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PONE-D-23-08403Vital D: A Modifiable Occupational Risk Factor for Healthcare WorkersPLOS ONE

Dear Dr. Subramanian,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Nasser Hadal Alotaibi

Academic Editor

PLOS ONE

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"The work was supported by funds from Mid and South Essex Hospitals charity. We also would like to thank research and development department Mid and South Essex hospitals U.K. for their support and junior doctors of Mid and South Essex hospitals who volunteered to assist in sample collection."

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- The Mid and South Essex Hospitals Charity

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Title: add UK Healthcare workers

Introduction, paragraph 1: Clarify winter months in the UK (i.e. Canada's winters last at least oct-march/april); expand on signs and symptoms of vit D def

Line 35 has an upside down exclamation mark.

Study population: Clarify the healthcare workers' positions i.e. nurses, docs, porters, respiratory therapists, etc

Line 108: missing period

All tables: I would place percentages behind the value i.e. 42 (6.6%)

Future considerations: Sample same group in winter months and then again at peak summer months

The article would be stronger if the authors expanded on the current literature, such as Sowah et al's 2017 article that was only briefly mentioned. Another suggstion: "Prevention of COVID-19 with oral vitamin D supplemental therapy in essential healthcare teams (PROTECT): protocol for a multicentre, triple-blind, randomised, placebo-controlled trial" by Ducharme et al (2023).

Reviewer #2: The authors aimed to investigate deficiency and insufficiency of serum Vitamin D levels in 639 volunteered front-line healthcare workers in the UK.

Introduction:

Other factors, such as hand hygiene, personal protective equipment (PPE) use, and vaccination status, also play crucial roles in infection prevention for front-line healthcare workers, which must be mentioned in the introduction or discussion section.

Materials and methods:

This study was carried out at Mid and South Essex NHS Foundation Trust, and the population does not represent UK front-line healthcare workers. Please modify it appropriately in different parts of the manuscript.

The first subsection of the Materials and methods is called study design. However, it is more about sample size calculation and justification.

Relevant dates, including periods of recruitment, exposure, and data collection, should be mentioned.

It is not well clear that the inclusion criteria were for workers at the “Mid and South Essex NHS Foundation Trust” or the National Health Service UK.

The size of participants from the sampling frame and the proportion who agreed to take part in this study are not mentioned.

Different subsections of materials and methods are mixed up together. Based on the STROBE statement, it could be good to have the following subsections: Study design, Setting, Participants, Variables, Measurements, Data sources, Bias, Study design, Quantitative variables, and Statistical methods.

Results:

Following the STROBE statement for writing and presenting the results could be more appropriate.

Adding the percentages to the counts in Table 1 makes it more informative, and it is possible to delete the two sentences in Lines 119-122.

It is similar to other tables, and combining Tables 1, 2, 3, 4 and 5 could be reasonable.

Marking the mean and median in Figure 1 could be informative.

Discussion:

The authors concluded that vitamin D deficiency/insufficiency puts the front-line UK NHS healthcare Workers at risk of infection with an unfavourable outcome beyond this study's design, measurements and analysis.

Reviewer #3: Well described manuscript with focus on the Health Care Workers (HCW). As vitamins are the vital one for the healthy living, much more studies are essential on this area of research in the upcoming years for the future benefits.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Vital D: A Modifiable Occupational Risk Factor of UK Healthcare Workers

PONE-D-23-08403R1

Dear Dr. Subramanian,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Nasser Hadal Alotaibi

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: Thanks for the ammendments.

The authors have adequately addressed your comments raised in a previous round of review and I feel that this manuscript is now acceptable for publication

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

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