严重急性呼吸综合征冠状病毒 2 感染后的病毒变异体和疫苗接种状况的急性后期后遗症：一项多中心横断面研究。
Post-Acute Sequelae After Severe Acute Respiratory Syndrome Coronavirus 2 Infection by Viral Variant and Vaccination Status: A Multicenter Cross-Sectional Study.
机构信息
Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St. Gallen, Switzerland.
Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
出版信息
Clin Infect Dis. 2023 Jul 26;77(2):194-202. doi: 10.1093/cid/ciad143.
BACKGROUND
Disentangling the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and vaccination on the occurrence of post-acute sequelae of SARS-CoV-2 (PASC) is crucial to estimate and reduce the burden of PASC.
METHODS
We performed a cross-sectional analysis (May/June 2022) within a prospective multicenter healthcare worker (HCW) cohort in north-eastern Switzerland. HCWs were stratified by viral variant and vaccination status at time of their first positive SARS-CoV-2 nasopharyngeal swab. HCWs without positive swab and with negative serology served as controls. The sum of 18 self-reported PASC symptoms was modeled with univariable and multivariable negative-binomial regression to analyze the association of mean symptom number with viral variant and vaccination status.
RESULTS
Among 2912 participants (median age: 44 years; 81.3% female), PASC symptoms were significantly more frequent after wild-type infection (estimated mean symptom number: 1.12; P < .001; median time since infection: 18.3 months), after Alpha/Delta infection (0.67 symptoms; P < .001; 6.5 months), and after Omicron BA.1 infections (0.52 symptoms; P = .005; 3.1 months) versus uninfected controls (0.39 symptoms). After Omicron BA.1 infection, the estimated mean symptom number was 0.36 for unvaccinated individuals versus 0.71 with 1-2 vaccinations (P = .028) and 0.49 with ≥3 prior vaccinations (P = .30). Adjusting for confounders, only wild-type (adjusted rate ratio [aRR]: 2.81; 95% confidence interval [CI]: 2.08-3.83) and Alpha/Delta infections (aRR: 1.93; 95% CI: 1.10-3.46) were significantly associated with the outcome.
CONCLUSIONS
Previous infection with pre-Omicron variants was the strongest risk factor for PASC symptoms among our HCWs. Vaccination before Omicron BA.1 infection was not associated with a clear protective effect against PASC symptoms in this population.
背景
区分严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）变体和疫苗接种对 SARS-CoV-2 后急性后遗症（PASC）发生的影响对于评估和减轻 PASC 的负担至关重要。
方法
我们在瑞士东北部的一个前瞻性多中心医护人员（HCW）队列中进行了一项横断面分析（2022 年 5 月/6 月）。在他们第一次 SARS-CoV-2 鼻咽拭子检测呈阳性时，根据病毒变体和疫苗接种状态对 HCWs 进行分层。没有阳性拭子和阴性血清学的 HCWs 作为对照组。使用单变量和多变量负二项式回归模型对 18 种自我报告的 PASC 症状进行建模，以分析平均症状数与病毒变体和疫苗接种状态的关系。
结果
在 2912 名参与者中（中位年龄：44 岁；81.3%为女性），与未感染对照相比，野生型感染（估计平均症状数：1.12；P <.001；感染后中位时间：18.3 个月）、Alpha/Delta 感染（0.67 种症状；P <.001；6.5 个月）和 Omicron BA.1 感染（0.52 种症状；P =.005；3.1 个月）后 PASC 症状更为频繁。与未接种疫苗的个体相比，Omicron BA.1 感染后未接种疫苗的个体的估计平均症状数为 0.36，接种 1-2 剂疫苗的个体为 0.71（P =.028），接种≥3 剂疫苗的个体为 0.49（P =.30）。调整混杂因素后，仅野生型（调整后的比率比 [aRR]：2.81；95%置信区间 [CI]：2.08-3.83）和 Alpha/Delta 感染（aRR：1.93；95% CI：1.10-3.46）与该结果显著相关。
结论
在我们的 HCW 中，之前感染 pre-Omicron 变体是 PASC 症状的最强危险因素。在 Omicron BA.1 感染之前接种疫苗与该人群中 PASC 症状的明确保护作用无关。
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