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不同抗体状态医护人员的SARS-CoV-2感染率

Incidence of SARS-CoV-2 Infection in Health Care Workers by Antibody Status

2021年2月11日

朗读者：Dr. Stephen Morrissey, NEJM执行主编

SARS-CoV-2感染可诱导产生免疫应答；但既往感染者可在多大程度上免于二次感染尚不确定。了解感染后的免疫力是否存在以及持续多长时间对于我们抗击SARS-CoV-2大流行具有重要意义。短视频中总结了新的研究发现。

NEJM医学前沿不同抗体状态医护人员的SARS-CoV-2感染率小程序

医护人员的SARS-CoV-2抗体状态和感染率

Antibody Status and Incidence of SARS-CoV-2 Infection in Health Care Workers

摘 要

背景

SARS-CoV-2抗体阳性与之后的再次感染风险之间的关系尚不明确。

Background

The relationship between the presence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the risk of subsequent reinfection remains unclear.

方法

此项研究在参与英国牛津大学医院无症状和有症状工作人员检测的血清反应阳性的和血清反应阴性医护人员中评估了通过聚合酶链反应（PCR）确诊的SARS-CoV-2感染率。基线抗体状态通过抗刺突蛋白（主要分析）和抗核壳IgG检测法确定；本研究对医护人员进行了长达31周随访。针对年龄、参与者报告的性别和随时间推移的发生率变化进行校正后，我们估算了不同抗体状态下，PCR阳性检测结果和新发有症状感染的相对发生率。

Methods

We investigated the incidence of SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) in seropositive and seronegative health care workers attending testing of asymptomatic and symptomatic staff at Oxford University Hospitals in the United Kingdom. Baseline antibody status was determined by anti-spike (primary analysis) and anti-nucleocapsid IgG assays, and staff members were followed for up to 31 weeks. We estimated the relative incidence of PCR-positive test results and new symptomatic infection according to antibody status, adjusting for age, participant-reported gender, and changes in incidence over time.

结果

共计12,541名医护人员参与研究并接受了抗刺突蛋白IgG测定；11,364名在抗体结果呈阳性后接受了随访，1265名在抗体结果呈阳性后接受了随访，包括在随访期间血清转阳的88人。223名抗刺突蛋白血清反应阴性的医护人员的PCR检测结果呈阳性（1.09例/10,000风险日），100名是在筛查期间无症状的情况下发现，123名是在有症状的情况下发现；2名抗刺突蛋白血清反应阳性的医护人员的PCR检测结果呈阳性（0.13例/10,000风险日），而且这两名医护人员在检测时均无症状（校正后的发生率比，0.11；95%置信区间，0.03~0.44；P=0.002）。抗刺突蛋白抗体阳性的医护人员均未发生有症状的感染。不论是单独使用抗核壳IgG检测法确定基线状态，还是结合使用抗核壳IgG检测法与抗刺突蛋白IgG检测法确定基线状态，我们获得的发生率比均相似。

Result

A total of 12,541 health care workers participated and had anti-spike IgG measured; 11,364 were followed up after negative antibody results and 1265 after positive results, including 88 in whom seroconversion occurred during follow-up. A total of 223 anti-spike–seronegative health care workers had a positive PCR test (1.09 per 10,000 days at risk), 100 during screening while they were asymptomatic and 123 while symptomatic, whereas 2 anti-spike–seropositive health care workers had a positive PCR test (0.13 per 10,000 days at risk), and both workers were asymptomatic when tested (adjusted incidence rate ratio, 0.11; 95% confidence interval, 0.03 to 0.44; P=0.002). There were no symptomatic infections in workers with anti-spike antibodies. Rate ratios were similar when the anti-nucleocapsid IgG assay was used alone or in combination with the anti-spike IgG assay to determine baseline status.

结论

抗刺突蛋白或抗核壳IgG抗体阳性与之后6个月期间SARS-CoV-2的再次感染风险显著降低相关。（由英国保健及社会服务署[U.K. Government Department of Health and Social Care]等资助。）

Conclusions

The presence of anti-spike or anti-nucleocapsid IgG antibodies was associated with a substantially reduced risk of SARS-CoV-2 reinfection in the ensuing 6 months. (Funded by the U.K. Government Department of Health and Social Care and others.)

Sheila F. Lumley, Denise O’Donnell, Nicole E. Stoesser, et al. Antibody Status and Incidence of SARS-CoV-2 Infection in Health Care Workers. DOI: 10.1056/NEJMoa2034545