Article Type : Research Article
Authors : Kaya SD and Kizmaz YU
Keywords : COVID-19; Healthcare worker; Vaccine
Introduction: The COVID-19 global pandemic caused by severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in December 2019 in
Wuhan, China and has spread worldwide. Healthcare workers play a key role in
this pandemic to provide ongoing care for large numbers of COVID-19 patients.
Frontline healthcare personnel are 3.4 times more likely to become infected
than the general population. In this study, it was aimed to determine the pre-
and post-vaccine infection rates in healthcare workers of a 3rd level training
and research hospital.
Material and Method: There are a total of 1582 healthcare
workers in our hospital. There are 356 doctors, 689 nurses, 34 technicians, 207
cleaning personnel, 262 medical secretaries and 34 security personnel. In the
diagnosis of acute infection it is recommended to demonstrate the presence of
viral RNA in respiratory tract clinical samples (nasopharyngeal swab, tracheal
aspirate, Broncho alveolar lavage, sputum) by real-time reverse
transcriptase-polymerase chain reaction (rRT-PCR). The treatments were arranged
according to the Covid 19 Guidelines of the Ministry of Health in accordance
with the 2020 update. Covid 19 vaccination statuses were obtained
retrospectively from the employee health data of our hospital.
Results: Between March 1 and September 1 2021, a total of
468 people were infected. Before Covid 19 vaccine came to our country, the
infection of healthcare workers were 52 doctors, 150 nurses, 60 cleaning staff,
26 laboratory technicians, 20 medical secretaries and 9 security guards. After
Covid 19 vaccine of healthcare workers, Covid 19 PCR test of 78 people was
positive. After the dose, 73 people (52 women, 21 men) were positive for Covid
19 PCR for an average of 50.9 days. 1 doctor (7th days after 2 sinovac
vaccine), 1 nurse (7th day after 2nd sinovac vaccine) were admitted to the Covid
service. 42 UK variants detected; 7 physicians (all 2 doses vaccinated)
infected on average 55 days (4 females, 3 males) after 2nd dose vaccination.
South African variant was seen in 5 people. 3 nurses (3 females) were detected
35 days after the 2nd dose of vaccine, and 1 of 2 security personnel (1 female,
1 male) was detected 46 days after the 2nd dose of vaccination.
Conclusion: Healthcare workers are at high risk
of exposure to coronavirus disease-2019 (COVID-19), with priority given to
COVID-19 vaccine during the pandemic.
The virus is
transmitted from person to person by droplet route and close contact, and after
an incubation period of 5.2 days (2-14 days), it is often asymptomatic, but
fever, cough, fatigue, shortness of breath, headache, sore throat, and runny
nose, taste/odor it may progress with non-specific symptoms such as loss of
sensation, diarrhoea, and haemoptysis [1,2]. The COVID-19 vaccine is the most effective
way to control the pandemic and there are different types of vaccines. As of
January 13, 2021, Turkey granted emergency use permission to 'Corona Vac'
produced by the Chinese biopharmaceutical company Sinovac. Corona Vac is a
chemical developed against SARS-CoV-2 It is an inactivated vaccine [3,4].
Corona Vac was the only vaccine available in the country. More than a million
healthcare workers (more than 95% of all healthcare workers) received their
first dose within a week. It started with healthcare workers on January 14,
2021. Vaccination was done with two doses of Corona Vac, 4 weeks apart.
The vaccination
schedule is two doses of 3 mcg 28 days apart. Healthcare professionals had
their second dose of vaccine administered in mid-February 2021 [5]. With the
arrival of Biontech vaccine in our country on June 30, 2021, healthcare workers
continued to be vaccinated (1 vial (0.45 ml) of 6 doses (each dose contains 30
micrograms of BNT162b2 mRNA in lipid nanoparticles). Descriptive statistics
(mean, median, std. deviation, etc.) were used for continuous numerical
variables in the analysis. Categorical variables are expressed as numbers and
percentages in frequency tables. Group distributions of categorical variables
are shown in numbers and percentages using crosstab statistics. The statistical
significance limit was taken as p<0.05. SPSS 21 program was used for
statistical analysis [6-8].
A total of 1582 healthcare workers are in our hospital. There are 356 physicians, 689 nurses, 34 technicians, 207 cleaning staff, 262 medical secretaries, and 34 security personnel. Starting from March 1, 2020 until September 1, 2021, 468 people were infected (Tables 1,2).
Table 1: COVID 19 infection numbers by occupational group of healthcare professionals before Coronavac Vaccine.
|
Total numbers |
Mean ±
Std. deviation |
Length of stay |
24 |
4,88 ±
2,82 |
Leukocyte count (×103 /µl) |
23 |
5615,22 ±
1825,54 |
Hemoglobin (gr/dl) |
23 |
13,70 ±
1,26 |
Cytokine (pg/ml) |
16 |
31,13 ±
26,91 |
Ferritin (ng/ml) |
11 |
203,17 ±
138,50 |
AST (U/L) |
23 |
29,39 ±
13,73 |
ALT (U/L) |
23 |
32,74 ±
26,30 |
Creatinin (mg/dl) |
23 |
1,75 ±
3,92 |
Trombosit (×103
/µl) |
23 |
228,70 ±
57,94 |
Neutrophil count (×103 /µl) |
23 |
64,95 ±
11,32 |
CRP (mg/lt) |
23 |
23,63 ±
31,22 |
D-dimer (µg/lt) |
23 |
0,39 ±
0,31 |
Fibrinogen (mg/dl) |
6 |
436,67 ±
107,88 |
Glucose (mg/dl) |
22 |
111,14 ±
30,33 |
Table 2: Laboratory parameters of unvaccinated personnel.
Occupation |
Total numbers of vaccinated |
SARS-CoV-2 PCR positivity before vaccinated |
n(%) |
||
Physician |
356 |
52 (%14) |
Nurse |
689 |
150 (%22) |
Medical secretary |
262 |
20 (%8) |
Cleaning staff |
207 |
60 (%29) |
Technician |
34 |
26 (%76) |
Security |
34 |
9 (%26) |
TOTAL |
1582 |
317(%20) |
The situation where
healthcare workers were infected with Covid 19 before being vaccinated was as
follows: 52 doctors, 150 nurses, 60 cleaning staff, 26 laboratory technicians,
20 medical secretaries, 9 security guards. The hospitalization to the Covid 19 service
in the hospital: 7 doctors, 8 nurses, 3 technicians, 2 medical secretaries, 3
cleaning staff. Treatments were arranged according to the Covid 19 guidelines
of the Ministry of Health. After the vaccine has reached to country and health
workers started to be vaccinated, due to Covid 19 infection: 1 physician and 1
nurse (7 days after the second dose of Corona vac vaccine) were hospitalized.
After vaccination was completed 78 people found Covid 19 PCR positive, 5 people
after first dose of vaccine (4 females, 1 male) after an average of 78 days.
After second dose, 73 subjects (52 women, 21 men) were Covid 19 PCR positive
for an average of 50.9 days. We detected a total of 42 UK variants in
healthcare workers at our centre; 7 physicians (16%) (All vaccinated with 2
doses) became infected for an average of 55 days (4 females, 3 males) after
receiving the second dose vaccine. 1 resident was admitted to the doctor.
Because of her involvement in computed tomography (CT) and oxygen saturation of
93%, fever and leukopenia. The UK variant was detected in 18 (42%) nurses. 8 of
them had 2 doses vaccine. After an average of 59.2 days (7 females, 1 male), 5
technicians (12%); 2 technicians 2 people (2 females) who received the second
dose of vaccination 34 days later, 3 medical secretaries (% 7); 1 medical
secretary after 2nd dose of vaccination (0 females, 1 male) after an average of
55.6 days, 2 security personnel (5%); 1 security personnel (31 days after 2nd
dose, 7 cleaning personnel (18%) vaccinated; 4 persons ( 1 female 3 males)
British variant infection was seen 70.2 days after the second dose of vaccine.
South African variant was seen in 5 people. It was detected in 3 nurses (60%)
(3women) on average 35 days after the second dose of vaccination, and 46 days after
the second dose vaccination in 1 of 2 security personnel (40%) (1 female, 1
male). Since the beginning of the pandemic, 25 healthcare workers (25%) were
hospitalized. The most common complaint of 23 unvaccinated healthcare workers
who tested positive for COVID-19 was flu-like symptoms such as fever, cough,
headache, chills, sore throat and muscle pain in 11 (48%). tested for disease
symptoms. Two people who were vaccinated were hospitalized. They were found to
be British variants. No intensive care hospitalization or death was observed in
the patients followed in the Covid 19 ward. The treatments were given in
accordance with the current guidelines of the Ministry of Health [5]. In recent
studies rate domestic transmission was found between 11% and 19% [6]. Domestic
contact and traveling with a case with COVID-19 increase the risk of
transmission 6-7 times higher compared to other forms of close contact.
Sometimes, the transmission rate reaches 75% only in domestic contacts. In our
study, the friend contact of the healthcare professionals working without
knowing that they had Covid 19 was reported as 3 people.
Healthcare workers
working in hospitals constitute a high-risk group during the epidemic.
Healthcare workers' risk of infection may increase during an ongoing outbreak
due to a variety of factors, including continued exposure to patients, lack of
personal protective equipment, and inadequate infection control training.
During the 2003 severe acute respiratory syndrome (SARS) epidemic in Hong Kong,
the first major cluster of transmission occurred at the Prince of Wales
Hospital, where healthcare workers accounted for a significant portion of the
infection, with 43.6% of cases admitted to this hospital.8 Protecting
healthcare workers from infection plays a crucial role in controlling
hospital-acquired transmission. In addition, healthcare professionals were a
reliable source of information about vaccines for patients [9]. In our country,
273,000 people had COVID-19 until September 2020, and it was announced that 29
865 of them were healthcare professionals [10-12]. In a phase 3 randomized
controlled study conducted in 12 688 individuals in Brazil, 14 days after 2
doses of vaccination on days 0-14, it was reported that the vaccine's
protection against symptomatic COVID-19 was 51% and protection against
hospitalization was 100% [13]. In Turkey 0-14 in a phase 3 randomized
controlled trial in 13 000 people it has been reported that 14 days after 2
doses of vaccination on days 2, the protection against symptomatic COVID-19 of
the vaccine was 84% and the protection against hospitalization was 100% [14].
Before healthcare workers of our hospital were vaccinated, 317 people (20%) had
covid 19 infection. 5 people (0.3%) after the 1st dose of vaccination, 73
people (4.6%) became infected after second dose. The hospitalization rate was
1.4% (n: 23) in the unvaccinated and 0.1% (n: 2) on the 7th day of the second
dose of vaccine. The UK variant emerged in the UK in September 2020 and was
found to contain multiple mutations. This variant has been noted to spread more
easily and quickly than other variants and has since been detected in many
countries around the world [15]. 42 UK variants were detected in our healthcare
workers; 7 physicians (16%) became infected for an average of 55 days (4
females, 3 males) after receiving the second dose of vaccine. The UK variant
was detected in 18 nurses (42%). 8 people had received 2 doses of vaccine. It
was after 59.2 days on average. (7 females, 1 male), 5 technicians (12%); 2
technicians, 2 persons (2 females) who received the 2nd dose vaccine after 34
days, 3 medical secretaries (7%); 1 medical secretary 2nd dose 1 male after
55.6 days on average, 2 security workers (5%); 1 security worker 31 days after
2nd dose, 7 cleaning staff (18%) vaccinated; 4 subjects (1 female, 3 males)
developed a UK variant infection 70.2 days after second dose of vaccine. The
South African variant arose independently of other variants and was first
identified in early August 2020. It has been reported that it shares some
mutations with the UK variant, and similarly, this variant is more contagious
than the original virus [15]. In our study, the South African variant was
detected in 3 nurses (60%) an average of 35 days after the second dose of vaccine,
and 46 days after the second dose in 1 of 2 security workers (40%). It has been
noted that most of the employees diagnosed with COVID-19 had only mild or
nonspecific symptoms during the clinical trial. Early and non-specific symptoms
are difficult to identify, so healthcare professionals may inadvertently infect
vulnerable patients or other personnel [16].
As a result, COVID 19
remains a threat to the entire world. Vaccination, personal and social measures
will increase the chances of success in the fight against Covid 19. Although it
cannot completely prevent the disease, the prevention of critical illness and
death should be considered a great success for vaccines. Any symptoms of
COVID-19 found among vaccinated healthcare workers should not be considered
vaccine-related events, and these healthcare workers should be considered
suspected COVID-19 cases until COVID-19 infection has been ruled out. In
addition, active and passive surveillance and routine laboratory testing are
necessary to identify COVID-19 among healthcare workers, even if they are
vaccinated, to prevent transmission to other healthcare workers and healthcare
settings. The importance of promoting vaccination among healthcare workers has
been recognized.