Impact of rotating night shift work on immune homeostasis among hospital employees during the COVID-19 pandemic

Background: Night shifts may disrupt circadian rhythms and immunity, potentially leading to health issues such as increased susceptibility to infectious diseases and impaired vaccine responses. This concern is particularly relevant for hospital employees during the COVID-19 pandemic. Our study aims to investigate the immune homeostasis of hospital workers engaged in rotating night shifts during the pandemic. Methods: Healthy hospital employees aged 18-60 were enrolled and divided into two groups: the day shift (DS) group (n = 19) and the rotating night shift (RNS) group (n = 40). Blood samples were collected for analysis, including complete blood count, biochemistry, cytokines, anti-SARS-CoV-2 S1 antibody (anti-S1 IgG) titers, and immune cell subsets. Results: The RNS group exhibited skewed Th1 immunity, characterized by significant elevations in IL-6 and IL-22, increasing trends in TNF-α and the IFN-γ/IL-5 ratio, along with a significant reduction in IL-5. Both groups demonstrated comparable rates of COVID-19 infection, and all participants showed effectively boosted anti-S1 IgG titers following antigen exposure (natural infection or vaccination). However, the RNS had lower anti-S1 IgG titers 3 to 6 months after antigen exposure. Additionally, decreased proportions of naïve B, and NKT cells along with an increase in T cell subsets, were detected in the RNS group. A significant positive correlation was also found between anti-S1 IgG titers and the proportion of NKT cells. Conclusion: These findings suggest that RNS work induces low-grade inflammation and disrupts immune homeostasis, possibly lowering long-term anti-S1 IgG level after COVID-19 antigen exposure. © 2025 Elsevier Ltd