zurniimtpeМедицина труда и промышленная экологияRussian Journal of Occupational Health and Industrial Ecology1026-94282618-8945FSBSI “Izmerov Research Institute of Occupational Health”10.31089/1026-9428-2021-61-5-286-304zurniimtpe-2728Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESФормирование коллективного иммунитета и риск COVID-19 у медицинских работниковImmune response to SARS-CoV-2 and the risk of COVID-19 among different groups of healthcare workershttps://orcid.org/0000-0001-9506-563XФатхутдиноваЛилия МинвагизовнаFatkhutdinovaLiliya M.

Зав. кафедрой гигиены, медицины труда ФГОУ ВО «Казанский государственный медицинский университет» Минздрава РФ, д-р мед. наук, профессор.

e-mail: liliya.fatkhutdinova@gmail.com

Head of the Department of Hygiene and Occupational Medicine, Kazan State Medical University, Dr. of Sci. (Med.)., professor.

e-mail: liliya.fatkhutdinova@gmail.com

liliya.fatkhutdinova@gmail.comhttps://orcid.org/0000-0003-0088-6422БадамшинаГ. Г.BadamshinaGulnara G.noemail@neicon.ruhttps://orcid.org/0000-0002-6302-3993СизоваЕ. П.SizovaElena P.noemail@neicon.ruhttps://orcid.org/0000-0002-8642-5194ПатяшинаМ. А.PatyashinaMarina A.noemail@neicon.ruhttps://orcid.org/0000-0001-5987-5328СтавропольскаяЛ. В.StavropolskayaLidiya V.noemail@neicon.ruhttps://orcid.org/0000-0003-2616-5017ГабидиноваГ. Ф.GabidinovaGulnaz F.noemail@neicon.ruhttps://orcid.org/0000-0003-2062-0058ЗаляловР. Р.ZalyalovRamil R.noemail@neicon.ruФГБОУ ВО «Казанский государственный медицинский университет» Минздрава РФРоссияKazan State Medical UniversityRussian FederationФГБОУ ВО «Казанский государственный медицинский университет» Минздрава РФ; ФБУЗ «Центр гигиены и эпидемиологии в Республике Татарстан»РоссияKazan State Medical University; Center of Hygiene and Epidemiology in the Republic of TatarstanRussian FederationФБУЗ «Центр гигиены и эпидемиологии в Республике Татарстан»РоссияCenter of Hygiene and Epidemiology in the Republic of TatarstanRussian FederationУправление Роспотребнадзора по Республике ТатарстанРоссияDepartment of Rospotrebnadzor for the Republic of TatarstanRussian FederationФГБОУ ВО «Казанский государственный медицинский университет» Минздрава РФ; ГАУЗ «Республиканский медицинский информационно-аналитический центр»РоссияKazan State Medical University; Republican Medical Center for Information and AnalysisRussian Federation202113072021615286304Copyright © Фатхутдинова Л.М., Бадамшина Г.Г., Сизова Е.П., Патяшина М.А., Ставропольская Л.В., Габидинова Г.Ф., Залялов Р.Р., 20212021Фатхутдинова Л.М., Бадамшина Г.Г., Сизова Е.П., Патяшина М.А., Ставропольская Л.В., Габидинова Г.Ф., Залялов Р.Р.Fatkhutdinova L.M., Badamshina G.G., Sizova E.P., Patyashina M.A., Stavropolskaya L.V., Gabidinova G.F., Zalyalov R.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.journal-irioh.ru/jour/article/view/2728Введение

Введение. На сегодняшний день особый интерес вызывают вопросы, касающиеся защиты медицинских работников от заражения COVID-19, включая данные по иммунологической защищенности медицинского персонала.

Цель исследования — изучение серопревалентности по наличию IgG к белку нуклеокапсида вируса SARS-CoV-2 методом иммуноферментного анализа в различных группах медицинских работников с последующей оценкой риска развития COVID-19 в зависимости от иммунного статуса и профессиональной группы.

Материалы и методы

Материалы и методы. Изучение напряжённости иммунитета к COVID-19 проводилось в рамках широкомасштабной программы Роспотребнадзора по оценке популяционного иммунитета к вирусу SARS-CoV-2 у населения Российской Федерации [15] с учётом протокола, рекомендованного ВОЗ, на базе лабораторий ФБУЗ «Центр гигиены и эпидемиологии в Республике Татарстан (Татарстан)». Из выборки исследования, проведённого в Республике Татарстан, были отобраны медицинские работники (301 человек) без новой коронавирусной инфекции в анамнезе и с отсутствием клинической симптоматики данного заболевания в момент забора биоматериала (июнь 2020 г.); отсутствие перенесённой новой коронавирусной инфекции верифицировалось по Единой государственной информационной системе «Электронное здравоохранение Республики Татарстан». В группу сравнения были включены 52 работника, относящихся к инженерно-техническому персоналу и не занятых в лечебных учреждениях, соответствовавших указанным выше критериям включения. В совокупности группа наблюдения (медицинские работники и группа сравнения) включала 12,1% участников популяционного исследования.

Результаты

Результаты. В контрольной группе было выявлено 36,5% серопозитивных на наличие антител IgG к белку нуклеокапсида, среди врачей — 23,7%, медицинских сестёр — 38,9%. У медицинских сестёр по сравнению с врачами серопозитивность обнаруживалась достоверно чаще. Занятость медицинских работников в условиях временных инфекционных госпиталей не повлияла на формирование антител к нуклеокапсиду вируса SARS-CoV-2. Выявлена сравнительно низкая распространённость серопозитивности среди врачей временных инфекционных госпиталей.

Вероятность сероконверсии уменьшалась с возрастом и не зависела от пола и указания в анамнезе на недавний контакт с больными COVID-19.

Анализ дожития до конца исследуемого периода показал, что вероятность остаться здоровыми к концу периода наблюдения была наиболее низкой у врачей из лечебных учреждений, не относящихся к временным инфекционным госпиталям. Риск COVID-19 у серонегативных лиц был повышенным, но без статистической достоверности.

Заключение

Заключение. По данным иммунологических исследований на наличие антител IgG к белку нуклеокапсида вируса SARS-CoV-2 установлено, что распространённость серопревалентности у медицинских сестёр достоверно выше по сравнению с врачами, медицинские сестры лечебных организаций молодого возраста имеют более высокие показатели серопревалентности к белку нуклеокапсида вируса SARS-CoV-2. По данным проспективного наблюдения выявлено что врачи лечебных организаций, не отнесённых к временным инфекционным госпиталям, имеют более высокий риск развития симптоматической формы COVID-19, что может быть связано как с недостаточной эффективностью противоэпидемических мероприятий, так и с особенностями иммунного ответа и подходами, применяемыми для его оценки. В текущей эпидемической ситуации выявление антител IgG к вирусу SARS-CoV-2 может быть использовано для принятия решения о распределении обязанностей среди медицинского персонала.

Introduction

Introduction. To date, issues related to the protection of medical workers from COVID-19 infection, including immunological protection, are of particular interest.

The aim of the study was to explore seroprevalence of the IgG to SARS-CoV-2 N-protein in various groups of medical workers with the following assessment of the risk of COVID-19, depending on the seropositivity and occupational group.

Materials and methods

Materials and methods. The study of the strength of immunity to COVID-19 was carried out within the framework of the large-scale Rospotrebnadzor program to assess population immunity to the SARS-CoV-2 virus in the population of the Russian Federation, considering the protocol recommended by WHO, on the basis of the laboratories of the Center for Hygiene and Epidemiology in the Republic of Tatarstan. From the sample of the study conducted in the Republic of Tatarstan, medical workers (301) were selected without a history of a new coronavirus infection and with no clinical symptoms of this disease at the time of biomaterial sampling (June 2020); the absence of the transferred new coronavirus infection was verified by the Unified State Information System "Electronic Health of the Republic of Tatarstan". The comparison group included 52 employees belonging to the engineering and technical personnel and not employed in medical institutions who met the above inclusion criteria. In the aggregate, the observation group (medical workers and the comparison group) included 12.1% of the participants in the population study.

Results

Results. The rate of seropositivity was 36.5% in the control groups, 23.7% — in doctors, and 38.9% — in nurses. Compared to doctors, seroprevalence was higher in nurses. The employment of medical workers in temporary infectious diseases hospitals did not affect the production of the IgG to SARS-CoV-2 N-protein. A relatively low prevalence of seropositivity among doctors of temporary infectious diseases hospitals was revealed.

The probability of seroconversion decreased with age and did not depend on gender or history of recent contacts with COVID-19 patients.

The survival analysis showed that the probability of remaining healthy by the end of the follow-up was the lowest among doctors from medical and preventive institutions that did not serve as temporary infectious diseases hospitals. The risk of COVID-19 in seronegative individuals was higher, but without statistical significance.

Conclusion

Conclusion. According to the data of immunological studies for the presence of IgG antibodies to the nucleocapsid protein of the SARS-CoV-2 virus, it was found that the prevalence of seroprevalence in nurses is significantly higher than that of doctors, nurses of medical and prophylactic organizations of young age have higher seroprevalence to the nucleocapsid protein of the SARS-CoV-2. According to prospective observation, it was revealed that doctors of medical and prophylactic organizations that are not classified as temporary infectious diseases hospitals have a higher risk of developing a symptomatic form of COVID-19, which may be due to both the insufficient effectiveness of anti-epidemic measures and the peculiarities of the immune response and approaches, used to evaluate it. In the current epidemic situation, the detection of IgG antibodies to the SARS-CoV-2 virus can be used to decide on the distribution of responsibilities among medical personnel.

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The authors declare that there are no conflicts of interest present.