Personal household air pollution exposure and SARS-CoV-2 antibody responses among women and infants: an analysis within the HAPIN trial.

BACKGROUND

While extensive research has linked ambient air pollution to increased COVID-19 infection rates and severity, the role of household air pollution-a major public health exposure affecting nearly 3 billion people globally-remains understudied. Here, we evaluate associations between a clean cooking intervention, personal household air pollution exposure, and serologic evidence of prior SARS-CoV-2 infection using exploratory intention-to-treat and exposure-response analyses.

METHODS

The Household Air Pollution Intervention Network (HAPIN) Trial randomized 3,200 households in Guatemala, India, Peru, and Rwanda to either continue using traditional solid fuel cookstoves or receive liquefied petroleum gas stoves with continuous fuel supply and behavioral messaging. The current ancillary study leveraged personal exposures to PM2.5 and carbon monoxide (CO) and dried blood spot (DBS) samples collected in the Guatemala, India, and Peru HAPIN sites to study the association between personal air pollution exposures and COVID-19; Rwanda was excluded due to low COVID-19 prevalence at the time of collection. SARS-CoV-2-specific antibodies were measured from DBS samples to define serology-based infection status and quantify immune response. Analyses included exploratory intention-to-treat and observational exposure-response analyses of associations between personal air pollution exposure and serology-based SARS-CoV-2 infection status and antibody levels.

RESULTS

While the intervention effectively reduced household air pollution exposures, no significant differences in COVID-19 infection or antibody levels between intervention and control groups were found. However, exposure-response analyses were suggestive of potential inverse associations between PM2.5 exposure and antibody levels, diverging from most studies of ambient air pollution.

CONCLUSIONS

These findings suggest that household air pollution may influence SARS-CoV-2 infection and immune response through mechanisms distinct from those described for ambient air pollution.