Prevalence of SARS-CoV-2 antibodies in pediatric healthcare workers

Abstract

Objectives: To determine SARS-CoV-2-antibody prevalence in pediatric healthcare workers (pHCWs).

Design: Baseline prevalence of anti-SARS-CoV-2-IgG was assessed in a prospective cohort study from a large pediatric healthcare facility. Prior SARS-CoV-2 testing history, potential risk factors and anxiety level about COVID-19 were determined. Prevalence difference between emergency department (ED)-based and non-ED-pHCWs was modeled controlling for those covariates. Chi-square test-for-trend was used to examine prevalence by month of enrollment.

Results: Most of 642 pHCWs enrolled were 31-40years, female and had no comorbidities. Half had children in their home, 49% had traveled, 42% reported an illness since January, 31% had a known COVID-19 exposure, and 8% had SARS-CoV-2 PCR testing. High COVID-19 pandemic anxiety was reported by 71%. Anti-SARS-CoV-2-IgG prevalence was 4.1%; 8.4% among ED versus 2.0% among non-ED pHCWs (p < 0.001). ED-work location and known COVID-19 exposure were independent risk factors. 31% of antibody-positive pHCWs reported no symptoms. Prevalence significantly (p < 0.001) increased from 3.0% in April-June to 12.7% in July-August.

Conclusions: Anti-SARS-CoV-2-IgG prevalence was low in pHCWs but increased rapidly over time. Both working in the ED and exposure to a COVID-19-positive contact were associated with antibody-seropositivity. Ongoing universal PPE utilization is essential. These data may guide vaccination policies to protect front-line workers.

Keywords: Anti-SARS-CoV-2-IgG Antibodies; COVID-19; Emergency Department; Personal Protective Equipment (PPE); SARS-CoV-2; healthcare workers.

Figure 1

Anti-SARS-CoV-2-IgG endpoint titers in 26 seropositive pediatric healthcare workers enrolled in a prospective cohort study, Atlanta, Georgia, April–August 2020. A total of 642 participants enrolled. Seroprevalence is 4.1%, with 26 pediatric healthcare workers (HCWs) testing positive for anti-SARS-CoV-2 IgG antibodies. Endpoint titers <200 are considered negative (n=616).

Figure 2

(A) Percent anti-SARS-CoV-2-IgG seropositive by month for A. 642 Children’s Healthcare of Atlanta pediatric healthcare workers enrolled in a prospective cohort study in Atlanta, Georgia and B. COVID-19 infections reported by month in Georgia, April–August 2020, and (B) Trend in 7-day average daily COVID-19 diagnoses in Georgia from April–August 2020 (Data source: Centers for Disease Control and Prevention, COVID-19 Response. COVID-19 Case Surveillance Public Data Access, Summary, and Limitations; version date: January 31, 2021) In 2A, the filled black circles represent emergency department (ED)-based pediatric healthcare workers (pHCWs) while non-ED based pHCWs are represented by opened black circles, and red filled circles represent the overall % seropositive enrolled each month. Numbers beneath each month represent the number of pHCWs enrolled that month. IgG positivity in this cohort is driven primarily by the pediatric ED-based HCWs. The first case of COVID-19 reported in Georgia was diagnosed on March 2, 2020. A Georgia statewide shelter-in-place order took effect on April 3, which was lifted May 1, 2020 for some businesses and restaurants, and lifted for medically fragile Georgians and those over 65 years old on June 12, 2020. Enforcement of the shelter-in-place order was limited, and there was no federal mask mandate in Georgia during the time of this study. Public social distancing practices liberalized over the summer, associated with a spike in community cases in July-August 2020 in Georgia. A universal PPE policy was implemented within the pediatric EDs at Children’s Healthcare of Atlanta that included use of surgical masks and goggles for all patient-facing activities on March 21, 2020, with N95 masks utilized for traumas, resuscitations and intubations.