TY - JOUR
T1 - Differentiation of Individuals Previously Infected with and Vaccinated for SARS-CoV-2 in an Inner-City Emergency Department
AU - Beck, Evan J.
AU - Hsieh, Yu Hsiang
AU - Fernandez, Reinaldo E.
AU - Dashler, Gaby
AU - Egbert, Emily R.
AU - Truelove, Shawn A.
AU - Garliss, Caroline
AU - Wang, Richard
AU - Bloch, Evan M.
AU - Shrestha, Ruchee
AU - Blankson, Joel
AU - Cox, Andrea L.
AU - Manabe, Yukari C.
AU - Kickler, Thomas
AU - Rothman, Richard E.
AU - Redd, Andrew D.
AU - Tobian, Aaron A.R.
AU - Milstone, Aaron M.
AU - Quinn, Thomas C.
AU - Laeyendecker, Oliver
N1 - Funding Information:
We acknowledge the staff and patients at the Johns Hopkins Hospital for making this research possible. We thank Morgan Keruly, Ethan Klock, and Olivia Ajayi for technical assistance. We also acknowledge the generosity of the collective community of donors to the Johns Hopkins University School of Medicine and the Johns Hopkins Health System for COVID research. This work was supported by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH). Other support was provided by extramural support from NIAID (R01AI120938, R01AI120938S1, and R01AI128779 to A.A.R.T.; K01AI100681 to Y.-H.H.; UM1-AI068613 for supporting R.E.F.); the NIH Center of Excellence in Influenza Research and Surveillance (HHSN272201400007C to R.E.R.); and the National Heart Lung and Blood Institute (K23HL151826 to E.M.B.).
Funding Information:
This work was supported by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH). Other support was provided by extramural support from NIAID (R01AI120938, R01AI120938S1, and R01AI128779 to A.A.R.T.; K01AI100681 to Y.-H.H.; UM1-AI068613 for supporting R.E.F.); the NIH Center of Excellence in Influenza Research and Surveillance (HHSN272201400007C to R.E.R.); and the National Heart Lung and Blood Institute (K23HL151826 to E.M.B.).
Publisher Copyright:
© 2022 American Society for Microbiology. All rights reserved.
PY - 2022/3
Y1 - 2022/3
N2 - Emergency departments (EDs) can serve as surveillance sites for infectious diseases. The objective of this study was to determine the burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to monitor the prevalence of vaccination against coronavirus disease 2019 (COVID-19) among patients attending an urban ED in Baltimore City. Using 1,914 samples of known exposure status, we developed an algorithm to differentiate previously infected, vaccinated, and unexposed individuals using a combination of antibody assays. We applied this testing algorithm to 4,360 samples from ED patients obtained in the spring of 2020 and 2021. Using multinomial logistic regression, we determined factors associated with infection and vaccination. For the algorithm, sensitivity and specificity for identifying vaccinated individuals were 100% and 99%, respectively, and 84% and 100% for previously infected individuals. Among the ED subjects, seroprevalence to SARS-CoV-2 increased from 2% to 24% between April 2020 and March 2021. Vaccination prevalence rose to 11% by mid-March 2021. Marked differences in burden of disease and vaccination coverage were seen by sex, race, and ethnicity. Hispanic patients, though accounting for 7% of the study population, had the highest relative burden of disease (17% of total infections) but with similar vaccination rates. Women and white individuals were more likely to be vaccinated than men or Black individuals. Individuals previously infected with SARS-CoV-2 can often be differentiated from vaccinated individuals using a serologic testing algorithm. The utility of this algorithm can aid in monitoring SARS-CoV-2 exposure and vaccination uptake frequencies and can potentially reflect gender, race, and ethnic health disparities.
AB - Emergency departments (EDs) can serve as surveillance sites for infectious diseases. The objective of this study was to determine the burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to monitor the prevalence of vaccination against coronavirus disease 2019 (COVID-19) among patients attending an urban ED in Baltimore City. Using 1,914 samples of known exposure status, we developed an algorithm to differentiate previously infected, vaccinated, and unexposed individuals using a combination of antibody assays. We applied this testing algorithm to 4,360 samples from ED patients obtained in the spring of 2020 and 2021. Using multinomial logistic regression, we determined factors associated with infection and vaccination. For the algorithm, sensitivity and specificity for identifying vaccinated individuals were 100% and 99%, respectively, and 84% and 100% for previously infected individuals. Among the ED subjects, seroprevalence to SARS-CoV-2 increased from 2% to 24% between April 2020 and March 2021. Vaccination prevalence rose to 11% by mid-March 2021. Marked differences in burden of disease and vaccination coverage were seen by sex, race, and ethnicity. Hispanic patients, though accounting for 7% of the study population, had the highest relative burden of disease (17% of total infections) but with similar vaccination rates. Women and white individuals were more likely to be vaccinated than men or Black individuals. Individuals previously infected with SARS-CoV-2 can often be differentiated from vaccinated individuals using a serologic testing algorithm. The utility of this algorithm can aid in monitoring SARS-CoV-2 exposure and vaccination uptake frequencies and can potentially reflect gender, race, and ethnic health disparities.
KW - COVID-19 vaccination prevalence
KW - emergency department
KW - factors associated with SARS-CoV-2 infection
KW - seroprevalence of SARS-CoV-2 antibody
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U2 - 10.1128/jcm.02390-21
DO - 10.1128/jcm.02390-21
M3 - Article
C2 - 35044204
AN - SCOPUS:85127728934
SN - 0095-1137
VL - 60
JO - Journal of Clinical Microbiology
JF - Journal of Clinical Microbiology
IS - 3
M1 - e02390-21
ER -