• Aya Mostafa, Sahar Kandil, Manal H El-Sayed, Samia Girgis, Hala Hafez, Mostafa Yosef, Saly Saber, Hoda Ezzelarab, Marwa Ramadan, Eman Algohary, Gehan Fahmy, Iman Afifi, Fatmaelzahra Hassan, Shaimaa Elsayed, Amira Reda, Doaa Fattuh, Asmaa Mahmoud, Amany Mansour, Moshira Sabry, Petra Habeb, Fatma Se Ebeid, Ali Elanwar, Ayman Saleh, Ossama Mansour, Ashraf Omar, and Mahmoud El-Meteini.
• Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Electronic address: aya.kamaleldin@med.asu.edu.eg.
• Int. J. Infect. Dis. 2021 Mar 1; 104: 534-542.

BackgroundWe examined Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) seroconversion incidence and risk factors 21 days after baseline screening among healthcare workers (HCWs) in a resource-limited setting.MethodsA prospective cohort study of 4040 HCWs took place at 12 university healthcare facilities in Cairo, Egypt; April-June 2020. Follow-up exposure and clinical data were collected through online survey. SARS-CoV-2 testing was done using rapid IgM and IgG serological tests and reverse transcriptase-polymerase chain reaction (RT-PCR) for those with positive serology. Cox proportional hazards modelling was used to estimate adjusted hazard ratios (HR) of seroconversion.Results3870/4040 (95.8%) HCWs tested negative for IgM, IgG and PCR at baseline; 2282 (59.0%) returned for 21-day follow-up. Seroconversion incidence (positive IgM and/or IgG) was 100/2282 (4.4%, 95% CI:3.6-5.3), majority asymptomatic (64.0%); daily hazard of 0.21% (95% CI:0.17-0.25)/48 746 person-days of follow-up. Seroconversion was: 4.0% (64/1596; 95% CI:3.1-5.1) among asymptomatic; 5.3% (36/686; 95% CI:3.7-7.2) among symptomatic HCWs. Seroconversion was independently associated with older age; lower education; contact with a confirmed case >15 min; chronic kidney disease; pregnancy; change/loss of smell; and negatively associated with workplace contact.ConclusionsMost seroconversions were asymptomatic, emphasizing need for regular universal testing. Seropositivity was three-fold that observed at baseline. Cumulative infections increased nationally by a similar rate, suggesting HCW infections reflect community not nosocomial transmission.Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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