加拿大魁北克省 10 家医院医护人员中 SARS-CoV-2 血清流行率：一项横断面研究。
SARS-CoV-2 seroprevalence in health care workers from 10 hospitals in Quebec, Canada: a cross-sectional study.
机构信息
Institut national de santé publique du Québec (Brousseau, Ouakki, De Serres), Montréal, Que.; Centre de recherche du CHU de Québec-Université Laval (Brousseau, Morin, De Serres), Québec, Que.; Départements de médecine et de médecine des laboratoires (Savard), Centre Hospitalier de l'Université de Montréal; Centre de recherche du Centre Hospitalier de l'Université de Montréal (Savard); Department of Microbiology, Infectious Diseases & Immunology (Quach), CHU Sainte-Justine, Université de Montréal; Jewish General Hospital (Longtin); Divisions of Infectious Disease and Medical Microbiology (Cheng), McGill University Health Center, Montréal, Que.; CIUSSS de l'Estrie - CHUS (Carignan, Lévesque, Martin); Département de microbiologie et infectiologie (Carignan, Lévesque, Martin), Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Que.; Département de médecine (Dufresne, Lavallée), CIUSSS-de-l'Est-de-l'Île-de-Montréal; CIUSSS du Nord-de-l'Île-de-Montréal (Leduc, Gauthier), Montréal, Que.; Hôpital de l'Enfant-Jésus du CHU de Québec (Bestman-Smith), Québec, Que.; CIUSSS de l'Ouest-de-l'Île-de-Montréal (Arrieta); CIUSSS du Centre-Sud-de-l'île-de-Montréal (Ishak), Montréal, Que.
出版信息
CMAJ. 2021 Dec 13;193(49):E1868-E1877. doi: 10.1503/cmaj.202783.
BACKGROUND
The COVID-19 pandemic has disproportionately affected health care workers. We sought to estimate SARS-CoV-2 seroprevalence among hospital health care workers in Quebec, Canada, after the first wave of the pandemic and to explore factors associated with SARS-CoV-2 seropositivity.
METHODS
Between July 6 and Sept. 24, 2020, we enrolled health care workers from 10 hospitals, including 8 from a region with a high incidence of COVID-19 (the Montréal area) and 2 from low-incidence regions of Quebec. Eligible health care workers were physicians, nurses, orderlies and cleaning staff working in 4 types of care units (emergency department, intensive care unit, COVID-19 inpatient unit and non-COVID-19 inpatient unit). Participants completed a questionnaire and underwent SARS-CoV-2 serology testing. We identified factors independently associated with higher seroprevalence.
RESULTS
Among 2056 enrolled health care workers, 241 (11.7%) had positive SARS-CoV-2 serology. Of these, 171 (71.0%) had been previously diagnosed with COVID-19. Seroprevalence varied among hospitals, from 2.4% to 3.7% in low-incidence regions to 17.9% to 32.0% in hospitals with outbreaks involving 5 or more health care workers. Higher seroprevalence was associated with working in a hospital where outbreaks occurred (adjusted prevalence ratio 4.16, 95% confidence interval [CI] 2.63-6.57), being a nurse or nursing assistant (adjusted prevalence ratio 1.34, 95% CI 1.03-1.74) or an orderly (adjusted prevalence ratio 1.49, 95% CI 1.12-1.97), and Black or Hispanic ethnicity (adjusted prevalence ratio 1.41, 95% CI 1.13-1.76). Lower seroprevalence was associated with working in the intensive care unit (adjusted prevalence ratio 0.47, 95% CI 0.30-0.71) or the emergency department (adjusted prevalence ratio 0.61, 95% CI 0.39-0.98).
INTERPRETATION
Health care workers in Quebec hospitals were at high risk of SARS-CoV-2 infection, particularly in outbreak settings. More work is needed to better understand SARS-CoV-2 transmission dynamics in health care settings.
背景
COVID-19 大流行对医护人员造成了不成比例的影响。我们旨在估计加拿大魁北克省医院医护人员在大流行第一波后的 SARS-CoV-2 血清流行率，并探讨与 SARS-CoV-2 血清阳性相关的因素。
方法
在 2020 年 7 月 6 日至 9 月 24 日期间，我们招募了来自 10 家医院的医护人员，其中 8 家来自 COVID-19 发病率较高的地区（蒙特利尔地区），2 家来自魁北克发病率较低的地区。符合条件的医护人员是在 4 种护理单元（急诊室、重症监护室、COVID-19 住院病房和非 COVID-19 住院病房）工作的医生、护士、勤杂工和清洁人员。参与者完成了一份问卷并接受了 SARS-CoV-2 血清学检测。我们确定了与更高血清阳性率相关的独立因素。
结果
在 2056 名入组的医护人员中，有 241 名（11.7%）的 SARS-CoV-2 血清学检测呈阳性。其中，171 名（71.0%）曾被诊断患有 COVID-19。医院之间的血清流行率存在差异，发病率较低的地区为 2.4%至 3.7%，而暴发涉及 5 名或 5 名以上医护人员的医院则为 17.9%至 32.0%。较高的血清流行率与在发生暴发的医院工作相关（调整后的患病率比 4.16，95%置信区间 [CI] 2.63-6.57），与护士或护理助理（调整后的患病率比 1.34，95% CI 1.03-1.74）或勤杂工（调整后的患病率比 1.49，95% CI 1.12-1.97）有关，与黑人或西班牙裔种族有关（调整后的患病率比 1.41，95% CI 1.13-1.76）。较低的血清流行率与在重症监护病房（调整后的患病率比 0.47，95% CI 0.30-0.71）或急诊室（调整后的患病率比 0.61，95% CI 0.39-0.98）工作有关。
解释
魁北克省医院的医护人员感染 SARS-CoV-2 的风险很高，尤其是在暴发环境中。需要进一步努力，以更好地了解医疗机构中 SARS-CoV-2 的传播动态。
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