Differential occupational risks to healthcare workers from SARS-CoV-2 observed during a prospective observational study
- University of Oxford, United Kingdom
- Oxford University Hospitals, United Kingdom
- Nuffield Department of Medicine, University of Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, United Kingdom
- Oxford University, United Kingdom
- Target Discovery Institute, University of Oxford, United Kingdom
Abstract
We conducted voluntary Covid-19 testing programmes for symptomatic and asymptomatic staff at a UK teaching hospital using naso-/oro-pharyngeal PCR testing and immunoassays for IgG antibodies. 1128/10,034(11.2%) staff had evidence of Covid-19 at some time. Using questionnaire data provided on potential risk-factors, staff with a confirmed household contact were at greatest risk (adjusted odds ratio [aOR] 4.82 [95%CI 3.45-6.72]). Higher rates of Covid-19 were seen in staff working in Covid-19-facing areas (22.6% vs. 8.6% elsewhere) (aOR 2.47 [1.99-3.08]). Controlling for Covid-19-facing status, risks were heterogenous across the hospital, with higher rates in acute medicine (1.52 [1.07-2.16]) and sporadic outbreaks in areas with few or no Covid-19 patients. Covid-19 intensive care unit staff were relatively protected (0.44 [0.28-0.69]), likely by a bundle of PPE-related measures. Positive results were more likely in Black (1.66 [1.25-2.21]) and Asian (1.51 [1.28-1.77]) staff, independent of role or working location, and in porters and cleaners (2.06 [1.34-3.15]).
Data availability
The data studied are available from the Infections in Oxfordshire Research Database (https://oxfordbrc.nihr.ac.uk/research-themes-overview/antimicrobial-resistance-and-modernising-microbiology/infections-in-oxfordshire-research-database-iord/), subject to an application and research proposal meeting the ethical and governance requirements of the Database. For further details on how to apply for access to the data and for a research proposal template please email iord@ndm.ox.ac.uk.
Article and author information
Author details
Bernadette C Young
Philip George Drennan
Alexander J Mentzer
Funding
UK Government: Department of Health and Social Care
- David W Eyre
- Sheila F Lumley
- Denise O'Donnell
- Mark Campbell
- Elizabeth Sims
- Elaine Lawson
- Fiona Warren
- Tim James
- Stuart Cox
- Alison Howarth
- George Doherty
- Stephanie B Hatch
- James Kavanagh
- Kevin K Chau
- Philip W Fowler
- Jeremy Swann
- Denis Volk
- Fan Yang-Turner
- Nicole Stoesser
- Philippa C Matthews
- Maria Dudareva
- Timothy Davies
- Robert H Shaw
- Leon Peto
- Louise O Downs
- Alexander Vogt
- Ali Amini
- Bernadette C Young
- Philip George Drennan
- Alexander J Mentzer
- Donal T Skelly
- Fredrik Karpe
- Matt J Neville
- Monique Andersson
- Andrew J Brent
- Nicola Jones
- Lucas Martins Ferreira
- Thomas Christott
- Brian D Marsden
- Sarah Hoosdally
- Richard Cornall
- Derrick W Crook
- David I Stuart
- Gavin Screaton
- Timothy EA Peto
- Bruno Holthof
- Anne-Marie O'Donnell
- Daniel Ebner
- Christopher P Conlon
- Katie Jeffery
- Timothy M Walker
Wellcome Trust Clinical Research Training Fellow (216417/Z/19/Z)
- Ali Amini
NIHR Clinical Lecturer
- Bernadette C Young
Structural Genomics Consortium
- Lucas Martins Ferreira
- Thomas Christott
- Brian D Marsden
Kennedy Trust for Rheumatology Research
- Brian D Marsden
Wellcome Trust Senior Investigator
- Gavin Screaton
Schmidt Foundation
- Gavin Screaton
Wellcome Trust Career Development Fellow (214560/Z/18/Z)
- Timothy M Walker
National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance (HPRU-2012-10041)
- David W Eyre
- Sheila F Lumley
- Denise O'Donnell
- Mark Campbell
- Elizabeth Sims
- Elaine Lawson
- Fiona Warren
- Tim James
- Stuart Cox
- Alison Howarth
- George Doherty
- Stephanie B Hatch
- James Kavanagh
- Kevin K Chau
- Philip W Fowler
- Jeremy Swann
- Denis Volk
- Fan Yang-Turner
- Nicole Stoesser
- Philippa C Matthews
- Maria Dudareva
- Timothy Davies
- Robert H Shaw
- Leon Peto
- Louise O Downs
- Alexander Vogt
- Ali Amini
- Bernadette C Young
- Philip George Drennan
- Alexander J Mentzer
- Donal T Skelly
- Fredrik Karpe
- Matt J Neville
- Monique Andersson
- Andrew J Brent
- Nicola Jones
- Lucas Martins Ferreira
- Thomas Christott
- Brian D Marsden
- Sarah Hoosdally
- Richard Cornall
- Derrick W Crook
- David I Stuart
- Gavin Screaton
- Timothy EA Peto
- Bruno Holthof
- Anne-Marie O'Donnell
- Daniel Ebner
- Christopher P Conlon
- Katie Jeffery
- Timothy M Walker
Robertson Foundation
- David W Eyre
NIHR Oxford BRC Senior Fellow
- David W Eyre
- Philippa C Matthews
Wellcome Trust Clinical Research Fellow
- Sheila F Lumley
Medical Research Council (MR/N00065X/1)
- David I Stuart
Wellcome Trust Intermediate Fellowship (110110/Z/15/Z)
- Philippa C Matthews
NIHR Doctoral Research Fellow
- Maria Dudareva
Medical Research Foundation (MRF-145-004-TPG-AVISO)
- Kevin K Chau
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Ethics
Human subjects: All asymptomatic staff data collection and testing were part of enhanced hospital infection prevention and control measures instituted by the UK Department of Health and Social Care (DHSC). Deidentified data from staff testing and patients were obtained from the Infections in Oxfordshire Research Database (IORD) which has generic Research Ethics Committee, Health Research Authority and Confidentiality Advisory Group approvals (19/SC/0403, ECC5-017(A)/2009). De-identified patient data extracted included admission and discharge dates, ward location and positive Covid-19 test results.
Copyright
© 2020, Eyre et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
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Differential occupational risks to healthcare workers from SARS-CoV-2 observed during a prospective observational study
eLife 9:e60675.
https://doi.org/10.7554/eLife.60675
Further reading
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- Epidemiology and Global Health
Background:
Biological aging exhibits heterogeneity across multi-organ systems. However, it remains unclear how is lifestyle associated with overall and organ-specific aging and which factors contribute most in Southwest China.
Methods:
This study involved 8396 participants who completed two surveys from the China Multi-Ethnic Cohort (CMEC) study. The healthy lifestyle index (HLI) was developed using five lifestyle factors: smoking, alcohol, diet, exercise, and sleep. The comprehensive and organ-specific biological ages (BAs) were calculated using the Klemera–Doubal method based on longitudinal clinical laboratory measurements, and validation were conducted to select BA reflecting related diseases. Fixed effects model was used to examine the associations between HLI or its components and the acceleration of validated BAs. We further evaluated the relative contribution of lifestyle components to comprehension and organ systems BAs using quantile G-computation.
Results:
About two-thirds of participants changed HLI scores between surveys. After validation, three organ-specific BAs (the cardiopulmonary, metabolic, and liver BAs) were identified as reflective of specific diseases and included in further analyses with the comprehensive BA. The health alterations in HLI showed a protective association with the acceleration of all BAs, with a mean shift of –0.19 (95% CI −0.34, –0.03) in the comprehensive BA acceleration. Diet and smoking were the major contributors to overall negative associations of five lifestyle factors, with the comprehensive BA and metabolic BA accounting for 24% and 55% respectively.
Conclusions:
Healthy lifestyle changes were inversely related to comprehensive and organ-specific biological aging in Southwest China, with diet and smoking contributing most to comprehensive and metabolic BA separately. Our findings highlight the potential of lifestyle interventions to decelerate aging and identify intervention targets to limit organ-specific aging in less-developed regions.
Funding:
This work was primarily supported by the National Natural Science Foundation of China (Grant No. 82273740) and Sichuan Science and Technology Program (Natural Science Foundation of Sichuan Province, Grant No. 2024NSFSC0552). The CMEC study was funded by the National Key Research and Development Program of China (Grant No. 2017YFC0907305, 2017YFC0907300). The sponsors had no role in the design, analysis, interpretation, or writing of this article.
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- Epidemiology and Global Health
- Microbiology and Infectious Disease
Background:
In many settings, a large fraction of the population has both been vaccinated against and infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Hence, quantifying the protection provided by post-infection vaccination has become critical for policy. We aimed to estimate the protective effect against SARS-CoV-2 reinfection of an additional vaccine dose after an initial Omicron variant infection.
Methods:
We report a retrospective, population-based cohort study performed in Shanghai, China, using electronic databases with information on SARS-CoV-2 infections and vaccination history. We compared reinfection incidence by post-infection vaccination status in individuals initially infected during the April–May 2022 Omicron variant surge in Shanghai and who had been vaccinated before that period. Cox models were fit to estimate adjusted hazard ratios (aHRs).
Results:
275,896 individuals were diagnosed with real-time polymerase chain reaction-confirmed SARS-CoV-2 infection in April–May 2022; 199,312/275,896 were included in analyses on the effect of a post-infection vaccine dose. Post-infection vaccination provided protection against reinfection (aHR 0.82; 95% confidence interval 0.79–0.85). For patients who had received one, two, or three vaccine doses before their first infection, hazard ratios for the post-infection vaccination effect were 0.84 (0.76–0.93), 0.87 (0.83–0.90), and 0.96 (0.74–1.23), respectively. Post-infection vaccination within 30 and 90 days before the second Omicron wave provided different degrees of protection (in aHR): 0.51 (0.44–0.58) and 0.67 (0.61–0.74), respectively. Moreover, for all vaccine types, but to different extents, a post-infection dose given to individuals who were fully vaccinated before first infection was protective.
Conclusions:
In previously vaccinated and infected individuals, an additional vaccine dose provided protection against Omicron variant reinfection. These observations will inform future policy decisions on COVID-19 vaccination in China and other countries.
Funding:
This study was funded the Key Discipline Program of Pudong New Area Health System (PWZxk2022-25), the Development and Application of Intelligent Epidemic Surveillance and AI Analysis System (21002411400), the Shanghai Public Health System Construction (GWVI-11.2-XD08), the Shanghai Health Commission Key Disciplines (GWVI-11.1-02), the Shanghai Health Commission Clinical Research Program (20214Y0020), the Shanghai Natural Science Foundation (22ZR1414600), and the Shanghai Young Health Talents Program (2022YQ076).
