JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
J Med Virol. 2024 Feb;96(2):e29326. doi: 10.1002/jmv.29326.
The recurrent multiwave nature of coronavirus disease 2019 (COVID-19) necessitates updating its symptomatology. We characterize the effect of variants on symptom presentation, identify the symptoms predictive and protective of death, and quantify the effect of vaccination on symptom development. With the COVID-19 cases reported up to August 25, 2022 in Hong Kong, an iterative multitier text-matching algorithm was developed to identify symptoms from free text. Multivariate regression was used to measure associations between variants, symptom development, death, and vaccination status. A least absolute shrinkage and selection operator technique was used to identify a parsimonious set of symptoms jointly associated with death. Overall, 70.9% (54 450/76 762) of cases were symptomatic with 102 symptoms identified. Intrinsically, the wild-type and delta variant caused similar symptoms among unvaccinated symptomatic cases, whereas the wild-type and omicron BA.2 subvariant had heterogeneous patterns, with seven symptoms (fatigue, fever, chest pain, runny nose, sputum production, nausea/vomiting, and sore throat) more frequent in the BA.2 cohort. With ≥2 vaccine doses, BA.2 was more likely than delta to cause fever among symptomatic cases. Fever, blocked nose, pneumonia, and shortness of breath remained jointly predictive of death among unvaccinated symptomatic elderly in the wild-type-to-omicron transition. Number of vaccine doses required for reducing occurrence varied by symptoms. We substantiate that omicron has a different clinical presentation compared to previous variants. Syndromic surveillance can be bettered with reduced reliance on symptom-based case identification, increased weighing on symptoms predictive of death in outcome prediction, individual-based risk assessment in care homes, and incorporating free-text symptom reporting.
2019 年冠状病毒病（COVID-19）的反复发作多波性质需要更新其症状。我们描述了变异对症状表现的影响，确定了对死亡有预测和保护作用的症状，并量化了疫苗接种对症状发展的影响。利用截至 2022 年 8 月 25 日在香港报告的 COVID-19 病例，开发了一种迭代多层次文本匹配算法来从自由文本中识别症状。使用多元回归来测量变异、症状发展、死亡和疫苗接种状况之间的关联。使用最小绝对收缩和选择算子技术来识别与死亡有共同关联的一组简约症状。总体而言，70.9%（54 450/76 762）的病例有症状，共确定了 102 种症状。本质上，野生型和 delta 变异在未接种疫苗的有症状病例中引起类似的症状，而野生型和 omicron BA.2 亚变异则具有异质模式，有七种症状（疲劳、发烧、胸痛、流鼻涕、咳痰、恶心/呕吐和喉咙痛）在 BA.2 队列中更为常见。在有≥2 剂疫苗的情况下，BA.2 在有症状病例中引起发烧的可能性大于 delta。在野生型到 omicron 的转变中，发烧、鼻塞、肺炎和呼吸急促仍然是未接种疫苗的有症状老年患者死亡的共同预测因素。减少发生所需的疫苗剂量因症状而异。我们证实，omicron 的临床表现与之前的变异不同。症状监测可以通过减少对基于症状的病例识别的依赖、在预后预测中增加对死亡有预测作用的症状的权重、在养老院中进行基于个体的风险评估以及纳入自由文本症状报告来得到改善。
