Risk Factors Associated with SARS-CoV-2 Seropositivity among US Health Care Personnel

Jesse T. Jacob, Julia M. Baker, Scott K. Fridkin, Benjamin A. Lopman, James P. Steinberg, Robert H. Christenson, Brent King, Surbhi Leekha, Lyndsay M. O'Hara, Peter Rock, Gregory M. Schrank, Mary K. Hayden, Bala Hota, Michael Y. Lin, Brian D. Stein, Patrizio Caturegli, Aaron M. Milstone, Clare Rock, Annie Voskertchian, Sujan C. ReddyAnthony D. Harris

Research output: Contribution to journalArticlepeer-review

Abstract

Importance: Risks for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among health care personnel (HCP) are unclear. Objective: To evaluate the risk factors associated with SARS-CoV-2 seropositivity among HCP with the a priori hypothesis that community exposure but not health care exposure was associated with seropositivity. Design, Setting, and Participants: This cross-sectional study was conducted among volunteer HCP at 4 large health care systems in 3 US states. Sites shared deidentified data sets, including previously collected serology results, questionnaire results on community and workplace exposures at the time of serology, and 3-digit residential zip code prefix of HCP. Site-specific responses were mapped to a common metadata set. Residential weekly coronavirus disease 2019 (COVID-19) cumulative incidence was calculated from state-based COVID-19 case and census data. Exposures: Model variables included demographic (age, race, sex, ethnicity), community (known COVID-19 contact, COVID-19 cumulative incidence by 3-digit zip code prefix), and health care (workplace, job role, COVID-19 patient contact) factors. Main Outcome and Measures: The main outcome was SARS-CoV-2 seropositivity. Risk factors for seropositivity were estimated using a mixed-effects logistic regression model with a random intercept to account for clustering by site. Results: Among 24749 HCP, most were younger than 50 years (17233 [69.6%]), were women (19361 [78.2%]), were White individuals (15157 [61.2%]), and reported workplace contact with patients with COVID-19 (12413 [50.2%]). Many HCP worked in the inpatient setting (8893 [35.9%]) and were nurses (7830 [31.6%]). Cumulative incidence of COVID-19 per 10000 in the community up to 1 week prior to serology testing ranged from 8.2 to 275.6; 20072 HCP (81.1%) reported no COVID-19 contact in the community. Seropositivity was 4.4% (95% CI, 4.1%-4.6%; 1080 HCP) overall. In multivariable analysis, community COVID-19 contact and community COVID-19 cumulative incidence were associated with seropositivity (community contact: adjusted odds ratio [aOR], 3.5; 95% CI, 2.9-4.1; community cumulative incidence: aOR, 1.8; 95% CI, 1.3-2.6). No assessed workplace factors were associated with seropositivity, including nurse job role (aOR, 1.1; 95% CI, 0.9-1.3), working in the emergency department (aOR, 1.0; 95% CI, 0.8-1.3), or workplace contact with patients with COVID-19 (aOR, 1.1; 95% CI, 0.9-1.3). Conclusions and Relevance: In this cross-sectional study of US HCP in 3 states, community exposures were associated with seropositivity to SARS-CoV-2, but workplace factors, including workplace role, environment, or contact with patients with known COVID-19, were not. These findings provide reassurance that current infection prevention practices in diverse health care settings are effective in preventing transmission of SARS-CoV-2 from patients to HCP..

Original languageEnglish (US)
Article numbere211283
JournalJAMA Network Open
Volume4
Issue number3
DOIs
StatePublished - Mar 10 2021

ASJC Scopus subject areas

  • Medicine(all)

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