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Using serological data to understand unobserved SARS-CoV-2 risk in health-care settings
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Using serological data to understand unobserved SARS-CoV-2 risk in health-care settings
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Journal Article
Using serological data to understand unobserved SARS-CoV-2 risk in health-care settings
2020
Overview
During past outbreaks of severe acute respiratory syndrome and Middle East respiratory syndrome, many infections occurred within health-care settings.1 Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), growing evidence of nosocomial transmission has been observed, but tracking such outbreaks is challenging because a substantial proportion of infected individuals might exhibit mild or no symptoms.2 In The Lancet Infectious Diseases, Kasper Iversen and colleagues3 report results from a large seroprevalence survey of almost 30 000 hospital employees in Denmark.3 The authors found that 1163 (4·04%) of 28 792 staff were seropositive overall, which was slightly higher than the 3·04% (142 of 4672) prevalence observed among local blood donors (risk ratio [RR] 1·33 [95% CI 1·12–1·58]). Staff working in dedicated COVID-19 wards showed substantially higher rates of seropositivity (1·65 [1·34–2·03]; p<0·001) than other frontline health-care workers working in hospitals, reflecting increased risk for this group, a pattern that has also been reported in neighbouring Sweden.4 Although Iversen and colleagues used a point-of-care lateral flow immunoassay, which is generally considered less conclusive than enzyme-linked immunosorbent assays or similar laboratory-based methods,5 the authors did a comprehensive pre-study test assessment and estimated a sensitivity of 82·5–90·6% and specificity of 99·2–99·5%. Important questions remain about the precise role of humoral and cellular immunity following SARS-CoV-2 exposure, and whether seropositivity or antibody titres can be considered a proxy measure of protective immunity.8 If the seroprevalence estimated in the Danish hospital staff does indeed reflect the extent of immunity that would prevent infection, this would be substantially below the level required to generate localised herd immunity that could stop future nosocomial transmission.
Publisher
Elsevier Ltd,Elsevier Limited
Subject
