呈负相关。
大多数血清转换为无症状，强调需要定期进行普遍检测。血清阳性率是基线时的三倍。全国累计感染率以相似的速度增加，这表明 HCW 的感染反映了社区而不是医院内的传播。
