Credit ACIP/CDC
#17,243
Last night CIDRAP published a report on research published last week in Nature Reviews Microbiology that estimates more than 65 million survivors of COVID are suffering from persistent, and sometimes debilitating, `long COVID' symptoms.
We've previously looked at literally dozens of studies that have identified `post-COVID' sequelae, including:
Neurology: Incidence of Epilepsy and Seizures Over the First 6 Months After a COVID-19 Diagnosis: A Retrospective Cohort Study
The Lancet: Neurological and Psychiatric Risk Trajectories After SARS-CoV-2 Infection
MMWR: Post–COVID-19 Symptoms and Conditions Among Children and Adolescents
Nature: Long-term Cardiovascular Outcomes of COVID-19
Nature: Long-term Neurologic Outcomes of COVID-19
Making matters worse, these risks appear to increase with every infection (see Nature: Acute and Postacute Sequelae Associated with SARS-CoV-2 Reinfection). Which the exact mechanism behind these `Long-COVID' symptoms isn't known, the extrapulmonary spread of the virus - particularly to the brain and the heart - is strongly suspected to contribute.
Yesterday the JAMA Network published a detailed look at post-covid symptoms and the impact of vaccination either before or after COVID infection.
Since this sort of study requires a lengthy post-infection follow up period, the cohort used in this study were all infected during the pre-Omicron phase of this pandemic. Future studies will be needed to see if the same trends persisted with this newer strain.
That said, this study finds that COVID infection is associated with increased health-care encounters over the 6 months after infection, and that vaccination prior to infection was linked to a lower risk of long-term COVID-19 symptoms.
Interestingly, even post-infection vaccination was associated with a 41% lower risk of reporting symptoms at 6 months.
I've only posted some excerpts, so follow the link to read it in its entirety.
January 18, 2023
Persistent COVID-19 Symptoms at 6 Months After Onset and the Role of Vaccination Before or After SARS-CoV-2 Infection
Stephanie A. Richard, PhD1,2; Simon D. Pollett, MBBS1,2; Anthony C. Fries, PhD3; et alCatherine M. Berjohn, MD, MPH1,4,5; Ryan C. Maves, MD1,4; Tahaniyat Lalani, MBBS1,2,6; Alfred G. Smith, MD6; Rupal M. Mody, MD7; Anuradha Ganesan, MBBS, MPH1,2,8; Rhonda E. Colombo, MD1,2,5,9; David A. Lindholm, MD5,10; Michael J. Morris, MD10; Nikhil Huprikar, MD5,8; Christopher J. Colombo, MD5,9; Cristian Madar, MD11; Milissa Jones, MD, MPH11,12; Derek T. Larson, DO5,13; Samantha E. Bazan, AN14; Katrin Mende, PhD1,2,10; David Saunders, MD5; Jeffrey Livezey, MD12; Charlotte A. Lanteri, MD1; Ann I. Scher, PhD; Celia Byrne, PhD; Jennifer Rusiecki, PhD; Evan Ewers, MD1,13; Nusrat J. Epsi, PhD1,2; Julia S. Rozman, BS1,2; Caroline English1,2; Mark P. Simons, PhD1; David R. Tribble, MD1,15; Brian K. Agan, MD1,2; Timothy H. Burgess, MD1; for the Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases With Pandemic Potential (EPICC) COVID-19 Cohort Study Group
Author Affiliations Article InformationJAMA Netw Open. 2023;6(1):e2251360. doi:10.1001/jamanetworkopen.2022.51360
Key Points
Question
What factors are associated with persistent post–COVID-19 symptoms, and how do post–COVID-19 medical encounters change over time?
Findings
In this cohort study of 1832 US adults, the risk of reporting symptoms for 28 or more days after COVID-19 onset was significantly higher in participants who were unvaccinated at the time of infection and those who reported moderate or severe acute illness symptoms. At 6 months after onset, participants had significantly higher risk of pulmonary, diabetes, neurological, and mental health encounters vs preinfection baseline.
Meaning
The findings suggest that COVID-19 is associated with increased health care encounters through 6 months after infection; vaccination was associated with lower risk of long-term COVID-19 symptoms.
Abstract
Importance
Understanding the factors associated with post-COVID conditions is important for prevention.
Objective
To identify characteristics associated with persistent post–COVID-19 symptoms and to describe post–COVID-19 medical encounters.
Design, Setting, and Participants
This cohort study used data from the Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases With Pandemic Potential (EPICC) study implemented in the US military health system (MHS); MHS beneficiaries aged 18 years or older who tested positive for SARS-CoV-2 from February 28, 2020, through December 31, 2021, were analyzed, with 1-year follow-up.
Exposures SARS-CoV-2 infection.
Main Outcomes and Measures The outcomes analyzed included survey-reported symptoms through 6 months after SARS-CoV-2 infection and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis categories reported in medical records 6 months following SARS-CoV-2 infection vs 3 months before infection.
Results More than half of the 1832 participants in these analyses were aged 18 to 44 years (1226 [66.9%]; mean [SD] age, 40.5 [13.7] years), were male (1118 [61.0%]), were unvaccinated at the time of their infection (1413 [77.1%]), and had no comorbidities (1290 [70.4%]). A total of 728 participants (39.7%) had illness that lasted 28 days or longer (28-89 days: 364 [19.9%]; ≥90 days: 364 [19.9%]).
Participants who were unvaccinated prior to infection (risk ratio [RR], 1.39; 95% CI, 1.04-1.85), reported moderate (RR, 1.80; 95% CI, 1.47-2.22) or severe (RR, 2.25; 95% CI, 1.80-2.81) initial illnesses, had more hospitalized days (RR per each day of hospitalization, 1.02; 95% CI, 1.00-1.03), and had a Charlson Comorbidity Index score of 5 or greater (RR, 1.55; 95% CI, 1.01-2.37) were more likely to report 28 or more days of symptoms.
Among unvaccinated participants, postinfection vaccination associated with increased health care encounters through 6 months after infection was associated with a 41% lower risk of reporting symptoms at 6 months (RR, 0.59; 95% CI, 0.40-0.89). Participants had higher risk of pulmonary (RR, 2.00; 95% CI, 1.40-2.84), diabetes (RR, 1.46; 95% CI, 1.00-2.13), neurological (RR, 1.29; 95% CI, 1.02-1.64), and mental health–related medical encounters (RR, 1.28; 95% CI, 1.01-1.62) at 6 months after symptom onset than at baseline (before SARS-CoV-2 infection).
Conclusions and Relevance In this cohort study, more severe acute illness, a higher Charlson Comorbidity Index score, and being unvaccinated were associated with a higher risk of reporting COVID-19 symptoms lasting 28 days or more. Participants with COVID-19 were more likely to seek medical care for diabetes, pulmonary, neurological, and mental health–related illness for at least 6 months after onset compared with their pre-COVID baseline health care use patterns. These findings may inform the risk-benefit ratio of COVID-19 vaccination policy.
(SNIP)
Discussion
Participants who were vaccinated prior to COVID-19 onset were significantly less likely to report 28 or more days of illness, which is consistent with previously published findings.16,17 Other factors associated with longer-term symptoms that are identified in the literature, such as obesity, age, and female sex, were not associated with longer duration of symptoms when included in a multivariable model. A recent meta-analysis demonstrated that severity of COVID-19 (as measured by hospitalization) was not associated with risk of PCCs.26 In the EPICC study cohort, participants were at higher risk of reporting 28 or more days of symptoms if they were hospitalized during their initial infection or if they had higher self-reported symptom severity. Our findings may contribute to prognostic frameworks for advising those who may be more likely to develop PCCs.
Vaccination after onset was also associated with a lower risk of reporting symptoms at 6 months after symptom onset. The correlation between postinfection vaccination and mitigation of PCC risk has been noted,15,27 but further studies should confirm this and also examine possible mechanisms that may explain this statistical association. The observations of postinfection vaccination benefit may reflect enhanced clearance of persistent virus28 or nonspecific immunomodulation, which may alter possible inflammatory drivers of PCC symptoms.
