From the Division of Pharmacoepidemiology (Y.X.), Clinical Epidemiology Center, Research and Development Service (Y.X., T.C., Z.A.-A.), and the Nephrology Section, Medicine Service (Z.A.-A.), Veterans Affairs St. Louis Health Care System, the Veterans Research and Education Foundation of St. Louis (Y.X., T.C., Z.A.-A.), the Department of Medicine, Washington University School of Medicine (Z.A.-A.), and the Institute for Public Health, Washington University in St. Louis (Z.A.-A.) - all in St. Louis.
N Engl J Med. 2024 Aug 8;391(6):515-525. doi: 10.1056/NEJMoa2403211. Epub 2024 Jul 17.
Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) can affect many organ systems. However, temporal changes during the coronavirus disease 2019 (Covid-19) pandemic, including the evolution of SARS-CoV-2, may have affected the risk and burden of PASC. Whether the risk and burden of PASC have changed over the course of the pandemic is unclear.
We used health records of the Department of Veterans Affairs to build a study population of 441,583 veterans with SARS-CoV-2 infection between March 1, 2020, and January 31, 2022, and 4,748,504 noninfected contemporaneous controls. We estimated the cumulative incidence of PASC at 1 year after SARS-CoV-2 infection during the pre-delta, delta, and omicron eras of the Covid-19 pandemic.
Among unvaccinated persons infected with SARS-CoV-2, the cumulative incidence of PASC during the first year after infection was 10.42 events per 100 persons (95% confidence interval [CI], 10.22 to 10.64) in the pre-delta era, 9.51 events per 100 persons (95% CI, 9.26 to 9.75) in the delta era, and 7.76 events per 100 persons (95% CI, 7.57 to 7.98) in the omicron era (difference between the omicron and pre-delta eras, -2.66 events per 100 persons [95% CI, -2.93 to -2.36]; difference between the omicron and delta eras, -1.75 events per 100 persons [95% CI, -2.08 to -1.42]). Among vaccinated persons, the cumulative incidence of PASC at 1 year was 5.34 events per 100 persons (95% CI, 5.10 to 5.58) during the delta era and 3.50 events per 100 persons (95% CI, 3.31 to 3.71) during the omicron era (difference between the omicron and delta eras, -1.83 events per 100 persons; 95% CI, -2.14 to -1.52). Vaccinated persons had a lower cumulative incidence of PASC at 1 year than unvaccinated persons (difference during the delta era, -4.18 events per 100 persons [95% CI, -4.47 to -3.88]; difference during the omicron era, -4.26 events per 100 persons [95% CI, -4.49 to -4.05]). Decomposition analyses showed 5.23 (95% CI, 4.97 to 5.47) fewer PASC events per 100 persons at 1 year during the omicron era than during the pre-delta and delta eras combined; 28.11% of the decrease (95% CI, 25.57 to 30.50) was attributable to era-related effects (changes in the virus and other temporal effects), and 71.89% (95% CI, 69.50 to 74.43) was attributable to vaccines.
The cumulative incidence of PASC during the first year after SARS-CoV-2 infection decreased over the course of the pandemic, but the risk of PASC remained substantial even among vaccinated persons who had SARS-CoV-2 infection in the omicron era. (Supported by the Department of Veterans Affairs.).
严重急性呼吸综合征冠状病毒 2 （SARS-CoV-2）感染的急性后期后遗症（PASC）可能影响许多器官系统。然而，在 2019 年冠状病毒病（Covid-19）大流行期间，包括 SARS-CoV-2 的演变，可能会影响 PASC 的风险和负担。在大流行期间，PASC 的风险和负担是否发生了变化尚不清楚。
我们使用退伍军人事务部的健康记录，建立了一个由 441583 名在 2020 年 3 月 1 日至 2022 年 1 月 31 日期间感染 SARS-CoV-2 的退伍军人和 4748504 名同期未感染的对照组成的研究人群。我们估计了在 SARS-CoV-2 感染后 1 年内 PASC 的累积发病率，分为新冠疫情的德尔塔前、德尔塔和奥密克戎时代。
在未接种疫苗的 SARS-CoV-2 感染者中，感染后第 1 年的 PASC 累积发病率在德尔塔前时代为每 100 人 10.42 例（95%置信区间[CI]，10.22 至 10.64），在德尔塔时代为每 100 人 9.51 例（95%CI，9.26 至 9.75），在奥密克戎时代为每 100 人 7.76 例（95%CI，7.57 至 7.98）（奥密克戎与德尔塔前时代之间的差异为每 100 人减少 2.66 例[95%CI，2.93 至 2.36]；奥密克戎与德尔塔时代之间的差异为每 100 人减少 1.75 例[95%CI，2.08 至 1.42]）。在接种疫苗的人群中，在奥密克戎时代，感染后第 1 年的 PASC 累积发病率为每 100 人 5.34 例（95%CI，5.10 至 5.58），在德尔塔时代为每 100 人 3.50 例（95%CI，3.31 至 3.71）（奥密克戎与德尔塔时代之间的差异为每 100 人减少 1.83 例[95%CI，2.14 至 1.52]）。与未接种疫苗的人相比，接种疫苗的人在感染后第 1 年的 PASC 累积发病率较低（差异在德尔塔时代为每 100 人减少 4.18 例[95%CI，4.47 至 3.88]；在奥密克戎时代为每 100 人减少 4.26 例[95%CI，4.49 至 4.05]）。分解分析显示，与德尔塔前和德尔塔时代相比，奥密克戎时代每 100 人在感染后第 1 年减少了 5.23 例（95%CI，4.97 至 5.47）的 PASC 事件；28.11%的减少（95%CI，25.57 至 30.50）归因于与时代相关的影响（病毒和其他时间相关的变化），71.89%（95%CI，69.50 至 74.43）归因于疫苗。
在 SARS-CoV-2 感染后第 1 年，PASC 的累积发病率在大流行期间有所下降，但即使在奥密克戎时代感染 SARS-CoV-2 的接种人群中，PASC 的风险仍然很大。（由退伍军人事务部支持）。
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