Abstract
(1) Background: Health workers (HWs) are at high risk of acquiring SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infections. Therefore, health authorities further recommend screening strategies for SARS-CoV-2 infection in exposed or high-risk HWs. Nevertheless, to date, the best/optimal method to screen HWs for SARS-CoV-2 infection is still under debate, and data on the prevalence of SARS-CoV-2 infection in HWs are still scarce. The present study aims to assess the SARS-CoV-2 infection rate amongst HWs in a teaching hospital in Central Italy and the diagnostic performance of SARS-CoV-2 serology (index test) in comparison with the SARS-CoV-2 RNA PCR assay (reference standard). (2) Methods: A cross-sectional study on the retrospective data of HWs tested for SARS-CoV-2 by RNA-RT-PCR on nasopharyngeal swabs and by an IgM/IgG serology assay on venous blood samples, irrespective of exposure and/or symptoms, was carried out. (3) Results: A total of 2057 HWs (median age 46, 19–69 years, females 60.2%) were assessed by the RNA RT-PCR assay and 58 (2.7%) tested positive for SARS-CoV-2 infection. Compared with negative HWs, SARS-CoV-2-positives were younger (mean age 41.7 versus 45.2, p < 0.01; 50% versus 31% under or equal to 40 years old, p < 0.002) and had a shorter duration of employment (64 versus 125 months, p = 0.02). Exposure to SARS-CoV-2 was more frequent in positive HWs than in negatives (55.2% versus 27.5%, p < 0.0001). In 44.8% of positive HWs, no exposure was traced. None of the positive HWs had a fatal outcome, none of them had acute respiratory distress syndrome, and only one required hospitalization for mild/moderate pneumonia. In 1084 (51.2%) HWs, nasopharyngeal swabs and an IgM/IgG serology assay were performed. With regard to IgM serology, sensitivity was 0% at a specificity of 98.99% (positive predictive value, PPV 0%, negative predictive value, NPV 99.2%). Concerning IgG serology and irrespective of the time interval between nasopharyngeal swab and serology, sensitivity was 50% at a specificity of 99.1% (PPV 28.6%, NPV 99.6%). IgG serology showed a higher diagnostic performance when performed at least two weeks after testing SARS-CoV-2-positive at the RNA RT-PCR assay by a nasopharyngeal swab. (4) Conclusions: Our experience in Central Italy demonstrated a low prevalence of SARS-CoV-2 infection amongst HWs, but higher than in the general population. Nearly half of the positive HWs reported no previous exposure to SARS-CoV-2-infected subjects and were diagnosed thanks to the proactive screening strategy implemented. IgG serology seems useful when performed at least two weeks after an RNA RT-PCR assay. IgM serology does not seem to be a useful test for the diagnosis of active SARS-CoV-2 infection. High awareness of SARS-CoV-2 infection is mandatory for all people, but especially for HWs, irrespective of symptoms, to safeguard their health and that of patients.
Highlights
Since December 2019, the entire world is still fighting against an infection caused by a novel coronavirus, designated as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2).The epidemic started in China and has spread rapidly worldwide, becoming a pandemic [1].Before the 2009 influenza A(H1N1) pandemic, most European Union (EU) Member States, including Italy, had already developed preparedness plans including planning assumptions on what can be expected during a pandemic and on how a pandemic virus might behave [2], considering the infective risk related to the global movements of the population [3]
(4) Conclusions: Our experience in Central Italy demonstrated a low prevalence of SARS-CoV-2 infection amongst Health workers (HWs), but higher than in the general population
Half of the positive HWs reported no previous exposure to SARS-CoV-2-infected subjects and were diagnosed thanks to the proactive screening strategy implemented
Summary
Since December 2019, the entire world is still fighting against an infection caused by a novel coronavirus, designated as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2).The epidemic started in China and has spread rapidly worldwide, becoming a pandemic [1].Before the 2009 influenza A(H1N1) pandemic, most European Union (EU) Member States, including Italy, had already developed preparedness plans including planning assumptions on what can be expected during a pandemic and on how a pandemic virus might behave [2], considering the infective risk related to the global movements of the population [3]. Since December 2019, the entire world is still fighting against an infection caused by a novel coronavirus, designated as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). Since the first outbreak of SARS-CoV-2 disease (CoViD-19) at the end of February 2020 in Northern Italy, the epidemic gradually spread across the Country [4]. From a clinical point of view, the CoViD-19 syndrome is characterized by fever, dry cough, shortness of breath, and in severe cases, by acute respiratory distress syndrome, sepsis, septic shock, and multi-organ failure [5]. SARS-CoV-2 is highly contagious and its main route of human-to-human transmission occurs through direct contact or air droplets with a higher risk of transmission within one meter from the infected person [6]. A possible fecal–oral transmission has been described, and feces of SARS-CoV-2-positive patients are potentially infectious [7]
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