The seroprevalence of SARS-CoV-2 antibodies among health care workers before the era of vaccination: a systematic review and meta-analysis

Abstract

Background: The prevalence of SARS-CoV-2 infection among health care workers (HCWs) provides information about the spread of COVID-19 within health care facilities, and the risk groups.

Objectives: We aimed to describe the rate of SARS-CoV-2 seroprevalence and its determinants among HCWs.

Data sources: We used Web of Science, PubMed, Scopus, MEDLINE, EBSCOhost and Cochrane Library.

Study eligibility criteria: We included the reports of SARS-CoV-2 seroprevalence with a sample size of minimum 1000 HCWs.

Methods: The study was registered at the International Prospective Register of Systematic Reviews (PROSPERO, no. CRD42021230456). We used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The keywords were "COVID-19", "SARS-CoV-2", "Coronavirus", "seroprevalence", "health care workers" and "risk factors".

Results: In total 4329 reports were retrieved, duplications were removed; after filtering according to the title and abstract, 25 studies were selected. Risk of bias was assessed in 25 studies; it was low in 13 studies, medium in four studies, and high in eight studies. In meta-analysis using the random effect model, the weighted average of seroprevalence was calculated as 8% (95% CI 6-10%). The pooled seroprevalence rates of the selected variables that have a rate above the average were male HCWs with 9% (95% CI 7-11%); HCWs from ethnic minorities with 13% (95% CI 9-17%); high exposure 9% (95% CI 6-13%); exposure to the virus outside the health care setting 22% (95% CI 14-32%).

Conclusions: Our analysis indicates a SARS-CoV-2 seroprevalence rate of 8% among studies that included >1000 HCWs for the year 2020, before vaccinations started. The most common risk factors associated with higher seroprevalence rate were ethnicity, male gender and having a higher number of household contacts. Working as a frontline HCW was inconsistent in its association with higher seroprevalence.

Keywords: Before vaccination; Covid-19; Healthcare workers; Risk factors; Seroprevalence.

Fig. 1

Flowchart for selection of the study reports.

Fig. 2

(A) The rates of SARS CoV-2 seropositivity among HCWs by antibody test among 25 studies. (B) The rates of SARS CoV-2 seropositivity among HCWs by antibody test after quality assessment among 13 studies.

Fig. 3

(A) Forest plot of the severe acute respiratory syndrome coronavirus-2 seroprevalence rate among HCWs in 25 studies (see Fig. 2A). (B) Forest plot of the severe acute respiratory syndrome coronavirus-2 seroprevalence rate among HCWs after quality assessment, in 13 studies (see Fig. 2B).

Fig. 4

Pooled analysis of SARS-CoV-2 seroprevalence rates among health care workers according to selected variables.