SARS-CoV-2 Antibody Prevalence among Industrial Livestock Operation Workers and Nearby Community Residents, North Carolina, 2021 to 2022

Abstract

Industrial livestock operations (ILOs), particularly processing facilities, emerged as centers of coronavirus disease 2019 (COVID-19) outbreaks in spring 2020. Confirmed cases of COVID-19 underestimate true prevalence. To investigate the prevalence of antibodies against SARS-CoV-2, we enrolled 279 participants in North Carolina from February 2021 to July 2022: 90 from households with at least one ILO worker (ILO), 97 from high-ILO intensity areas (ILO neighbors [ILON]), and 92 from metropolitan areas (metro). More metro (55.4%) compared to ILO (51.6%) and ILON participants (48.4%) completed the COVID-19 primary vaccination series; the median completion date was more than 4 months later for ILO compared to ILON and metro participants, although neither difference was statistically significant. Participants provided a saliva swab we analyzed for SARS-CoV-2 IgG using a multiplex immunoassay. The prevalence of infection-induced IgG (positive for nucleocapsid and receptor binding domain) was higher among ILO (63%) than ILON (42.9%) and metro (48.7%) participants (prevalence ratio [PR], 1.38; 95% confidence interval [CI], 1.06 to 1.80; reference category ILON and metro combined). The prevalence of infection-induced IgG was also higher among ILO participants than among an Atlanta health care worker cohort (PR, 2.45; 95% CI, 1.80 to 3.33) and a general population cohort in North Carolina (PRs, 6.37 to 10.67). The infection-induced IgG prevalence increased over the study period. Participants reporting not masking in public in the past 2 weeks had higher infection-induced IgG prevalence (78.6%) than participants reporting masking (49.3%) (PR, 1.59; 95% CI, 1.19 to 2.13). Lower education, more people per bedroom, Hispanic/Latino ethnicity, and more contact with people outside the home were also associated with higher infection-induced IgG prevalence. IMPORTANCE Few studies have measured COVID-19 seroprevalence in North Carolina, especially among rural, Black, and Hispanic/Latino communities that have been heavily affected. Antibody results show high rates of COVID-19 among industrial livestock operation workers and their household members. Antibody results add to evidence of health disparities related to COVID-19 by socioeconomic status and ethnicity. Associations between masking and physical distancing with antibody results also add to evidence of the effectiveness of these prevention strategies. Delays in the timing of receipt of COVID-19 vaccination reinforce the importance of dismantling vaccination barriers, especially for industrial livestock operation workers and their household members.

Keywords: COVID-19; SARS-CoV-2; health disparities; industrial livestock operations; seroprevalence.

FIG 1

COVID-19 vaccination over time by study group^a, North Carolina, 2021 to 2022. Origin is the date of the first FDA emergency use authorization for a vaccine against COVID-19 (Pfizer-BioNTech), 11 December 2020, and the dotted line is the date on which the CDC expanded eligibility for a booster shot to all adults, 29 November 2021 (54). ILO, study participants living in a household with at least one adult working at an industrial hog or poultry operation, meatpacking plant, or animal rendering plant; ILON, participants living near these facilities without any known occupational exposure to livestock; metro, participants living in metropolitan areas.

FIG 2

SARS-CoV-2 infection-induced IgG prevalence ratios (PRs) among North Carolina ILO household group participants (measured April 2021 to July 2022) compared to other southern United States reference populations. ILO, study participants living in a household with at least one adult working at an industrial hog or poultry operation, meatpacking plant, or animal rendering plant; ILON, participants living near these facilities without any known occupational exposure to livestock; metro, participants living in metropolitan areas; C3PI, the MURDOCK Cabarrus County COVID-19 Prevalence and Immunity (C3PI) Study cohort, representative of the general population of Cabarrus County, North Carolina; COPE, the COVID-19 Prevention in Emory Healthcare Personnel (COPE) Study cohort.