{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T18:11:00Z","timestamp":1778523060867,"version":"3.51.4"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["GH002235"],"award-info":[{"award-number":["GH002235"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Tourism is central to Belize\u2019s economy, yet the influx of international travelers may contribute to infectious disease introduction and transmission among local workers, including SARS-CoV-2. In June 2022, we conducted a cross-sectional seroepidemiologic study among tourism and government workers in the tropical island tourism center of Ambergris Caye, Belize. The goal of this study was to determine SARS-CoV-2 antibody prevalence for both vaccination (anti-spike protein) and natural infection (anti-nucleocapsid protein), vaccine uptake, history of COVID-like symptoms, and risks for infection two years into the pandemic. Workers from 30 hotels and government agencies were enrolled. Participants completed questionnaires to capture demographics, medical history, COVID-19 exposures, and vaccination history. Serum samples were tested for SARS-CoV-2 anti-spike IgG (indicative of vaccination and\/or infection) and anti-nucleocapsid IgG (infection only). Of 551 participants, 428 (78%) were tourism workers and 123 (22%) government employees. COVID-19 vaccine uptake was high (98%), and anti-spike IgG seroprevalence was 99%; only three vaccinated participants were seronegative. Anti-nucleocapsid prevalence was 81%, indicating a high prevalence of past natural infection. Based on multivariable analysis, nucleocapsid positivity was independently associated with having \u22655 people in household (aOR=2.08, p\u2009=\u20090.018), while receiving a COVID-19 booster was protective (aOR=0.57, p\u2009=\u20090.013). Among 282 participants reporting previous COVID-19 or COVID-19-like illness, 46% sought medical care and eight were hospitalized. High seroprevalence of both vaccine- and infection-induced antibodies was observed, highlighting the emergence of hybrid immunity among frontline workers. These findings underscore the importance of continued surveillance and targeted public health interventions in tourism-dependent settings.<\/jats:p>","DOI":"10.1371\/journal.pgph.0006204","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:25:42Z","timestamp":1778520342000},"page":"e0006204","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hybrid SARS-CoV-2 immunity among frontline workers in a high-tourism setting: A community-based serosurvey in Ambergris Caye, Belize, June 2022"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9223-5194","authenticated-orcid":true,"given":"Oluwadara","family":"Okeremi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0122-2193","authenticated-orcid":true,"given":"Ella","family":"Hawes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8974-9637","authenticated-orcid":true,"given":"Anh N.","family":"Ly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Russell","family":"Manzanero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah M.","family":"Gunter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shannon 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J.","family":"Nilles","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerhaldine","family":"Morazan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6921-3413","authenticated-orcid":true,"given":"Kristy O.","family":"Murray","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"pgph.0006204.ref001","author":"World Bank G","year":"2025"},{"key":"pgph.0006204.ref002","author":"US International Trade Administration","year":"2024"},{"key":"pgph.0006204.ref003","author":"Belize Tourism Board","year":"2025"},{"key":"pgph.0006204.ref004","author":"Government of Belize Press Office","year":"2020"},{"key":"pgph.0006204.ref005","author":"Government of Belize Press Office.","year":"2020"},{"key":"pgph.0006204.ref006","author":"Belize 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