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Prevalence of Sars-Cov-2 Infection in Health Workers (HWs) and Diagnostic Test Performance: The Experience of a Teaching Hospital in Central Italy

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  • Edith Lahner

    (Department of Medical Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy
    Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy)

  • Emanuele Dilaghi

    (Department of Medical Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy
    Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy)

  • Claudio Prestigiacomo

    (Department of Medical Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy
    Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy)

  • Giuliano Alessio

    (Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy)

  • Laura Marcellini

    (Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy)

  • Maurizio Simmaco

    (Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy
    Department of Neurosciences, Mental Health, and Sensory Organs, “Sapienza” University of Rome, via di Grottarossa 1035-1039, 00189 Rome, Italy)

  • Iolanda Santino

    (Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy
    Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, via di Grottarossa 1035-1039, 00189 Rome, Italy)

  • Giovanni Battista Orsi

    (Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy
    Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy)

  • Paolo Anibaldi

    (Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy)

  • Adriano Marcolongo

    (Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy)

  • Bruno Annibale

    (Department of Medical Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy
    Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy)

  • Christian Napoli

    (Department of Medical Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy
    Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy)

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.

Suggested Citation

  • Edith Lahner & Emanuele Dilaghi & Claudio Prestigiacomo & Giuliano Alessio & Laura Marcellini & Maurizio Simmaco & Iolanda Santino & Giovanni Battista Orsi & Paolo Anibaldi & Adriano Marcolongo & Brun, 2020. "Prevalence of Sars-Cov-2 Infection in Health Workers (HWs) and Diagnostic Test Performance: The Experience of a Teaching Hospital in Central Italy," IJERPH, MDPI, vol. 17(12), pages 1-12, June.
  • Handle: RePEc:gam:jijerp:v:17:y:2020:i:12:p:4417-:d:373817
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    1. Christian Napoli & Flavia Riccardo & Silvia Declich & Maria Grazia Dente & Maria Grazia Pompa & Caterina Rizzo & Maria Cristina Rota & Antonino Bella & The National Working Group, 2014. "An Early Warning System Based on Syndromic Surveillance to Detect Potential Health Emergencies among Migrants: Results of a Two-Year Experience in Italy," IJERPH, MDPI, vol. 11(8), pages 1-13, August.
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    2. Kenan Rodríguez de Limia Ramírez & Nicolás Ruiz-Robledillo & José Luis Duro-Torrijos & Vicente García-Román & Natalia Albaladejo-Blázquez & Rosario Ferrer-Cascales, 2021. "Prevalence of SARS-CoV-2 Infection in a Sample of Health Workers in Two Health Departments of the Valencian Community in Spain," IJERPH, MDPI, vol. 19(1), pages 1-13, December.
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