lancet-header

Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.

Do Antibody Positive Healthcare Workers Have Lower SARS-CoV-2 Infection Rates than Antibody Negative Healthcare Workers? Large Multi-Centre Prospective Cohort Study (The SIREN Study), England: June to November 2020

28 Pages Posted: 2 Feb 2021

See all articles by Victoria Jane Hall

Victoria Jane Hall

Public Health England Colindale; University of Oxford - NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance

Sarah Foulkes

Public Health England Colindale

Andre Charlett

Public Health England Colindale

Ana Atti

Public Health England Colindale

Edward JM Monk

Public Health England Colindale

Ruth Simmons

Public Health England Colindale

Edgar Wellington

Public Health England Colindale

Michelle Cole

Public Health England Colindale

Ayoub Saei

Public Health England Colindale

Blanche Oguti

Public Health England Colindale

Katie Munro

Public Health England Colindale

S. Wallace

Public Health England Colindale

Peter D. Kirwan

Public Health England Colindale

Madhumita Shrotri

Public Health England Colindale; University College London - Institute for Health Informatics

Amoolya Vusirikala

Public Health England Colindale

Sakib Rokadiya

Public Health England Colindale

Meaghan Kall

Public Health England Colindale

Maria Zambon

Public Health England - Virus Reference Department

Mary E. Ramsay

Public Health England - Immunisation, Hepatitis, and Blood Safety Department

T. Brooks

Public Health England Colindale

SIREN Study Group

Independent

Colin Brown

Public Health England Colindale

Meera A. Chand

Public Health England Colindale

Susan Hopkins

University of Oxford - NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance; Public Health England Colindale

More...

Abstract

Background: There is an urgent need to better understand whether individuals who have recovered from COVID-19 are protected from future SARS-CoV-2 infection.

Methods: A large multi-centre prospective cohort was recruited from publicly funded hospital staff in the UK. Participants attended regular SARS-CoV-2 PCR and antibody testing (every 2-4 weeks) and completed fortnightly questionnaires on symptoms and exposures. At enrolment, participants were assigned to either the positive cohort (antibody positive or prior PCR/antibody test positive) or negative cohort (antibody negative, not previously known to be PCR/antibody positive). Potential reinfections were clinically reviewed and classified according to case definitions (confirmed, probable, possible (subdivided by symptom-status)) depending on hierarchy of evidence. Individuals in the primary infection were excluded from this analysis if infection was confirmed by antibody only. Reinfection rates in the positive cohort were compared against new PCR positives in the negative cohort using a mixed effective multivariable logistic regression analysis.

Findings: Between 18 June and 09 November 2020, 44 reinfections (2 probable, 42 possible) were detected in the baseline positive cohort of 6,614 participants, collectively contributing 1,339,078 days of follow-up. This compares with 318 new PCR positive infections and 94 antibody seroconversions in the negative cohort of 14,173 participants, contributing 1,868,646 days of follow-up. The incidence density per 100,000 person days between June and November 2020 was 3.2 reinfections in the positive cohort, compared with 22.4 new PCR confirmed infections in the negative cohort. The adjusted odds ratio was 0.17 for all reinfections (95% CI 0.13-0.24) compared to PCR confirmed primary infections. The median interval between primary infection and reinfection was over 160 days.

Interpretation: A prior history of SARS-CoV-2 infection was associated with an 83% lower risk of infection, with median protective effect observed five months following primary infection. This is the minimum likely effect as seroconversions were not included.

Trial Registration: Trial registered with ISRCTN, Trial ID: ISRCTN11041050. https://www.isrctn.com/ISRCTN11041050.

Funding Statement: Department of Health and Social Care and Public Health England, with contributions from the Scottish, Welsh and Northern Irish governments.

Declaration of Interests: No conflicts of interest declared.

Ethics Approval Statement: IRAS ID 284460, Berkshire Research Ethics Committee, Health Research Authority and Health and Care Research Wales approval granted 22 May 2020.

Suggested Citation

Hall, Victoria Jane and Foulkes, Sarah and Charlett, Andre and Atti, Ana and Monk, Edward JM and Simmons, Ruth and Wellington, Edgar and Cole, Michelle and Saei, Ayoub and Oguti, Blanche and Munro, Katie and Wallace, S. and Kirwan, Peter D. and Shrotri, Madhumita and Vusirikala, Amoolya and Rokadiya, Sakib and Kall, Meaghan and Zambon, Maria and Ramsay, Mary E. and Brooks, T. and Group, SIREN Study and Brown, Colin and Chand, Meera A. and Hopkins, Susan, Do Antibody Positive Healthcare Workers Have Lower SARS-CoV-2 Infection Rates than Antibody Negative Healthcare Workers? Large Multi-Centre Prospective Cohort Study (The SIREN Study), England: June to November 2020. Available at SSRN: https://ssrn.com/abstract=3768524 or http://dx.doi.org/10.2139/ssrn.3768524

Victoria Jane Hall (Contact Author)

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

University of Oxford - NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance

Oxford
United Kingdom

Sarah Foulkes

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Andre Charlett

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Ana Atti

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Edward JM Monk

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Ruth Simmons

Public Health England Colindale

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Edgar Wellington

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Michelle Cole

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Ayoub Saei

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Blanche Oguti

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Katie Munro

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

S. Wallace

Public Health England Colindale

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Peter D. Kirwan

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Madhumita Shrotri

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

University College London - Institute for Health Informatics ( email )

Gower Street
London, WC1E 6BT
United Kingdom

Amoolya Vusirikala

Public Health England Colindale

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Sakib Rokadiya

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Meaghan Kall

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Maria Zambon

Public Health England - Virus Reference Department ( email )

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

Mary E. Ramsay

Public Health England - Immunisation, Hepatitis, and Blood Safety Department ( email )

United Kingdom

T. Brooks

Public Health England Colindale

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

SIREN Study Group

Independent

Colin Brown

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Meera A. Chand

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Susan Hopkins

University of Oxford - NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance ( email )

Oxford
United Kingdom

Public Health England Colindale ( email )

61 Colindale Avenue
London, NW9 5EQ
United Kingdom

Click here to go to TheLancet.com

Paper statistics

Abstract Views
1,177
Downloads
138
PlumX Metrics