Sars-Cov-2 Breakthrough Infection and its Covariates Among Healthcare Providers of a Hospital in Bangladesh During the Omicron the Wave

Introduction: Breakthrough infection by SARS-COV-2 virus among vaccinated individuals have been reported from all over the world and it has created substantial challenge in designing strategies to live with the virus in the post-pandemic era. Factors affecting the extent and nature of breakthrough infection are still not fully understood and those are known to vary depending on host and agent factors. Health Care Providers (HCPs), specially in hospital settings, are front-liners in combating the epidemic and, consequently, they are more vulnerable to breakthrough infection by SARS-COV-2. Like most of the countries of the world, Bangladesh went through several waves of COVID-19 and the last (3rd wave) was the widespread Omicron wave during the winter of 2022. HCPs in Bangladesh have been disproportionately affected by the virus. Under this context, the present study was undertaken to explore breakthrough infection and its host-related covariates pandemic among HCPs of a COVID dedicated city-based hospital during the Omicron wave in Bangladesh.Materials and Methods: An observational cross-sectional study was conducted on 267 HCPs of the Narayanganj Tertiary (300-bed) hospital during February-March 2022 which coincided with the terminal part of the 3rd wave. Data were collected by trained Field Assistants using Interviewer-administered Data Collection Forms cum Questionnaires (DCFQ) as instruments. Previous COVID-19 status (any time after the onset of the pandemic and within last 3 months) was explored by the history of specific symptoms as well as by the confirmatory RT-PCR test reports from DGHS approved laboratories Anti-nucleocapsid antibody (ANC-Ab) in venous blood samples, assayed by a chemiluminescent ELISA technique, was used as a seroprevalence-based marker of breakthrough infection during the preceding few months. Data were analyzed by bivariate as well as multivariate statistics using the IBM-SPSS software.Results: The median age (range) of the HCPs was 38 (21- 65) years; BMI (kg/m2) 25 (15-49); and WHR was 0.91 (0.46-1.32). The male subjects had significantly higher median age (p=0.01) and higher WHR (p=0.001) as compared to the female subjects. As per BMI category, subjects with overweight and obesity constituted 83.3% of the male subjects as compared to 61.6% of the female subjects (p= 0.001). The time lapse between receiving of 3rd dose and blood sampling was significantly higher among females compared to males (median days 60 vs 49, p<0.02) indicating earlier vaccination with 1st booster dose among females. A proportion of 51.85% male and 49.68% female subjects showed Anti-N-Ab positivity; there was no significant difference between the gender groups. Also, there was no significant difference among male and female subjects regarding the Ab levels. On Spearman correlation analysis, a tendency of association of WHR with Ab level (p=0.09) was observed among the male subjects. On binary logistic regression Ab positivity was found to be independently associated with WHR (p=0.03), and prior SARS-COV-2 infection within last 3 months (p=0.01) among males. When all the subjects were considered together, COVID symptom positivity during last 3-months (p=0.067) and receiving the 1st booster dose (p=0.07) showed a tendency of association with Ab positivity. On multiple regression analysis, Ab levels showed a negative association with WHR (p=0.035) among males.Conclusions: More than 50% of the vaccinated hospital-based Health Care Providers (HCP