SARS-Cov-2 Seroprevalence among Non-Vaccinated Healthcare Workers İn Saudi Arabia

Authors

  • Abdullah A Alsabaani Family and Community Medicine Department, College of Medicine, King Khalid University, Abha, Saudi Arabia

DOI:

https://doi.org/10.55489/njcm.161120255816

Keywords:

COVID-19, Serosurvey, Unvaccinated, Healthcare Workers

Abstract

Background: This cross-sectional study among healthcare workers (HCWs) in Abha, Saudi Arabia, assessed the prevalence of SARS-CoV-2 antibodies to understand exposure and potential immunity during the COVID-19 pandemic.

Methods: Between January 2021 and February 2021, 489 asymptomatic, unvaccinated HCWs from hospitals and clinics participated. Serological testing for SARS-CoV-2 antibodies was performed using ELISA.

Results: The overall seropositivity rate was 18.6% (95% CI: 15.2–22.0%). Nurses showed the highest adjusted seropositivity at 22.8%, followed by laboratory staff (20.2%) and physicians (14.9%). Multivariate analysis revealed nurses (OR=6.7) and laboratory staff (OR=6.1) had significantly higher odds of seropositivity. No significant differences were found based on age, gender, obesity, contact with COVID-19 patients, or adherence to PPE.

Conclusions: The findings suggest that PPE alone is insufficient to prevent virus transmission. A comprehensive strategy including vaccination, regular testing, symptom monitoring, ongoing training, and institutional support is essential for reducing infection risk and ensuring a safer healthcare environment.

References

Dzinamarira T, Murewanhema G, Mhango M, Iradukunda PG, Chitungo I, Mashora M, et al. COVID-19 prevalence among healthcare workers. A systematic review and meta-analysis. InInt J Environ Res Public Health. 2021 Dec 23;19(1):146. DOI: https://doi.org/10.3390/ijerph19010146 PMid:35010412 PMCid:PMC8750782

Ağalar C, Öztürk Engin D. Protective measures for COVID-19 for healthcare providers and laboratory personnel. Turk J Med Sci. 2020 Apr 21;50(SI-1):578-584. DOI: https://doi.org/10.3906/sag-2004-132 PMid:32299205 PMCid:PMC7195977

Alsofayan YM, Althunayyan SM, Khan AA, Hakawi AM, Assiri AM. Clinical characteristics of COVID-19 in Saudi Arabia: A national retrospective study. J Infect Public Health. 2020 Jul;13(7):920-925. DOI: https://doi.org/10.1016/j.jiph.2020.05.026 PMid:32534945 PMCid:PMC7833063

Kosztin A, Merkely B, Szabó AJ, Blaha B, Varga P, Vásárhelyi B, Vokó Z. Acute SARS-CoV-2 infection and seropositivity among healthcare workers and medical students in summer 2020, Hungary. Int J Occup Med Environ Health. 2022 Apr 11;35(2):209-216. DOI: https://doi.org/10.13075/ijomeh.1896.01804 PMid:34981793 PMCid:PMC10464783

Oran DP, Topol EJ. Prevalence of Asymptomatic SARS-CoV-2 Infection : A Narrative Review. Ann Intern Med. 2020 Sep 1;173(5):362-367. DOI: https://doi.org/10.7326/M20-3012 PMid:32491919 PMCid:PMC7281624

Galán MI, Velasco M, Casas ML, Goyanes MJ, Rodríguez-Caravaca G, Losa-García JE, Noguera C, Castilla V; Working Group Alcorcón COVID-19 investigators; Working Group Alcorcón COVID-19 investigators. Hospital-Wide SARS-CoV-2 seroprevalence in health care workers in a Spanish teaching hospital. Enferm Infecc Microbiol Clin (Engl Ed). 2020 Dec 18;40(6):302–309. DOI: https://doi.org/10.1016/j.eimc.2020.11.015 PMID: 33485676 PMCID: PMC7833995

Centers for Disease Control and Prevention. Interim Guidelines for COVID-19 Antibody Testing (updated Dec. 16, 2022). Available from: https://archive.cdc.gov/www_cdc_gov/coronavirus/2019-ncov/hcp/testing/antibody-tests-guidelines.html [Accessed date 23 Jun 2025]

Vargese SS, Dev SS, Soman AS, Kurian N, Varghese VA, Mathew E. Exposure risk and COVID-19 infection among frontline health-care workers: A single tertiary care centre experience. Clin Epidemiol Glob Health. 2022 Jan-Feb;13:100933. DOI: https://doi.org/10.1016/j.cegh.2021.100933 PMid:34926869 PMCid:PMC8667559

Mallik MU, Mahmud R, Azad S, Moniruzzaman M, Khatun T, Rafiquzzaman M, et al. SARS-CoV-2 Infection and Risk Stratification among Healthcare Workers in the Largest COVID-19 Dedicated Tertiary Care Hospital in Dhaka. Bangladesh J Medicine. 2022; 23(1):5-12. DOI: https://doi.org/10.3329/jom.v23i1.57930

Gouda D, Singh PM, Gouda P, Goudra B. An Overview of Health Care Worker Reported Deaths During the COVID-19 Pandemic. J Am Board Fam Med. 2021 Feb;34(Suppl):S244-S246. DOI: https://doi.org/10.3122/jabfm.2021.S1.200248 PMid:33622846

Nguyen L, Drew D, Graham M, Joshi A, Guo C, Ma W, et al. Coronavirus pandemic epidemiology consortium. risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Health. 2020;5(9):e475-e483. DOI: https://doi.org/10.1016/S2468-2667(20)30164-X PMid:32745512

Al-Herwi E, Baras M, Alhetar K, Farhan MA, Saleh RM, As-Suhbani A, et al. SARS-CoV-2 Antibody Prevalence Across Unvaccinated Health Care Workers During the COVID-19 Pandemic in Yemen: Cross-Sectional Study. JMIR Public Health Surveill. 2025 Aug 29;11:e67296. DOI: https://doi.org/10.2196/67296 PMid:40882614 PMCid:PMC12396825

Sakr CJ, Abou Hassan FF, Fakih L, Bou Hamdan M, Assaf S, Rahme D, et al. Risk Factors for SARS-CoV-2 Among a Cohort of Healthcare Workers in Lebanon. Workplace Health Saf. 2024 Feb;72(2):48-59. DOI: https://doi.org/10.1177/21650799231214234 PMid:38158826

Amer HA, Abdallah HA, Alkheledan HS, Alzarzour SH, Shrahily A, Tamim H, Alqahtani SA, Memish ZA. SARS-CoV-2 antibody prevalence among healthcare workers: A cross-sectional study at a quaternary healthcare center in Saudi Arabia. J Infect Public Health. 2022 Mar;15(3):343-348. DOI: https://doi.org/10.1016/j.jiph.2022.01.018 PMid:35167996 PMCid:PMC8802145

Singhal T, Shah S, Naik R, Kazi A, Thakkar P. Prevalence of COVID-19 antibodies in healthcare workers at the peak of the pandemic in Mumbai, India: A preliminary study. Indian J Med Microbiol. 2020 Jul-Dec;38(3 & 4):461-463. DOI: https://doi.org/10.4103/ijmm.IJMM_20_308 PMid:33154264 PMCid:PMC7709650

Marklund E, Leach S, Nyström K, Lundgren A, Liljeqvist JÅ, Nilsson S, et al. Longitudinal Follow Up of Immune Responses to SARS-CoV-2 in Health Care Workers in Sweden With Several Different Commercial IgG-Assays, Measurement of Neutralizing Antibodies and CD4+ T-Cell Responses. Front Immunol. 2021 Nov 2;12:750448. DOI: https://doi.org/10.3389/fimmu.2021.750448 PMid:34795668 PMCid:PMC8593002

Sempos CT, Tian L. Adjusting Coronavirus Prevalence Estimates for Laboratory Test Kit Error. Am J Epidemiol. 2021 Jan 4;190(1):109-115. DOI: https://doi.org/10.1093/aje/kwaa174 PMid:32803245 PMCid:PMC7454308

Algaissi AA, Alharbi NK, Hassanain M, Hashem AM. Preparedness and response to COVID-19 in Saudi Arabia: Building on MERS experience. J Infect Public Health. 2020; 13(6):834-838. DOI: https://doi.org/10.1016/j.jiph.2020.04.016 PMid:32451260 PMCid:PMC7211706

Alshahrani SM, Dehom S, Almutairi D, Alnasser BS, Alsaif B, Alabdrabalnabi AA, et al. Acceptability of COVID-19 vaccination in Saudi Arabia: A cross-sectional study using a web-based survey. Hum Vaccin Immunother. 2021; 17(10):3338-3347. DOI: https://doi.org/10.1080/21645515.2021.1936869 PMid:34236290 PMCid:PMC8437496

AlFattani A, AlMeharish A, Nasim M, AlQahtani K, AlMudraa S. Ten public health strategies to control the Covid-19 pandemic: The Saudi Experience. IJID Regions. 2021;1:12-19. DOI: https://doi.org/10.1016/j.ijregi.2021.09.003 PMid:35721774 PMCid:PMC8447545

Swaminathan A, Subramanian S. Reflections on designing population surveys for COVID-19 infection and prevalence. GeroScience. 2020 Dec;42(6):1445-1448. DOI: https://doi.org/10.1007/s11357-020-00253-6 Erratum in: Geroscience. 2020 Dec;42(6):1765. DOI: https://doi.org/10.1007/s11357-020-00264-3. PMid:32809094 PMCid:PMC7431744

Nishiura H, Kobayashi T, Miyama T, Suzuki A, Jung SM, Hayashi K, et al. Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19). Int J Infect Dis. 2020 May;94:154-155. DOI: https://doi.org/10.1016/j.ijid.2020.03.020 PMid:32179137 PMCid:PMC7270890

Oygar PD, Büyükçam A, Bal ZŞ, Dalgıç N, Bozdemir ŞE, Karbuz A, et al. SARS-CoV-2 seropositivity among pediatric health care personnel after the first peak of the pandemic: nationwide surveillance in Turkey. Int J Infect Dis. 2021; 113:184-189. DOI: https://doi.org/10.1016/j.ijid.2021.09.054 PMid:34592441 PMCid:PMC8474801

Mizumoto K, Kagaya K, Zarebski A, Chowell G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Eurosurveillance. 2020; 25(10):2000180. DOI: https://doi.org/10.2807/1560-7917.ES.2020.25.10.2000180 PMid:32183930 PMCid:PMC7078829

Jones N, Carver C. Are interventions such as social distancing effective at reducing the risk of asymptomatic healthcare workers transmitting COVID-19 infection to other household members. United Kingdom: Centre for Evidence Based Medicine. 2020. Available at https://www.cebm.net/covid-19/are-interventions-such-as-social-distancing-effective-at-reducing-the-risk-of-asymptomatic-healthcare-workers-transmitting-covid-19-infection-to-other-household-members/ [Last acessed 25 June 2025]

Oran DP, Topol EJ. The proportion of SARS-CoV-2 infections that are asymptomatic: a systematic review. Ann Intern Med. 2021;174(5):655-662. DOI: https://doi.org/10.7326/M20-6976 PMid:33481642 PMCid:PMC7839426

Chirico F, Magnavita N. The Crucial Role of Occupational Health Surveillance for Health-care Workers During the COVID-19 Pandemic. Workplace Health Saf. 2021 Jan;69(1):5-6. DOI: https://doi.org/10.1177/2165079920950161 PMid:32961069

Bouwman M, van Osch F, Crijns F, Trienekens T, Mehagnoul-Schipper J, van den Bergh JP, de Vries J. SARS-CoV-2 seroprevalence in healthcare workers of a teaching hospital in a highly endemic region in the Netherlands after the first wave: a cross-sectional study. BMJ Open. 2021 Oct 18;11(10):e051573. DOI: https://doi.org/10.1136/bmjopen-2021-051573 PMid:34663664 PMCid:PMC8523962

Alharbi NK, Alghnam S, Algaissi A, Albalawi H, Alenazi MW, Albargawi AM, et al. Nationwide seroprevalence of SARS-cov-2 in saudi arabia. J Infect Public Health. 2021; 14(7):832-838. DOI: https://doi.org/10.1016/j.jiph.2021.04.006 PMid:34118732 PMCid:PMC8188888

Prakash O, Solanki B, Sheth J, Makwana G, Kadam M, Vyas S, et al. SARS-CoV2 IgG antibody: Seroprevalence among health care workers. Clin Epidemiol Glob Health. 2021; 11:100766. DOI: https://doi.org/10.1016/j.cegh.2021.100766 PMid:33997477 PMCid:PMC8105124

Sandri MT, Azzolini E, Torri V, Carloni S, Pozzi C, Salvatici M, et al. SARS-CoV-2 serology in 4000 health care and administrative staff across seven sites in Lombardy, Italy. Sci Rep. 2021; 11(1):12312. DOI: https://doi.org/10.1038/s41598-021-91773-4 PMid:34112899 PMCid:PMC8192543

Costa SF, Giavina-Bianchi P, Buss L, Mesquita Peres CH, Rafael MM, Dos Santos LGN, et al. SARS-CoV-2 seroprevalence and risk factors among oligo/asymptomatic healthcare workers (HCW): estimating the impact of community transmission. Clin Infect Dis. 2021 Sep 7;73(5):e1214-e1218. DOI: https://doi.org/10.1093/cid/ciaa1845 PMid:33313659 PMCid:PMC7799298

Shields A, Faustini SE, Perez-Toledo M, Jossi S, Aldera E, Allen JD, et al. SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers: a cross-sectional study. Thorax. 2020; 75:1089-1094. DOI: https://doi.org/10.1136/thoraxjnl-2020-215414 PMid:32917840 PMCid:PMC7462045

Lombardi A, Mangioni D, Consonni D, Cariani L, Bono P, Cantù AP, et al. Seroprevalence of anti-SARS-CoV-2 IgG among healthcare workers of a large university hospital in Milan, Lombardy, Italy: a cross-sectional study. BMJ Open. 2021;11(2):e047216. DOI: https://doi.org/10.1136/bmjopen-2020-047216 PMid:33619203 PMCid:PMC7902322

Olayanju O, Bamidele O, Edem F, Eseile B, Amoo A, Nwaokenye J, et al. SARS-CoV-2 seropositivity in asymptomatic frontline health workers in Ibadan, Nigeria. Am J Trop Med Hyg. 2021;104(1):91-94. DOI: https://doi.org/10.4269/ajtmh.20-1235 PMid:33185181 PMCid:PMC7790104

Grant JJ, Wilmore SMS, McCann NS, Donnelly O, Lai RWL, Kinsella MJ, et al. Seroprevalence of SARS-CoV-2 antibodies in healthcare workers at a London NHS Trust. Infect Control Hosp Epidemiol. 2021 Feb;42(2):212-214. DOI: https://doi.org/10.1017/ice.2020.402 PMid:32746953 PMCid:PMC7438618

Rudberg A-S, Havervall S, Månberg A, Jernbom Falk A, Aguilera K, Ng H, et al. SARS-CoV-2 exposure, symptoms and seroprevalence in healthcare workers in Sweden. Nat Commun. 2020;11(1): 5064. DOI: https://doi.org/10.1038/s41467-020-18848-0 PMid:33033249 PMCid:PMC7544689

Iversen K, Bundgaard H, Hasselbalch RB, Kristensen JH, Nielsen PB, Pries-Heje M, et al. Risk of COVID-19 in health-care workers in Denmark: an observational cohort study. Lancet Infect Dis. 2020 Dec;20(12):1401-1408. DOI: https://doi.org/10.1016/S1473-3099(20)30589-2. PMID: 32758438; PMCID: PMC7398038

Barek MA, Aziz MA, Islam MS. Impact of age, sex, comorbidities and clinical symptoms on the severity of COVID-19 cases: a meta-analysis with 55 studies and 10014 cases. Heliyon. 2020; Dec;6(12):e05684. DOI: https://doi.org/10.1016/j.heliyon.2020.e05684 PMid:33344791 PMCid:PMC7737518

Kahlert CR, Persi R, Güsewell S, Egger T, Leal-Neto OB, Sumer J, et al. Non-occupational and occupational factors associated with specific SARS-CoV-2 antibodies among hospital workers-A multicentre cross-sectional study. Clin Microbiol Infect. 2021;27(9):1336-1344. DOI: https://doi.org/10.1016/j.cmi.2021.05.014 PMid:34020033 PMCid:PMC8131187

Shimamura Y, Komazawa H, Oikawa J, Furuta Y. Hospital-wide antigen screening for coronavirus disease in a tertiary reference center in Sapporo, Japan: A single-center observational study. Medicine. 2021;100(51):e28398. DOI: https://doi.org/10.1097/MD.0000000000028398 PMid:34941176 PMCid:PMC8701976

Hunter BR, Dbeibo L, Weaver CS, Beeler C, Saysana M, Zimmerman MK, et al. Seroprevalence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies among healthcare workers with differing levels of coronavirus disease 2019 (COVID-19) patient exposure. Infect Control Hosp Epidemiol. 2020; 41(12):1441-1442. DOI: https://doi.org/10.1017/ice.2020.390 PMid:32741406 PMCid:PMC7445457

Brousseau N, Morin L, Ouakki M, Savard P, Quach C, Longtin Y, et al. SARS-CoV-2 seroprevalence in health care workers from 10 hospitals in Quebec, Canada: a cross-sectional study. CMAJ. 2021;193(49):E1868-E1877. DOI: https://doi.org/10.1503/cmaj.202783 PMid:34903591 PMCid:PMC8677578

Jacob JT, Baker JM, Fridkin SK, Lopman BA, Steinberg JP, Christenson RH, et al. Risk factors associated with SARS-CoV-2 seropositivity among US health care personnel. JAMA Netw open. 2021;4(3):e211283. DOI: https://doi.org/10.1001/jamanetworkopen.2021.1283 PMid:33688967 PMCid:PMC7948059

Galanis P, Kaitelidou D, Prezerakos P, Kotsiopoulos I, Siskou O, Konstantakopoulou O, et al. Low seropositivity for SARS-CoV-2 antibodies among healthcare workers after the first COVID-19 pandemic wave in Greece. Public Health. 2021;198:223-229. DOI: https://doi.org/10.1016/j.puhe.2021.07.029 PMid:34482100 PMCid:PMC8324404

Sims MD, Maine GN, Childers KL, Podolsky RH, Voss DR, Berkiw-Scenna N, et al. Coronavirus disease 2019 (COVID-19) seropositivity and asymptomatic rates in healthcare workers are associated with job function and masking. Clin Infect Dis. 2021;73(Suppl 2):S154-S162. DOI: https://doi.org/10.1093/cid/ciaa1684 PMid:33150375 PMCid:PMC7665441

Saudi Ministry of Health. Guidance For Providing Dental Services in Governmental and Private Sectors During COVID-19 Pandemic. 2021. Available from: https://www.moh.gov.sa/Ministry/MediaCenter/Publications/Documents/MOH-Guidelines-for-re-opening-June-.pdf. [Last accessed 23 July 2025]

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2025-11-01

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Alsabaani AA. SARS-Cov-2 Seroprevalence among Non-Vaccinated Healthcare Workers İn Saudi Arabia. Natl J Community Med [Internet]. 2025 Nov. 1 [cited 2025 Nov. 1];16(11):1121-30. Available from: https://njcmindia.com/index.php/file/article/view/5816

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