Center for Pediatric Infectious Disease, Cleveland Clinic Childrens, Cleveland, Ohio, USA.
Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, Ohio, USA.
J Infect Dis. 2023 Feb 1;227(3):344-352. doi: 10.1093/infdis/jiac411.
Four severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants predominated in the United States since 2021. Understanding disease severity related to different SARS-CoV-2 variants remains limited.
Viral genome analysis was performed on SARS-CoV-2 clinical isolates circulating March 2021 through March 2022 in Cleveland, Ohio. Major variants were correlated with disease severity and patient outcomes.
In total 2779 patients identified with either Alpha (n 1153), Gamma (n 122), Delta (n 808), or Omicron variants (n 696) were selected for analysis. No difference in frequency of hospitalization, intensive care unit (ICU) admission, and death were found among Alpha, Gamma, and Delta variants. However, patients with Omicron infection were significantly less likely to be admitted to the hospital, require oxygen, or admission to the ICU (2 12.8, P .001; 2 21.6, P .002; 2 9.6, P .01, respectively). In patients whose vaccination status was known, a substantial number had breakthrough infections with Delta or Omicron variants (218/808 [26.9] and 513/696 [73.7], respectively). In breakthrough infections, hospitalization rate was similar regardless of variant by multivariate analysis. No difference in disease severity was identified between Omicron subvariants BA.1 and BA.2.
Disease severity associated with Alpha, Gamma, and Delta variants is comparable while Omicron infections are significantly less severe. Breakthrough disease is significantly more common in patients with Omicron infection.
自 2021 年以来，四种严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）变体在美国占主导地位。对不同 SARS-CoV-2 变体与疾病严重程度的关系了解有限。
对 2021 年 3 月至 2022 年 3 月在俄亥俄州克利夫兰循环的 SARS-CoV-2 临床分离株进行病毒基因组分析。主要变体与疾病严重程度和患者结局相关。
共选择了 2779 名患有 Alpha（n=1153）、Gamma（n=122）、Delta（n=808）或 Omicron 变体（n=696）的患者进行分析。Alpha、Gamma 和 Delta 变体在住院、重症监护病房（ICU）入院和死亡的频率上没有差异。然而，感染 Omicron 的患者住院、需要吸氧或 ICU 入院的可能性显著降低（2 12.8，P.001；2 21.6，P.002；2 9.6，P.01）。在已知疫苗接种状态的患者中，大量患者出现了 Delta 或 Omicron 变体的突破性感染（218/808[26.9]和 513/696[73.7]）。在突破性感染中，多变量分析显示，无论变体如何，住院率相似。在 Omicron 亚变体 BA.1 和 BA.2 中，未发现疾病严重程度存在差异。
与 Alpha、Gamma 和 Delta 变体相关的疾病严重程度相当，而 Omicron 感染明显较轻。Omicron 感染患者的突破性疾病更为常见。
