Portal de Periódicos da CAPES

Update Alert 9: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers

2021; American College of Physicians; Volume: 174; Issue: 7 Linguagem: Inglês

10.7326/l21-0302

1539-3704

Roger Chou, Tracy Dana, Shelley Selph, Annette M Totten, David Buckley, Rongwei Fu,

COVID-19 and Mental Health

Letters1 June 2021Update Alert 9: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care WorkersFREERoger Chou, MD, Tracy Dana, MLS, Shelley Selph, MD, MPH, Annette M. Totten, PhD, David I. Buckley, MD, MPH, Rongwei Fu, PhDRoger Chou, MDPacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, OregonSearch for more papers by this author, Tracy Dana, MLSPacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, OregonSearch for more papers by this author, Shelley Selph, MD, MPHPacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, OregonSearch for more papers by this author, Annette M. Totten, PhDPacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, OregonSearch for more papers by this author, David I. Buckley, MD, MPHPacific Northwest Evidence-based Practice Center and School of Public Health, Oregon Health & Science University–Portland State University, Portland, OregonSearch for more papers by this author, Rongwei Fu, PhDPacific Northwest Evidence-based Practice Center and School of Public Health, Oregon Health & Science University–Portland State University, Portland, OregonSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L21-0302 SectionsSupplemental MaterialAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail This is the ninth update alert for a living, rapid review on the epidemiology of and risk factors for coronavirus infection in health care workers (HCWs) (1). Updates were done monthly through update alert 7 (2), at which time the interval was switched to bimonthly. Update searches from 25 February 2021 to 24 April 2021 were done using the same search strategies as the original review. The update searches identified 3518 citations. We applied the same inclusion criteria used for prior updates, with previously described protocol modifications (3) to focus on higher-quality evidence and risk factors for coronavirus infections. Twenty-one studies on risk factors for SARS-CoV-2 infection were added for this update (Supplement Tables 1 to 6) (4–24).The original rapid review included 34 studies on risk factors for coronavirus infections (3 studies on SARS-CoV-2 infection, 29 studies on SARS-CoV-1 infection, and 2 studies on Middle East respiratory syndrome–CoV infection) (1); 84 studies (82 studies on SARS-CoV-2 infection and 2 studies on Middle East respiratory syndrome–CoV infection) were added in prior updates (2, 3, 25–29). For this update, 4 cohort studies (9, 11, 15, 22) and 17 cross-sectional studies (4–8, 10, 12–14, 16–21, 23, 24) were added (Supplement Table 1). Eight studies were done in Europe (2 in the United Kingdom [15, 22]; 2 in France [7, 10]; and 1 each in Belgium [11], Italy [9], Spain [21], and Sweden [20]), and 6 were done in the United States (5, 8, 12, 16, 18, 23). The remaining studies were done in Egypt (17), Pakistan (4), Turkey (6), India (14), Malaysia (24), Thailand (19), and Japan (13). As in prior updates, the studies had methodological limitations, including potential recall bias, low or unclear participation rates, small sample sizes, and potential collinearity. Some studies did not control for confounders; those that did report adjusted estimates were limited in their ability to control for exposures and personal protective equipment (PPE) use.Similar to prior updates, new studies did not indicate an association between sex (16 studies [4–10, 12–17, 19, 21, 24]) and risk for SARS-CoV-2 infection or seropositivity. Twelve new studies (5, 9–11, 13, 14, 16, 18, 21–24) found no consistent association between age and risk for SARS-CoV-2 infection, and 12 new studies (5–8, 10, 13–16, 21, 23, 24) found no consistent association between health worker role (nurse vs. physician) and risk for SARS-CoV-2 infection. Consistent with prior updates, 3 new studies (5, 16, 22) done in the United States or United Kingdom found that Black race compared with White race was associated with a statistically significant increased risk for SARS-CoV-2 infection (adjusted odds ratio, 2.83 [95% CI, 1.77 to 4.51]; 2.1 [CI, 1.8 to 2.4]; and 2.08 [CI, 1.25 to 3.45]), and Hispanic ethnicity compared with White race was associated with an increased risk for SARS-CoV-2 infection (adjusted odds ratio, 1.70 [CI, 1.35 to 2.13]) (5). Results of new studies were generally consistent with prior updates on the association between demographic or clinical characteristics and risk for SARS-CoV-2 infection in HCWs (Supplement Table 2).One new study found that incidence of reinfection in HCWs who were seropositive at baseline was lower than the incidence of new infection in HCWs who were seronegative at baseline (incidence per 1000 participants, 18.7 vs. 98.0 for any infection and 6.0 vs. 64.8 for symptomatic infections) (15). This evidence was consistent with a study included in the previous update (30) that found a decreased risk for new infection in seropositive HCWs (Supplement Table 2).Fifteen new studies that reported on the association between exposures indicated that more direct or more prolonged contact was associated with increased risk, although some findings were mixed or imprecise (5, 6, 8–10, 12–20, 24). In 3 studies that reported adjusted risk estimates, 2 found that working in a COVID-19 unit was associated with increased risk for SARS-CoV-2 infection versus not working in a COVID-19 unit (5, 20), and 1 study found decreased risk for infection (15). Three new studies found that direct contact with a COVID-19–infected coworker or patient was associated with an increased risk for infection versus no or limited contact (5, 16, 20), although differences were not all statistically significant (Supplement Table 3).One new study reported imprecise estimates for the association between training for PPE donning and doffing or implementation of PPE shortage protocols versus no training and risk for infection (Supplement Table 4) (5). Regarding mask and PPE use, 1 new study (15) found that consistent mask use versus inconsistent use was associated with lower risk for SARS-CoV-2 infection (Supplement Table 5), and 1 study (5) reported no significant decrease in risk for infection with exposure to a COVID-19–infected patient while wearing PPE (Supplement Table 6). Overall, results regarding training and PPE were judged to be consistent with prior updates (Supplement Tables 4 to 6).Evidence across all risk factors for SARS-CoV-2 infection in HCWs is summarized in Supplement Table 7. Despite large numbers of studies and participants, most evidence remains low or moderate certainty because of methodological limitations, imprecision, and inconsistency. Given little change in conclusions after 1 year of monthly or bimonthly updates, we are extending the interval between updates to every 6 months.References1. Chou R, Dana T, Buckley DI, et al. Epidemiology of and risk factors for coronavirus infection in health care workers. A living rapid review. Ann Intern Med. 2020;173:120-136. [PMID: 32369541] doi:10.7326/M20-1632 LinkGoogle Scholar2. Chou R, Dana T, Selph S, et al. Update alert 7: epidemiology of and risk factors for coronavirus infection in health care workers. Ann Intern Med. 2021;174:W45-W46. [PMID: 33556273] doi:10.7326/L21-0034 LinkGoogle Scholar3. Chou R, Dana T, Buckley DI, et al. Update alert 2: epidemiology of and risk factors for coronavirus infection in health care workers [Letter]. Ann Intern Med. 2020;173:W77. [PMID: 32663033] doi:10.7326/M20-4806 LinkGoogle Scholar4. Abbas S, Raza A, Iftikhar A, et al. Seroprevalence of SARS-CoV-2 antibodies among health care personnel at a health care system in Pakistan. Asia Pac J Public Health. 2021:10105395211011010. [PMID: 33880961] doi:10.1177/10105395211011010 CrossrefMedlineGoogle Scholar5. Akinbami LJ, Chan PA, Vuong N, et al. Severe acute respiratory syndrome coronavirus 2 seropositivity among healthcare personnel in hospitals and nursing homes, Rhode Island, USA, July-August 2020. Emerg Infect Dis. 2021;27:823-834. [PMID: 33622481] doi:10.3201/eid2703.204508 CrossrefMedlineGoogle Scholar6. Alkurt G, Murt A, Aydin Z, et al. Seroprevalence of coronavirus disease 2019 (COVID-19) among health care workers from three pandemic hospitals of Turkey. PLoS One. 2021;16:e0247865. [PMID: 33657142] doi:10.1371/journal.pone.0247865 CrossrefMedlineGoogle Scholar7. Bayle C, Cantin D, Vidal JS, et al; APHP COVID 19 Research Collaboration. Asymptomatic SARS COV-2 carriers among nursing home staff: a source of contamination for residents. Infect Dis Now. 2021;51:197-200. [PMID: 33521774] doi:10.1016/j.idnow.2020.11.008 CrossrefMedlineGoogle Scholar8. Clifton GT, Pati R, Krammer F, et al. SARS-CoV-2 infection risk among active duty military members deployed to a field hospital—New York City, April 2020. MMWR Morb Mortal Wkly Rep. 2021;70:308-311. [PMID: 33661864] doi:10.15585/mmwr.mm7009a3 CrossrefMedlineGoogle Scholar9. Comelli A, Focà E, Sansone E, et al. Serological response to SARS-CoV-2 in health care workers employed in a large tertiary hospital in Lombardy, northern Italy. Microorganisms. 2021;9. [PMID: 33669151] doi:10.3390/microorganisms9030488 CrossrefMedlineGoogle Scholar10. Davido B, Gautier S, Riom I, et al; Garches COVID-19 Collaborative Group. The first wave of COVID-19 in hospital staff members of a tertiary care hospital in the greater Paris area: a surveillance and risk factors study. Int J Infect Dis. 2021;105:172-179. [PMID: 33607301] doi:10.1016/j.ijid.2021.02.055 CrossrefMedlineGoogle Scholar11. Dillner J, Elfström KM, Blomqvist J, et al. Antibodies to SARS-CoV-2 and risk of past or future sick leave. Sci Rep. 2021;11:5160. [PMID: 33664279] doi:10.1038/s41598-021-84356-w CrossrefMedlineGoogle Scholar12. Fletcher JJ, Feucht EC, Hahn PY, et al. Health care acquired COVID-19 is less symptomatic than community acquired disease among healthcare workers. Infect Control Hosp Epidemiol. 2021:1-28. [PMID: 33853694] doi:10.1017/ice.2021.167 CrossrefMedlineGoogle Scholar13. Fukuda H, Seyama K, Ito K, et al. SARS-CoV-2 seroprevalence in healthcare workers at a frontline hospital in Tokyo. Sci Rep. 2021;11:8380. [PMID: 33863960] doi:10.1038/s41598-021-87688-9 CrossrefMedlineGoogle Scholar14. Gupta R, Dwivedi T, Gajendra S, et al. Seroprevalence of antibodies to SARS-CoV-2 in healthcare workers & implications of infection control practice in India. Indian J Med Res. 2021 Jan & Feb;153:207-213. [PMID: 33642348] doi:10.4103/ijmr.IJMR_3911_20 CrossrefMedlineGoogle Scholar15. Hall VJ, Foulkes S, Charlett A, et al; SIREN Study Group. SARS-CoV-2 infection rates of antibody-positive compared with antibody-negative health-care workers in England: a large, multicentre, prospective cohort study (SIREN). Lancet. 2021;397:1459-1469. [PMID: 33844963] doi:10.1016/S0140-6736(21)00675-9 CrossrefMedlineGoogle Scholar16. Jacob JT, Baker JM, Fridkin SK, et al. Risk factors associated with SARS-CoV-2 seropositivity among US health care personnel. JAMA Netw Open. 2021;4:e211283. [PMID: 33688967] doi:10.1001/jamanetworkopen.2021.1283 CrossrefMedlineGoogle Scholar17. Mukhtar A, Afishawy M, Alkhatib E, et al. Asymptomatic SARS-CoV-2 infection among healthcare workers in a non-COVID-19 teaching university hospital. J Public Health Res. 2021. [PMID: 33794599] doi:10.4081/jphr.2021.2102 CrossrefMedlineGoogle Scholar18. Newberry JA, Gautreau M, Staats K, et al. SARS-CoV-2 IgG seropositivity and acute asymptomatic infection rate among firefighter first responders in an early outbreak county in California. Prehosp Emerg Care. 2021:1-10. [PMID: 33819128] doi:10.1080/10903127.2021.1912227 CrossrefMedlineGoogle Scholar19. Nopsopon T, Pongpirul K, Chotirosniramit K, et al. Seroprevalence of hospital staff in a province with zero COVID-19 cases. PLoS One. 2021;16:e0238088. [PMID: 33793556] doi:10.1371/journal.pone.0238088 CrossrefMedlineGoogle Scholar20. Nygren D, Norén J, De Marinis, et al. Association between SARS-CoV-2 and exposure risks in health care workers and university employees—a cross-sectional study. Infect Dis (Lond). 2021;53:460-468. [PMID: 33689558] doi:10.1080/23744235.2021.1892819 CrossrefMedlineGoogle Scholar21. Rodriguez A, Arrizabalaga-Asenjo M, Fernandez-Baca V, et al. Seroprevalence of SARS-CoV-2 antibody among healthcare workers in a university hospital in Mallorca, Spain, during the first wave of the COVID-19 pandemic. Int J Infect Dis. 2021;105:482-486. [PMID: 33647507] doi:10.1016/j.ijid.2021.02.104 CrossrefMedlineGoogle Scholar22. Shorten RJ, Haslam S, Hurley MA, et al. Seroprevalence of SARS-CoV-2 infection in healthcare workers in a large teaching hospital in the north west of England: a period prevalence survey. BMJ Open. 2021;11:e045384. [PMID: 33727275] doi:10.1136/bmjopen-2020-045384 CrossrefMedlineGoogle Scholar23. Talbot LR, Romeiser JL, Spitzer ED, et al. Prevalence of IgM and IgG antibodies to SARS-CoV-2 in health care workers at a tertiary care New York hospital during the spring COVID-19 surge. Perioper Med (Lond). 2021;10:7. [PMID: 33648573] doi:10.1186/s13741-021-00177-5 CrossrefMedlineGoogle Scholar24. Wan KS, Tok PSK, Yoga Ratnam, et al. Implementation of a COVID-19 surveillance programme for healthcare workers in a teaching hospital in an upper-middle-income country. PLoS One. 2021;16:e0249394. [PMID: 33852588] doi:10.1371/journal.pone.0249394 CrossrefMedlineGoogle Scholar25. Chou R, Dana T, Buckley DI, et al. Update alert: epidemiology of and risk factors for coronavirus infection in health care workers [Letter]. Ann Intern Med. 2020;173:W46-W47. [PMID: 32515983] doi:10.7326/L20-0768 LinkGoogle Scholar26. Chou R, Dana T, Buckley DI, et al. Update alert 3: epidemiology of and risk factors for coronavirus infection in health care workers [Letter]. Ann Intern Med. 2020;173:W123-W124. [PMID: 32744870] doi:10.7326/L20-1005 LinkGoogle Scholar27. Chou R, Dana T, Buckley DI, et al. Update alert 4: epidemiology of and risk factors for coronavirus infection in health care workers [Letter]. Ann Intern Med. 2020;173:143-144. [PMID: 32915642] doi:10.7326/L20-1134 LinkGoogle Scholar28. Chou R, Dana T, Buckley DI, et al. Update alert 5: epidemiology of and risk factors for coronavirus infection in health care workers [Letter]. Ann Intern Med. 2020;173:W154-W55. [PMID: 33076695] doi:10.7326/L20-1227 LinkGoogle Scholar29. Chou R, Dana T, Selph S, et al. Update alert 6: epidemiology of and risk factors for coronavirus infection in health care workers [Letter]. Ann Intern Med. 2021;174:W18-W19. [PMID: 33226856] doi:10.7326/L20-1323 LinkGoogle Scholar30. Chou R, Dana T, Buckley DI, et al. Update alert 8: epidemiology of and risk factors for coronavirus infection in health care workers. Ann Intern Med. 2021;174:W48-W49. [PMID: 33780293] doi:10.7326/L21-0143 LinkGoogle Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Roger Chou, MD; Tracy Dana, MLS; Shelley Selph, MD, MPH; Annette M. Totten, PhD; David I. Buckley, MD, MPH; Rongwei Fu, PhDAffiliations: Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, OregonPacific Northwest Evidence-based Practice Center and School of Public Health, Oregon Health & Science University–Portland State University, Portland, OregonDisclaimer: The original review was funded by the World Health Organization. The World Health Organization staff developed the key questions and scope for the original review but did not have any role in the selection, assessment, or synthesis of evidence for this update.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L21-0302.Corresponding Author: Roger Chou, MD, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code BICC, Portland, OR 97239; e-mail, chour@ohsu.edu.This article was published at Annals.org on 1 June 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEpidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers Roger Chou , Tracy Dana , David I. Buckley , Shelley Selph , Rongwei Fu , and Annette M. Totten Update Alert: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers Roger Chou , Tracy Dana , David I. Buckley , Shelley Selph , Rongwei Fu , and Annette M. Totten Update Alert 2: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers Roger Chou , Tracy Dana , David I. Buckley , Shelley Selph , Rongwei Fu , and Annette M. Totten Update Alert 4: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers Roger Chou , Tracy Dana , David I. Buckley , Shelley Selph , Rongwei Fu , and Annette M. Totten Update Alert 5: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers Roger Chou , Tracy Dana , David I. Buckley , Shelley Selph , Rongwei Fu , and Annette M. Totten Update Alert 6: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers Roger Chou , Tracy Dana , Shelley Selph , Annette M. Totten , David I. Buckley , Rongwei Fu Update Alert 7: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers Roger Chou , Tracy Dana , Shelley Selph , Annette M. Totten , David I. Buckley , Rongwei Fu Update Alert 8: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers Roger Chou , Tracy Dana , David I. Buckley , Shelley Selph , Rongwei Fu , and Annette M. Totten Update Alert 10: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers Roger Chou , Tracy Dana , David I. Buckley , Shelley Selph , Rongwei Fu , Annette M. Totten Update Alert 11: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers Roger Chou , Tracy Dana , David I. Buckley , Shelley Selph , Rongwei Fu , Annette M. Totten Metrics Cited byCoworkers are more likely than patients to transmit SARS-CoV-2 infection to healthcare personnelSevere Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Dose, Infection, and Disease Outcomes for Coronavirus Disease 2019 (COVID-19): A ReviewRisk of Severe Acute Respiratory Syndrome Coronavirus 2 Acquisition Is Associated With Individual Exposure but Not Community-Level TransmissionUpdate Alert 11: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care WorkersRoger Chou, MD, Tracy Dana, MLS, David I. Buckley, MD, MPH, Shelley Selph, MD, MPH, Rongwei Fu, PhD, Annette M. Totten, PhDInfection prevention and control risk factors in health workers infected with SARS-CoV-2 in Jordan: A case control studyNichtinvasive respiratorische Unterstützung und invasive Beatmung bei COVID‑19Update Alert 10: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care WorkersRoger Chou, MD, Tracy Dana, MLS, David I. Buckley, MD, MPH, Shelley Selph, MD, MPH, Rongwei Fu, PhD, Annette M. Totten, PhDSARS-CoV-2 seropositivity among pediatric health care personnel after the first peak of the pandemic: nationwide surveillance in Turkey July 2021Volume 174, Issue 7 Page: W63-W64 Keywords COVID-19 Disclosure Epidemiology Global health Health care providers Medical risk factors Personal protective equipment Racial and ethnic issues Risk management Upper respiratory tract infections ePublished: 1 June 2021 Issue Published: July 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...