Risk factors for SARS-CoV-2 infection among health care workers.

BACKGROUND: Health care workers (HCWs) are on the front line for COVID-19. Better knowledge of risk factors for SARS-CoV-2 infection is crucial for their protection. We aimed to identify these risk factors with a focus on care activities. METHODS: We conducted a seroprevalence survey among HCWs in a French referral hospital. Data on COVID-19 exposures, care activities, and protective equipment were collected on a standardized questionnaire. Multivariate logistic regressions were used to assess risk factors for SARS-CoV-2 IgG adjusted on potential confounding. FINDINGS: Among the 3,234 HCWs enrolled, the prevalence of SARS-CoV-2 IgG was 3.8%. Risk factors included contact with relatives or HCWs with COVID-19 (odds ratio [OR] 2.20 [1.40-3.45] and 2.16 [1.46-3.18], respectively), but not contact with COVID-19 patients. In multivariate analyses, suboptimal use of protective equipment during nasopharyngeal sampling (OR 3.46 [1.15-10.40]), mobilisation of patients in bed (OR 3.30 [1.51-7.25]), clinical examination (OR 2.51 [1.16-5.43]), and eye examination (OR 2.90 [1.01-8.35]) were associated with SARS-CoV-2 infection. Patients washing and dressing and aerosol-generating procedures were additional risk factors, with or without appropriate use of protective equipment (OR 1.37 [1.04-1.81] and 1.74 [1.05-2.88]). CONCLUSIONS: Risk factors for SARS-CoV-2 infection among HCWs are (1) contact with relatives or HCWs with COVID-19, (2) close or prolonged contact with patients, (3) aerosol-generating procedures. Enhanced protective measures during the two latter care-activities may be warranted.

Delay between COVID-19 complete vaccination and SARS-CoV-2 infection among healthcare workers.

OBJECTIVES: Healthcare workers (HCWs), at increased risk of coronavirus disease 2019 (COVID-19) were among the primary targets for vaccination, which became mandatory for them on September 15th, 2021 in France. In November they were confronted to the fifth COVID-19 wave despite excellent vaccine coverage. We aimed to estimate the incidence of SARS-CoV-2 infection after complete vaccination among HCWs with different vaccination schemes, and its determinants. METHODS: We enrolled all HCWs in the university hospital of Rennes, France who had received complete vaccination (two doses of COVID-19 vaccine). The delay from last vaccination dose to SARS-CoV-2 infection was computed.Fitted mixed Cox survival model with a random effect applied to exposure risk periods to account for epidemic variation was used to estimate the determinants of SARS-CoV-2 infection after complete vaccination. RESULTS: Of the 6674 (82%) HCWs who received complete vaccination (36% BNT162b2, 29% mRNA-1273, and 34% mixed with ChAdOx1 nCoV-19) and were prospectively followed-up for a median of 7.0 [6.3-8.0] months, 160 (2.4%) tested positive for SARS-CoV-2 by RT-PCR. Incidence density of SARS-CoV-2 infection after complete vaccination was 3.39 [2.89-3.96] infections per 1000 person-month. Median time from vaccine completion to SARS-CoV-2 infection was 5.5 [3.2-6.6] months. Using fitted mixed Cox regression with the delay as a time-dependent variable and random effect applied to exposure risk periods, age (P < 0.001) was independently associated with the incidence of SARS-CoV-2 infection. Vaccine schemes were not associated with SARS-CoV-2 infection (P = 0.068). A period effect was significantly associated with the incidence of SARS-CoV-2 infection (P < 0.001). CONCLUSIONS: In this real-world study, incidence of SARS-CoV-2 infection increases with time in fully vaccinated HCWs with no differences according to the vaccination scheme. The short delay between complete vaccination and incident SARS-CoV-2 infection highlights the need for sustained barrier measures even in fully vaccinated HCWs.

COVID-19 vaccine hesitancy among healthcare workers.

OBJECTIVE: To characterize healthcare workers' (HCWs) intention to receive the COVID-19 vaccine by the beginning of the vaccine campaign in France. METHODS: Data were collected on a self-administered questionnaire through the website of a tertiary care center (February 9-18, 2021). RESULTS: Among 1,965 respondents, 1,436 (73.1%), 453 (23.1%), and 76 (3.9%) declared themselves in favor, hesitant, or against the COVID-19 vaccine: <60% of auxiliary nurses and technicians intended to be vaccinated, as compared to 60-79% of nurses and support staff, and>80% of medical staff. On multivariate analysis, age, occupation, flu vaccine history, and controversy over the AstraZeneca vaccine tolerability were independently associated with COVID-19 vaccine intention. CONCLUSIONS: Patterns of vaccine hesitancy related to the COVID-19 and influenza vaccines are similar among HCWs. Media communication on vaccine side effects have a dramatic effect on vaccine hesitancy. Efforts are requested to inform HCWs about the risk/benefit balance of COVID-19 vaccines.

Effectiveness of mRNA-BNT162b2, mRNA-1273, and ChAdOx1 nCoV-19 vaccines against COVID-19 in healthcare workers: an observational study using surveillance data.

OBJECTIVES: Healthcare workers (HCWs) at increased risk of coronavirus disease 2019 (COVID-19) were among the primary targets for vaccine campaigns. We aimed to estimate the protective efficacy of the first three COVID-19 vaccines available in Western Europe. METHODS: We merged two prospective databases that systematically recorded, in our institution: (a) HCWs positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by RT-PCR on nasopharyngeal samples, and (b) HCWs who received at least one dose of COVID-19 vaccine. We excluded HCWs with SARS-CoV-2 infection during the 6 months prior to the study. HCWs were categorized as non-vaccinated if they received no vaccine and until the first injection +13 days, partially vaccinated from the first injection +14 days to the second injection +13 days, and fully vaccinated thereafter. RESULTS: Of the 8165 HCWs employed in our institution, 360 (4.4%) tested positive for SARS-CoV-2 by RT-PCR during the study period (4th January to 17th May 2021). Incidence was 9.1% (8.2-10.0) in non-vaccinated HCWs, 1.2% (0.7-1.9) after one dose of ChAdOx1 nCoV-19, 1.4% (0.6-2.3) and 0.5% (0.1-1.0) after one and two doses of mRNA BNT162b2, 0.7% (0.1-1.9) and 0% after one and two doses of mRNA-1273 (p < 0.0001). Vaccine effectiveness (Cox model) was estimated at, respectively, 86.2% (76.5-91.0), 38.2% (6.3-59.2), and 49.2% (19.1-68.1) 14 days after the first dose for ChAdOx1 nCoV-19, mRNA-1273, and mRNA-BNT162b2, and 100% (ND) and 94.6% (61.0-99.2) 14 days after the second dose for mRNA-1273 and mRNA-BNT162b2. CONCLUSIONS: In this real-world study, the observed effectiveness of COVID-19 vaccines in HCWs was in line with the efficacy reported in pivotal randomized trials.

A lateral flow immunoassay test performance in SARS-CoV-2 seroprevalence surveys: a validation study among healthcare workers.

The objective of this study was to evaluate the validity and reliability of NG-Test® when used as a finger-prick test on healthcare workers and to compare it to the ELISA Wantai Immunoassay. Fifty-one healthcare workers who were RT-PCR SARS-CoV-2 positive and 59 who were RT-PCR SARS-CoV-2 negative accepted to participate in this study. They were subjected to an NG-Test® finger-prick test and collection of a blood sample on the same day. A second NG-Test® on another finger was performed for the first 30 cases and controls and read blinded to the first. Sera obtained from blood samples were used to perform the Wantai SARS-CoV-2 ELISA. The interobserver agreement for the NG-Test® test was perfect (kappa coefficient = 100% [98%-100%]). The sensitivity of NG-Test® was estimated to be 85% [71.9%-92.3%] and the specificity 98.3% [95.0%-100.0%]) for both IgG and IgM. The percentage of agreement between the Wantai immunoassay and NG-Test® was 92.73% for IgG (Kappa = 0.85 [0.75-0.95]) and 65.45% (Kappa = 0.42 [0.26-0.58]) for IgM. Our study highlights the need to validate rapid immunoassay tests under real-life conditions. If NG-Test® is used in seroprevalence surveys, we recommend that its diagnostic performance be taken into consideration to obtain a reliable estimation.