key: cord-0797577-drg22dee
authors: Calvimontes, D. M.; Krisher, L.; Cruz-Aguilar, A.; Pilloni-Alessio, D.; Crisostomo-Cal, L. E.; Castaneda-Sosa, E. A.; Butler-Dawson, J.; Olson, D.; Newman, L. S.; Asturias, E. J.
title: SARS-CoV-2 seroprevalence, vaccination, and hesitancy in agricultural workers in Guatemala
date: 2022-02-24
journal: nan
DOI: 10.1101/2022.02.22.22270907
sha: e11000591b69ff1df85fd56848073f415cb3ccf4
doc_id: 797577
cord_uid: drg22dee

Background: During the COVID-19 pandemic, serological tests to screen populations have provided better estimates of the cumulative incidence of infection. This study evaluated the seroprevalence of SARS-CoV-2 in agricultural workers in rural Guatemala, their COVID-19 vaccine uptake and attitudes and hesitancy to vaccination. Methods: A cross-sectional study was undertaken of from August to November of 2021, in prospective agricultural workers at a sugar plantation in Guatemala. A standardized questionnaire was used to collect demographic, previous COVID-19 infection, vaccination, and attitudes toward vaccination. Serological testing was performed to detect SARS-CoV-2 IgM and IgG. Results: Of 4,343 workers consented and with a viable sample, 1,279 (29.4%) were seropositive for SARS-CoV-2 IgG and/or IgM compared to 2.3% reporting having COVID-19 infection in the past; 85% had received the first dose of the COVID-19 vaccine and 21.9% the second dose at the time of the study. Vaccine refusal was 0.6%, and 13.9% expressed some degree of vaccine hesitancy. Vaccine hesitancy and refusal was inversely associated with uptake of any dose of COVID-19 vaccine and their interest in protecting the family, coworkers, and their community. Conclusion: Agricultural workers in countries like Guatemala, have suffered a high incidence of asymptomatic and undetected SARS-CoV-2 infection. Most have received the COVID-19 vaccine, but there are moderate degrees of vaccine hesitancy that require better public health information to overcome it.

In January 2020, the World Health Organization (WHO) declared COVID-19 a public health emergency of international concern and by May 2020, WHO declared Latin America the epicenter of the COVID-19 pandemic. Latin America has seen some of the highest numbers of cases and deaths from COVID-19 in the world. As of December 31, 2021, more than 102 million confirmed cases of SARS-CoV-2 infection and 2.4 million have been reported in the region. 1 However, these case counts underestimate the true cumulative incidence of infection. Serological tests to screen populations provide better estimates of the cumulative incidence of infection by complementing diagnostic tests for acute infection and helping to inform the public health response to COVID-19. A meta-analysis of seroprevalence studies carried out in various countries around the world showed that by 2020, seroprevalence was low in the general population (median 4.5%, IQR 2.4-8.4%). [2] [3] [4] Most seroprevalence studies have been performed for convenience in urban populations. The objective of this study was to evaluate the seroprevalence of rural agricultural workers in Guatemala, the vaccination coverage against COVID-19, and the level of hesitancy and perception of these workers to vaccination.

This cross-sectional epidemiological study was approved by the National Ethics Committee of the Ministry of Public Health and Social Assistance of Guatemala and considered a priority for public health. Agricultural workers over 18 years of age who applied to work at a sugar cane agro-industrial company from August to November 2021 were recruited. All participants signed an informed consent. Demographic data, underlying health, exposure to . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) 

Participants were categorized as seropositive (IgM and/or IgG positive) or seronegative (IgM and IgG negative). Differences by age, sex, education, report of exposure to COVID-19 and vaccination were explored, estimating prevalence ratios (PR and 95% CI), and comparing means using t-test and categorical variables by chi-square (Stata 14.2, College Park, TX, USA).

A total of 4,498 workers were recruited, of which 4,343 (96.6%) consented to participate and a serological sample for SARS-CoV-2 antibodies was obtained. The demographic characteristics of the workers are shown in Table 1 . The majority were men (99.5%), who . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) reported not yet fully recovered from the disease (persistent fever, joint or muscle pain, anosmia, and persistent cough) and symptoms lasting between three to five weeks. Ninety-seven (2.3%) workers reported close relatives who had suffered from COVID-19; 40.2% of previously infected workers based on seropositive status also had a family member who had COVID-19 symptoms.

Of the 4,343 workers, 85% had received the 1st dose of the COVID-19 vaccine at the time of the study (53% Moderna, 38% Sputnik-V, 9% AstraZeneca), and 21.9% the 2nd dose with the same vaccine antigens. No differences were observed in vaccination coverage according to SARS-CoV-2 seropositivity. A statistically significant but small proportion of SARS-CoV-2 seronegative workers expressed that the COVID-19 vaccine was very safe compared to seropositive workers (83.1 vs 80.3%; p=0.03).

The prevalence of vaccine refusal (not intending to get the vaccine) was 0.6%, and 13.9% of the workers showed some degree of vaccine hesitancy (stated by their intent to delay the decision to vaccinate, get vaccinated only as requirement, or having some insecurity about . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted February 24, 2022. ; https://doi.org/10.1101/2022.02.22.22270907 doi: medRxiv preprint the vaccine). As expected, workers with no hesitancy were more likely to have the first or second dose of vaccine and over 20% of workers that were vaccine hesitant had received one or two doses. (Table 2 ) Among the workers with no hesitancy, protecting family, friends and co-workers were the most common reasons for getting the COVID-19 vaccine.

Among workers who were hesitant, protecting family and friends and returning to work were the most common reasons, and among workers who refused 73% said they were unsure of a reason and 15% said to protect family and friends.

Forty percent of workers reported that they had received some information about vaccines, and 241 (5.6%) that there was not enough information received. As shown in Table 2 , most non-hesitant workers (57.3%) stated that there was enough information regarding the COVID-19 vaccines, compared to 39.1% of those with some hesitancy, and 15.4% of those refusing (p<0.001). Most workers trusted health care providers and the Ministry of Health to provide them with COVID-19 information, followed by their employer. In contrast, vaccine refusers had significantly more trust on their family or friends, or religious leaders to provide them with COVID-19 information. (Figure 1 ) The media (radio or television) were the least trusted source of vaccine information.

This is the first report of SARS-CoV-2 seroprevalence and COVID-19 vaccine decisionmaking in rural agricultural workers in a Latin American country. Guatemala, despite having achieved availability of COVID-19 vaccines, has managed by February 2022 to only vaccinate 41% of its population with 1 dose and 30% with 2 doses, with a large urban/rural disparity. Despite this, in agro-industrial companies, a high level of vaccination . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The prevalence of COVID-19 vaccine refusal in this population was very low, but we were able to detect a moderate level of COVID-19 vaccine hesitancy similar to other studies in Latin America. 10 These attitudes were directly linked to the probability of being vaccinated with 1 or 2 doses of COVID-19 vaccine and to the reasons and intentions for getting vaccinated. Our data also shows how COVID-19 vaccine information and communication impacted vaccine hesitancy, as most non-hesitant workers perceived that they had received enough vaccine information, especially from health care providers, the Ministry of . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted February 24, 2022. ; https://doi.org/10.1101/2022.02.22.22270907 doi: medRxiv preprint Health, or their employer. In contrast, those who expressed some hesitancy or refused to get vaccinated, were more likely to express insufficient vaccine information, and to rely on their family, friends, or religious leaders who may have provided vaccine misinformation.

Other studies in low and middle-income countries have shown that vaccine information is critical to dissipate fears and anxiety that have arose from the development of the COVID-19 vaccine and the misinformation spread thru the media and social platforms. 11, 12 It is important to remark on some limitations of this study. First, the population surveyed does not represent other populations of agricultural and rural workers, and there is a selection bias towards young and healthy men, who were probably vaccinated given the recommendations provided by the employer before applying for a job. Second, this is a cross-sectional study, and most reports were based on self-reporting by workers which may have introduced recall bias. Despite this, the study provides valuable data for agricultural worker populations from middle-income countries that are considered essential for the economy and global food security.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 

Our team would like to thank Pantaleon Foundation nurses and personnel who participated in the data and sample collection. We also will like to thank Juan Carlos Zapata at FUNDESA for his support and donations for this study, and Cesar Conde, MS for his technical advice and support at the National Laboratory of the Ministry of Public Health.

The listed authors certify that they have no affiliation with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted February 24, 2022. ; https://doi.org/10.1101/2022.02.22.22270907 doi: medRxiv preprint

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