Seroprevalence of SARS-CoV-2 antibodies and associated factors in healthcare workers: a systematic review and meta-analysis

J Hosp Infect. 2021 Feb;108:120-134. doi: 10.1016/j.jhin.2020.11.008. Epub 2020 Nov 16.


Background: Healthcare workers (HCWs) represent a high-risk population for infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

Aim: To determine the seroprevalence of SARS-CoV-2 antibodies among HCWs, and identify the factors associated with this seroprevalence.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were applied for this systematic review and meta-analysis. Databases including PubMed/MEDLINE and preprint services (medRχiv and bioRχiv) were searched from inception to 24th August 2020.

Findings: Forty-nine studies including 127,480 HCWs met the inclusion criteria. The estimated overall seroprevalence of SARS-CoV-2 antibodies among HCWs was 8.7% (95% confidence interval 6.7-10.9%). Seroprevalence was higher in studies conducted in North America (12.7%) compared with those conducted in Europe (8.5%), Africa (8.2) and Asia (4%). Meta-regression showed that increased sensitivity of antibody tests was associated with increased seroprevalence. The following factors were associated with seropositivity: male gender; Black, Asian and Hispanic HCWs; work in a coronavirus disease 2019 (COVID-19) unit; patient-related work; front-line HCWs; healthcare assistants; shortage of personal protective equipment; self-reported belief of previous SARS-CoV-2 infection; previous positive polymerase chain reaction test; and household contact with suspected or confirmed cases of COVID-19.

Conclusion: The seroprevalence of SARS-CoV-2 antibodies among HCWs is high. Excellent adherence to infection prevention and control measures; sufficient and adequate personal protective equipment; and early recognition, identification and isolation of HCWs infected with SARS-CoV-2 are imperative to decrease the risk of SARS-CoV-2 infection.

Keywords: Antibodies; COVID-19; Healthcare workers; SARS-CoV-2; Seroprevalence.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Africa / epidemiology
  • Antibodies, Viral / blood
  • Asia / epidemiology
  • COVID-19 / diagnosis
  • COVID-19 / epidemiology
  • COVID-19 / immunology*
  • COVID-19 / virology
  • COVID-19 Serological Testing / methods
  • Europe / epidemiology
  • Female
  • Guideline Adherence / standards
  • Health Personnel / statistics & numerical data*
  • Humans
  • Infectious Disease Transmission, Patient-to-Professional / prevention & control*
  • Male
  • Middle Aged
  • North America / epidemiology
  • Personal Protective Equipment / supply & distribution
  • Risk Factors
  • SARS-CoV-2 / genetics
  • SARS-CoV-2 / immunology*
  • Self Report
  • Sensitivity and Specificity
  • Seroepidemiologic Studies


  • Antibodies, Viral