Credit ACIP/CDC
#16,786
Yesterday, in MMWR: Post–COVID Conditions Among Adult COVID-19 Survivors Aged 18–64 and ≥65 Years we saw evidence suggesting that as many as 1 in 5 adults that have contracted COVID have experienced a post-infection medical event that might be related to their previous infection.
Other studies (see Post-Acute Sequelae of SARS-CoV-2 Infection Among Adults Aged ≥18 Years — Long Beach, California, April 1–December 10, 2020)) have suggested that as many as 30% of adult post-COVID cases experience long-term symptoms.
Some studies have suggested that vaccination - which is proven to lower the risk of hospitalization, severe illness, or death - may also lower the risk of developing `Long COVID'. Last March the UKHSA released a 24-page PDF report The effectiveness of vaccination against long COVID which offered evidence from a number of observational studies and found:
There is evidence that vaccinated people who are subsequently infected with COVID-19 are less likely to report symptoms of long COVID than unvaccinated people, in the short term (4 weeks after infection), medium term (12 to 20 weeks after infection) and long term (6 months after infection). This is in addition to any benefit of vaccination in preventing COVID-19 infection (5).
There is also evidence that unvaccinated people with long COVID who were subsequently vaccinated had, on average, reduced long COVID symptoms (though some people reported worsened symptoms after vaccination). Additionally, there was evidence that unvaccinated people with long COVID who were subsequently vaccinated reported fewer long COVID symptoms than those who remained unvaccinated. However, there is a risk of bias across all studies due to differences in people who were vaccinated and unvaccinated, the measurement of outcomes, and in the selection of participants.
Not exactly a slam dunk, but somewhat encouraging.
Yesterday, however, Nature published a new study - conducted by researchers at Washington University School of Medicine in St. Louis, Mo - that finds the benefit of vaccination against Long COVID to be fairly modest (roughly 15%).
There are other benefits of getting the COVID vaccine - including a 34% reduction in the risk of dying and nearly a 50% drop in some of the more severe long-COVID sequelae, but - the authors caution that the vaccine by itself is not a panacea for Long COVID.
First the abstract from Nature (follow the link to read it in its entirety), then a link, and some excerpts, from the Washington University School of Medicine press release.
Ziyad Al-Aly, Benjamin Bowe & Yan Xie
Nature Medicine (2022)
Abstract
The post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection—also referred to as Long COVID—have been described, but whether breakthrough SARS-CoV-2 infection (BTI) in vaccinated people results in post-acute sequelae is not clear.In this study, we used the US Department of Veterans Affairs national healthcare databases to build a cohort of 33,940 individuals with BTI and several controls of people without evidence of SARS-CoV-2 infection, including contemporary (n = 4,983,491), historical (n = 5,785,273) and vaccinated (n = 2,566,369) controls.At 6 months after infection, we show that, beyond the first 30 days of illness, compared to contemporary controls, people with BTI exhibited a higher risk of death (hazard ratio (HR) = 1.75, 95% confidence interval (CI): 1.59, 1.93) and incident post-acute sequelae (HR = 1.50, 95% CI: 1.46, 1.54), including cardiovascular, coagulation and hematologic, gastrointestinal, kidney, mental health, metabolic, musculoskeletal and neurologic disorders. The results were consistent in comparisons versus the historical and vaccinated controls.Compared to people with SARS-CoV-2 infection who were not previously vaccinated (n = 113,474), people with BTI exhibited lower risks of death (HR = 0.66, 95% CI: 0.58, 0.74) and incident post-acute sequelae (HR = 0.85, 95% CI: 0.82, 0.89).Altogether, the findings suggest that vaccination before infection confers only partial protection in the post-acute phase of the disease; hence, reliance on it as a sole mitigation strategy may not optimally reduce long-term health consequences of SARS-CoV-2 infection. The findings emphasize the need for continued optimization of strategies for primary prevention of BTI and will guide development of post-acute care pathways for people with BTI.
While risks higher for the unvaccinated, study points to need for more tools against the virus
by Kristina Sauerwein • May 25, 2022Vaccinated people with mild breakthrough COVID-19 infections can experience debilitating, lingering symptoms that affect the heart, brain, lungs and other parts of the body, according to researchers at Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System. However, a new study of more than 13 million veterans also found that vaccination against the virus that causes COVID-19 reduced the risk of death by 34% and the risk of getting long COVID-19 by 15%, compared with unvaccinated patients infected with the virus.Even vaccinated people with mild breakthrough COVID-19 infections can experience debilitating, lingering symptoms that affect the heart, brain, lungs and other parts of the body, according to new research from Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System.
The study of more than 13 million veterans also found that vaccination against the virus that causes COVID-19 reduced the risk of death by 34% and the risk of getting long COVID by 15%, compared with unvaccinated patients infected with the virus. However, vaccines were shown to be most effective in preventing some of the most worrisome manifestations of long COVID – lung and blood-clotting disorders – which declined about 49% and 56%, respectively, among those who were vaccinated.
The research is published May 25 in Nature Medicine.
“Vaccinations remain critically important in the fight against COVID-19,” said first author Ziyad Al-Aly, MD, a clinical epidemiologist at Washington University. “Vaccinations reduce the risk of hospitalization and dying from COVID-19. But vaccines seem to only provide modest protection against long COVID. People recovering from breakthrough COVID-19 infection should continue to monitor their health and see a health-care provider if lingering symptoms make it difficult to carry out daily activities.”
The researchers classified patients as fully vaccinated if they had received two doses of the Moderna or Pfizer-BioNTech vaccines or one dose of the Johnson & Johnson/Janssen vaccine. At the time the research was conducted, the database used for this study did not include information about whether patients received boosters.
“Now that we understand that COVID-19 can have lingering health consequences even among the vaccinated, we need to move toward developing mitigation strategies that can be implemented for the longer term since it does not appear that COVID-19 is going away any time soon,” said Al-Aly, who is also the chief of research and development at the VA St. Louis Health Care System. “We need to urgently develop and deploy additional layers of protection that could be sustainably implemented to reduce the risk of long COVID.”
Such protective layers could include nasal vaccines that are more convenient or potent than the current shots, or other types of vaccines or drugs aimed at minimizing the risks of long COVID.
“Getting COVID-19, even among vaccinated people, seems almost unavoidable nowadays,” said Al-Aly, noting that 8 to 12% of vaccinated people with breakthrough infections may develop long COVID. “Our current approach will likely leave a large number of people with chronic and potentially disabling conditions that have no treatments. This will not only affect people’s health, but their ability to work, life expectancy, economic productivity and societal well-being. We need to have a candid national conversation about the consequences of our current approach.”
While certainly not the result we were hoping for, any positive impact on the rate of Long-COVID by getting vaccinated is welcome.
