Antibody Seroprevalence and Rate of Asymptomatic Infections With SARS-CoV-2&nbsp;in Austrian Hospital Personnel
Authors: Leister Iris , Ponocny-Seliger Elisabeth , Kollaritsch Herwig , Dungel Peter , Holzer Barbara , Grillari Johannes , Redl Heinz , Ponocny Ivo , Wilfing Claudia , Aigner Ludwig , Exner Markus , Stainer Michaela , Hackl Matthias , Hausner Thomas , Mittermayr Rainer , Schaden Wolfgang 
Published: April 2021

Abstract
Context: On March 11, the World Health Organization (WHO) announced the current corona virus disease 2019 (COVID-19) outbreak as a pandemic. The first laboratory-confirmed case of COVID-19 in Austria was announced on February 27, 2020. Since then, the incidence of infection followed an exponential increase until a complete lockdown in March 2020. Thereafter easing of restrictions was gradually introduced and until mid-August daily infections remained mostly below 5 per 100.000 population. Objectives: The aims of this study are to determine i) how many employees in Austrian trauma hospitals and rehabilitation facilities have virus specific IgG and IgM, and/or neutralizing antibodies against SARS-CoV-2, ii) how many are active virus carriers (symptomatic and asymptomatic) during the study, iii) the antibody decline in seropositive subjects over a period of around six months, and iv) the utility of rapid antibody tests for outpatient screening.Study Design: Open uncontrolled observational cross-sectional study.Setting/Participants: A total of 3301 employees in 11 Austrian trauma hospitals and rehabilitation facilities of the Austrian Social Insurance for Occupational Risks (AUVA) participated in the study.Study Interventions and Measures: Rapid antibody tests for SARS-CoV-2 specific IgG and IgM antibodies, and RT-PCR tests based on oropharyngeal swab samples, as well as laboratory-based antibody tests using ELISA/PRNT were performed. The tests were conducted twice, with an interval of 42.4±7.7 (Min=30, Max=64) days. Additionally, participants filled out a questionnaire including questions related to personal health, traveling activities, living situation, as well as inquiries of symptoms and comorbidities. Antibody positive tested participants were re-tested with ELISA/PRNT tests at a third time point on average 188.0±12.8 days after their initial test.Results: In our study cohort, only 27 out of 3301 participants (0.81%) had a positive antibody test at any time point during the study confirmed via neutralization test. Among participants who had positive test results in either of the antibody tests, 50.4% did not report any symptoms consistent with common manifestations of COVID-19 during the study period or within the preceding six weeks. In the group who tested positive during or prior to study inclusion the most common symptoms of an acute viral illness were rhinitis (21.9%), and loss of taste and olfactory sense (21.9%).The rapid antibody test was generally more sensitive based on serum (sensitivity=86.6%) as compared to whole blood (sensitivity=65.4). Concerning both ELISA tests overall the Roche test detected 24 (sensitivity=88.9%) and the Diasorin test 22 positive participants (sensitivity=81.5%).In participants with a positive PRNT, a significant decrease in PRNT concentration from 31.8±22.9 (Md=32.0) at T1 to 26.1±17.6 (Md=21.3) at T2 to 21.4±13.4 (Md=16.0) at T3 (c2=23.848, df=2, p<0.001) was observed (c2=23.848, df=2, p<0.001) – with an average time of 42.4±7.7 days between T1 and T2 and 146.9±13.8 days between T2 and T3. Conclusions: During the study period (May 11th – December 21th) only 0.81% were tested positive for antibodies in our study cohort. The antibody concentration decreases significantly over time with 14.8% (4 out of 27) losing detectable antibodies.