{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:18:55Z","timestamp":1759796335300,"version":"build-2065373602"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CDC Interagency Agreements","award":["16FED1612328","16FED1612343","18FED1812054IPD","19FED19112003IPD"],"award-info":[{"award-number":["16FED1612328","16FED1612343","18FED1812054IPD","19FED19112003IPD"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The coronavirus disease 2019 (COVID-19) pandemic placed significant pressure on healthcare workers (HCWs) globally, exposing them to high risks of infection and psychological stress. This study assessed dynamic risks and protective factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among HCWs in Lima, Peru.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted the Peru Healthcare Worker COVID Cohort (PHCWCC), a prospective cohort study during the pre-COVID-19 vaccination period (August 2020\u2013May 2021) and the post-vaccination period (August 2021\u2013May 2022). Data included weekly nasal swabs for SARS-CoV-2 testing, reports on exposures, symptoms, perceived risks, and vaccination status. Incidence and factors associated with SARS-CoV-2 positivity were analyzed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 1369 HCWs, the infection rate increased from 1.15 (95% confidence interval [CI]: .90\u20131.14) to 1.71 (95% CI: 1.41\u20132.05) per 1000 HCW-days between the pre- and post-vaccination phases (P = .01). Despite 97% receiving the primary vaccine series and 75% a booster, perceived high infection risk rose from 26% to 35% (P &amp;lt; .001). Close contact with infected colleagues remained a consistent risk factor (odds ratio [OR] = 2.74, 95% CI: 1.85\u20134.05; P &amp;lt; .001). In the second phase, direct patient contact (OR = 1.92, 95% CI: 1.20\u20133.08; P = .006) and patient care environments (OR = 2.14, 95% CI: 1.35\u20133.40; P = .001) were linked to higher infection risk. Perceived infection risk was inversely associated with positivity (OR = 0.76, 95% CI: 0.63\u20130.91; P = .003).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Evolving infection risks highlight the need for sustained infection prevention, including during non-patient care activities. Fostering risk awareness may reduce infection rates and strengthen healthcare system resilience.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaf343","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T13:01:08Z","timestamp":1753794068000},"page":"467-477","source":"Crossref","is-referenced-by-count":0,"title":["COVID-19 Exposure, Protective Measures, Symptom Assessment, and Risk Perception Among Healthcare Workers in Peru: A Longitudinal Cohort Study (2020\u20132021)"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0871-8167","authenticated-orcid":false,"given":"Diana","family":"Ponce","sequence":"first","affiliation":[{"name":"Vysnova Partners, Inc. , Alexandria, Virginia, USA assigned to Clinical Trials Unit, NAMRU SOUTH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4773-8876","authenticated-orcid":false,"given":"Matthew","family":"Westercamp","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, U.S. Centers for Disease Control and Prevention (CDC) , Atlanta, Georgia ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6850-2638","authenticated-orcid":false,"given":"Giselle","family":"Soto","sequence":"additional","affiliation":[{"name":"Clinical Trials Unit, U.S. Naval Medical Unit Research SOUTH (NAMRU SOUTH) , Lima ,","place":["Peru"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda C","family":"Lessa","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, U.S. Centers for Disease Control and Prevention (CDC) , Atlanta, Georgia ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6726-6124","authenticated-orcid":false,"given":"Perrine","family":"Marcenac","sequence":"additional","affiliation":[{"name":"Influenza Division, U.S. Centers for Disease Control and Prevention (CDC) , Atlanta, Georgia ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Candice","family":"Romero","sequence":"additional","affiliation":[{"name":"Vysnova Partners, Inc. , Alexandria, Virginia, USA assigned to Clinical Trials Unit, NAMRU SOUTH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda","family":"Silva","sequence":"additional","affiliation":[{"name":"Clinical Trials Unit, U.S. Naval Medical Unit Research SOUTH (NAMRU SOUTH) , Lima ,","place":["Peru"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8337-1557","authenticated-orcid":false,"given":"Rachel","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, U.S. Centers for Disease Control and Prevention (CDC) , Atlanta, Georgia ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Garret","family":"Mahon","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, U.S. Centers for Disease Control and Prevention (CDC) , Atlanta, Georgia ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alejandro","family":"Llanos-Cuentas","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Tropical Medicine Department, Cayetano Heredia Hospital , Lima ,","place":["Peru"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3832-1657","authenticated-orcid":false,"given":"Eduardo","family":"Matos","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Arzobispo Loayza National Hospital , Lima ,","place":["Peru"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1214-3434","authenticated-orcid":false,"given":"Michael","family":"Prouty","sequence":"additional","affiliation":[{"name":"Clinical Trials Unit, U.S. Naval Medical Unit Research SOUTH (NAMRU SOUTH) , Lima ,","place":["Peru"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1578-6125","authenticated-orcid":false,"given":"Andres","family":"Espinosa-Bode","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, U.S. Centers for Disease Control and Prevention (CDC) , Atlanta, Georgia ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3708-9750","authenticated-orcid":false,"given":"Joan","family":"Neyra","sequence":"additional","affiliation":[{"name":"Clinical Trials Unit, U.S. Naval Medical Unit Research SOUTH (NAMRU SOUTH) , Lima ,","place":["Peru"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"author":"World Health Organization","key":"2025100602582570700_ciaf343-B1"},{"key":"2025100602582570700_ciaf343-B2","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1016\/S0140-6736(20)30917-X","article-title":"COVID-19: the case for health-care worker screening to prevent hospital transmission","volume":"395","author":"Black","year":"2020","journal-title":"The Lancet"},{"author":"Rodrigues","key":"2025100602582570700_ciaf343-B3"},{"author":"Aquino","key":"2025100602582570700_ciaf343-B4"},{"author":"Johns Hopkins 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