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Rudolph AE, Al Akoury N, Bogdanenko N, Markus K, Whittle I, Wright O, Haridy H, Spinardi JR, McLaughlin JM, Kyaw MH. Factors affecting the impact of COVID-19 vaccination on post COVID-19 conditions among adults: A systematic literature review. Hum Vaccin Immunother 2025; 21:2474772. [PMID: 40079963 PMCID: PMC11913386 DOI: 10.1080/21645515.2025.2474772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 02/24/2025] [Accepted: 02/27/2025] [Indexed: 03/15/2025] Open
Abstract
This systematic literature review summarizes the evidence across 56 publications and pre-prints (January 2020-July 2023) with low-risk of bias based on JBI critical appraisal, that report adjusted estimates for the relationship between COVID-19 vaccination and Post-COVID-19 Condition (PCC) by timing of vaccination relative to infection or PCC-onset. Comparisons of adjusted vaccine effectiveness (aVE) against ≥1 PCC (vs. unvaccinated) across study characteristics known to impact PCC burden or VE against other COVID-19 endpoints were possible for 31 studies where vaccination preceded infection. Seventy-seven percent of pre-infection aVE estimates were statistically significant (range: 7%-95%). Statistically significant pre-infection aVE estimates were slightly higher for mRNA (range: 14%-84%) than non-mRNA vaccines (range: 16%-38%) and aVE ranges before and during Omicron overlapped. Our findings suggest that COVID-19 vaccination before SARS-CoV-2 infection reduces the risk of PCC regardless of vaccine type, number of doses received, PCC definition, predominant variant, and severity of acute infections included.
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Appaneal HJ, Lopes VV, Puzniak L, Zasowski EJ, Jodar L, McLaughlin JM, Caffrey AR. Early effectiveness of the BNT162b2 KP.2 vaccine against COVID-19 in the US Veterans Affairs Healthcare System. Nat Commun 2025; 16:4033. [PMID: 40301395 PMCID: PMC12041242 DOI: 10.1038/s41467-025-59344-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Accepted: 04/18/2025] [Indexed: 05/01/2025] Open
Abstract
This test-negative case-control study within the US Veterans Affairs Healthcare System aims to estimate early vaccine effectiveness (VE) of the BNT162b2 KP.2 vaccine (2024-2025 formulation) compared to not receiving the KP.2 vaccine against COVID-19 outcomes. The study includes adult patients (age ≥18 years) with an acute respiratory infection (ARI) in hospital, emergency department and urgent care (ED/UC), or outpatient settings between September 5 and November 30, 2024. Separate multivariable logistic regression models compare the odds of receiving BNT162b2 KP.2 vaccine among SARS-CoV-2 positive cases and test-negative controls within each ARI outcome category, while adjusting for potentially confounding variables. Among 44,598 ARI episodes, VE is 68% (42-82%), 57% (46-65%), and 56% (36-69%) against COVID-19-associated hospitalizations, emergency department and urgent care visits, and outpatient visits, respectively. Uptake of updated COVID-19 vaccines is low (3.7%).
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Affiliation(s)
- Haley J Appaneal
- Infectious Diseases Research Program, Providence Veterans Affairs Healthcare System, Providence, RI, US
- Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Healthcare System, Providence, RI, US
- College of Pharmacy, University of Rhode Island, Kingston, RI, US
| | - Vrishali V Lopes
- Infectious Diseases Research Program, Providence Veterans Affairs Healthcare System, Providence, RI, US
| | | | | | | | | | - Aisling R Caffrey
- Infectious Diseases Research Program, Providence Veterans Affairs Healthcare System, Providence, RI, US.
- Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Healthcare System, Providence, RI, US.
- College of Pharmacy, University of Rhode Island, Kingston, RI, US.
- School of Public Health, Brown University, Providence, RI, US.
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3
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Gentilotti E, Canziani LM, Caponcello MG, Azzini AM, Savoldi A, De Nardo P, Palacios-Baena ZR, Tazza B, Caroccia N, Marchetti G, Antinori A, Giannella M, Rodríguez-Baño J, Tacconelli E. ORCHESTRA Delphi consensus: diagnostic and therapeutic management of Post-COVID-19 condition in vulnerable populations. Clin Microbiol Infect 2025:S1198-743X(25)00172-7. [PMID: 40252805 DOI: 10.1016/j.cmi.2025.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Revised: 04/03/2025] [Accepted: 04/07/2025] [Indexed: 04/21/2025]
Abstract
BACKGROUND Post-COVID condition (PCC) remains poorly understood, especially in clinically vulnerable groups. Within the ORCHESTRA Project, we applied the Delphi approach to drive recommendations for the diagnosis, management, and prevention of PCC in people living with HIV (PWH) and patients affected by rheumatological diseases (RD) and haematological malignancies (HM). METHODS Based on literature review, three areas of interest in PCC in PWH, HM, and RD were identified: 1) features and risk factors; 2) diagnosis and management; and 3) prevention. A three-round Delphi anonymous survey consisting of 15 questions was conducted including 69 experts. Consensus was measured by the 6-point Likert scale categorised into four tiers: strong disagreement, moderate disagreement, moderate agreement, and strong agreement. Statements were generated on questions achieving consensus. RESULTS Eleven statements were generated: six on features and risk factors of PCC in clinically vulnerable populations, two on diagnosis and management, and three on prevention. Chronic fatigue was identified as the most frequent presentation of PCC in PWH and RD populations. A different case definition of PCC is required for RD population, as symptoms of PCC and autoimmune disorders may overlap. Risk factors for PCC include age>65, severity of COVID-19, and female sex; this latter is also associated with increased smell/taste impairment. A clinical assessment or a routine laboratory test performed three months after acute infection is not suggested to diagnose PCC in PWH. PWH and RD should be screened to exclude additional autoimmune disorders in case of chronic fatigue/arthralgia of new onset. Full-course vaccination and early treatment for COVID-19 should be promoted to prevent PCC, while corticosteroids during acute infection are not recommended. CONCLUSION Diagnosis, management and prevention of PCC are still under discussion. This Delphi offers valuable insights on PCC in selected clinically vulnerable populations and suggests a tailored approach in vulnerable populations.
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Affiliation(s)
- Elisa Gentilotti
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Lorenzo Maria Canziani
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Maria Giulia Caponcello
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Hospital Universitario Virgen MacarenaDepartamento de Medicina, Universidad de SevillaCIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Anna Maria Azzini
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alessia Savoldi
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Pasquale De Nardo
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Zaira R Palacios-Baena
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Hospital Universitario Virgen MacarenaDepartamento de Medicina, Universidad de SevillaCIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Beatrice Tazza
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Natascia Caroccia
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giulia Marchetti
- . Clinic of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Andrea Antinori
- . Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; . Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Hospital Universitario Virgen MacarenaDepartamento de Medicina, Universidad de SevillaCIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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4
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Sterian M, Naganathan T, Corrin T, Waddell L. Evidence on the associations and safety of COVID-19 vaccination and post COVID-19 condition: an updated living systematic review. Epidemiol Infect 2025; 153:e62. [PMID: 40159916 PMCID: PMC12038765 DOI: 10.1017/s0950268825000378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 03/06/2025] [Accepted: 03/09/2025] [Indexed: 04/02/2025] Open
Abstract
Post COVID-19 condition (PCC) refers to persistent symptoms occurring ≥12 weeks after COVID-19. This living systematic review (SR) assessed the impact of vaccination on PCC and vaccine safety among those with PCC, and was previously published with data up to December 2022. Searches were updated to 31 January 2024 and standard SR methodology was followed. Seventy-eight observational studies were included (47 new). There is moderate confidence that two doses pre-infection reduces the odds of PCC (pooled OR (pOR) 0.69, 95% CI 0.64-0.74, I2 = 35.16%). There is low confidence for remaining outcomes of one dose and three or more doses. A booster dose may further reduce the odds of PCC compared to only a primary series (pOR 0.85, 95% CI 0.74-0.98, I2 = 16.85%). Among children ≤18 years old, vaccination may not reduce the odds (pOR 0.79, 95% CI 0.56-1.11, I2 = 37.2%) of PCC. One study suggests that vaccination within 12 weeks post-infection may reduce the odds of PCC. For those with PCC, vaccination appears safe (four studies) and may reduce the odds of PCC persistence (pOR 0.73, 95% CI 0.57-0.92, I2 = 15.5%).
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Affiliation(s)
- Melanie Sterian
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
| | - Thivya Naganathan
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
| | - Tricia Corrin
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
| | - Lisa Waddell
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
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5
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Guillén-Teruel A, Mellina-Andreu JL, Reina G, González-Billalabeitia E, Rodriguez-Iborra R, Palma J, Botía JA, Cisterna-García A. Identifying risk factors and predicting long COVID in a Spanish cohort. Sci Rep 2025; 15:10758. [PMID: 40155409 PMCID: PMC11953293 DOI: 10.1038/s41598-025-94765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Accepted: 03/17/2025] [Indexed: 04/01/2025] Open
Abstract
Many studies have investigated symptoms, comorbidities, demographic factors, and vaccine effects in relation to long COVID (LC-19) across global populations. However, a number of these studies have shortcomings, such as inadequate LC-19 categorisation, lack of sex disaggregation, or a narrow focus on certain risk factors like symptoms or comorbidities alone. We address these gaps by investigating the demographic factors, comorbidities, and symptoms present during the acute phase of primary COVID-19 infection among patients with LC-19 and comparing them to typical non-Long COVID-19 patients. Additionally, we assess the impact of COVID-19 vaccination on these patients. Drawing on data from the Regional Health System of the Region of Murcia in southeastern Spain, our analysis includes comprehensive information from clinical and hospitalisation records, symptoms, and vaccination details of over 675126 patients across 10 hospitals. We calculated age and sex-adjusted odds ratios (AOR) to identify protective and risk factors for LC-19. Our findings reveal distinct symptomatology, comorbidity patterns, and demographic characteristics among patients with LC-19 versus those with typical non-Long COVID-19. Factors such as age, female sex (AOR = 1.39, adjusted p < 0.001), and symptoms like chest pain (AOR > 1.55, adjusted p < 0.001) or hyposmia (AOR > 1.5, adjusted p < 0.001) significantly increase the risk of developing LC-19. However, vaccination demonstrates a strong protective effect, with vaccinated individuals having a markedly lower risk (AOR = 0.10, adjusted p < 0.001), highlighting the importance of vaccination in reducing LC-19 susceptibility. Interestingly, symptoms and comorbidities show no significant differences when disaggregated by type of LC-19 patient. Vaccination before infection is the most important factor and notably decreases the likelihood of long COVID. Particularly, mRNA vaccines offer more protection against developing LC-19 than viral vector-based vaccines (AOR = 0.48). Additionally, we have developed a model to predict LC-19 that incorporates all studied risk factors, achieving a balanced accuracy of 73% and ROC-AUC of 0.80. This model is available as a free online LC-19 calculator, accessible at ( LC-19 Calculator ).
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Affiliation(s)
- Antonio Guillén-Teruel
- Department of Information and Communication Engineering, University of Murcia, Murcia, 30100, Spain
| | - Jose L Mellina-Andreu
- Department of Information and Communication Engineering, University of Murcia, Murcia, 30100, Spain
| | - Gabriel Reina
- Servicio de Microbiología, Clínica, Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
| | | | - Ramón Rodriguez-Iborra
- Subdirección General de Tecnologías de la Información, Servicio Murciano de Salud, Murcia, Spain
| | - José Palma
- Department of Information and Communication Engineering, University of Murcia, Murcia, 30100, Spain
| | - Juan A Botía
- Department of Information and Communication Engineering, University of Murcia, Murcia, 30100, Spain
| | - Alejandro Cisterna-García
- Department of Information and Communication Engineering, University of Murcia, Murcia, 30100, Spain.
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6
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Ledebur K, Wiedermann M, Puta C, Thurner S, Klimek P, Brockmann D. Wearable data reveals distinct characteristics of individuals with persistent symptoms after a SARS-CoV-2 infection. NPJ Digit Med 2025; 8:167. [PMID: 40102642 PMCID: PMC11920215 DOI: 10.1038/s41746-025-01456-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 01/15/2025] [Indexed: 03/20/2025] Open
Abstract
Understanding the factors associated with persistent symptoms after SARS-CoV-2 infection is critical to improving long-term health outcomes. Using a wearable-derived behavioral and physiological dataset (n = 20,815), we identified individuals characterized by self-reported persistent fatigue and shortness of breath after SARS-CoV-2 infection. Compared with symptom-free COVID-19 positive (n = 150) and negative controls (n = 150), these individuals (n = 50) had higher resting heart rates (mean difference 2.37/1.49 bpm) and lower daily step counts (mean 3030/2909 steps fewer), even at least three weeks prior to SARS-CoV-2 infection. In addition, persistent fatigue and shortness of breath were associated with a significant reduction in mean quality of life (WHO-5, EQ-5D), even before infection. Here we show that persistent symptoms after SARS-CoV-2 infection may be associated with pre-existing lower fitness levels or health conditions. These findings additionally highlight the potential of wearable devices to track health dynamics and provide valuable insights into long-term outcomes of infectious diseases.
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Affiliation(s)
- Katharina Ledebur
- Institute of the Science of Complex Systems, CeDAS, Medical University of Vienna, Spitalgasse 23, A-1090, Vienna, Austria.
- Complexity Science Hub, Metternichgasse 8, A-1030, Vienna, Austria.
- Computational Epidemiology Group, Robert Koch Institute, 13353, Berlin, Germany.
| | - Marc Wiedermann
- Computational Epidemiology Group, Robert Koch Institute, 13353, Berlin, Germany
| | - Christian Puta
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University Jena, Jena, Germany
- Department for Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - Stefan Thurner
- Institute of the Science of Complex Systems, CeDAS, Medical University of Vienna, Spitalgasse 23, A-1090, Vienna, Austria
- Complexity Science Hub, Metternichgasse 8, A-1030, Vienna, Austria
- Santa Fe Institute, 1399 Hyde Park Road, Santa Fe, NM, 87501, USA
| | - Peter Klimek
- Institute of the Science of Complex Systems, CeDAS, Medical University of Vienna, Spitalgasse 23, A-1090, Vienna, Austria
- Complexity Science Hub, Metternichgasse 8, A-1030, Vienna, Austria
- Supply Chain Intelligence Institute Austria, Josefstädter Strasse 39, A-1080, Vienna, Austria
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-17177, Stockholm, Sweden
| | - Dirk Brockmann
- Computational Epidemiology Group, Robert Koch Institute, 13353, Berlin, Germany
- Center Synergy of Systems & Center for Interdisciplinary Digital Sciences, TUD Dresden University of Technology, 01069, Dresden, Germany
- Faculty of Biology, TUD Dresden University of Technology, 01069, Dresden, Germany
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7
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Rashid T, Arefin S, Bhattacharjee M, Islam A. Comparative study of stigma and discrimination among vaccinated and non-vaccinated COVID-19 survivors in Bangladesh. BMC Infect Dis 2025; 25:338. [PMID: 40065223 PMCID: PMC11895379 DOI: 10.1186/s12879-025-10734-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 03/03/2025] [Indexed: 03/14/2025] Open
Abstract
This study investigates the stigmatized experiences of vaccinated and non-vaccinated COVID-19 survivors in Bangladesh, emphasizing the factors contributing to stigma, the lived realities of stigmatization, and strategies for mitigating discrimination. Employing a qualitative comparative case study approach, the research draws on interviews with 22 survivors (13 non-vaccinated and 9 vaccinated) conducted during two critical phases of the pandemic: July-August 2020 and October 2022-April 2023. The findings reveal that stigma and discrimination were pervasive, stemming from deep-seated fears of death and infection, exacerbated by public health measures such as lockdowns, public announcements, and the symbolic marking of houses with red flags. Experiences surrounding COVID-19 testing further intensified stigma, influencing how survivors were perceived and treated by others. Notably, non-vaccinated survivors reported a broader spectrum of stigmatizing experiences compared to their vaccinated counterparts, highlighting the differential impact of vaccination status on social experiences. Despite these challenges, survivors identified key strategies for alleviating stigma, including robust social support, strengthened community connectivity, normalized attitudes toward COVID-19, and proactive media engagement. As a result, this study offers valuable insights for healthcare professionals and policymakers in Bangladesh, informing the development of effective pandemic management strategies. Additionally, it enhances our understanding of the complex interplay between policy, social perception, and individual experiences in shaping pandemic-related stigma and discrimination, highlighting the critical role of community support and care in addressing these challenges.
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Affiliation(s)
- Tamanna Rashid
- Department of Sociology, University of Massachusetts, Amherst, 200 Hicks Way, Thompson Hall, Amherst, MA, 01003, USA
| | - Shamsul Arefin
- Department of Sociology, University of Massachusetts, Amherst, 200 Hicks Way, Thompson Hall, Amherst, MA, 01003, USA.
- Department of Sociology, Gopalganj Science and Technology University, Gopalganj, 8100, Bangladesh.
| | | | - Ashraful Islam
- Department of Sociology, University of Dhaka, Dhaka, 1000, Bangladesh
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Pasculli P, Antonacci M, Zingaropoli MA, Dominelli F, Ciccone F, Pandolfi F, Fosso Ngangue YC, Masci GM, Campagna R, Iafrate F, Panebianco V, Catalano C, Turriziani O, Galardo G, Palange P, Mastroianni CM, Ciardi MR. SARS-CoV-2 vaccination influence in the development of long-COVID clinical phenotypes. Epidemiol Infect 2025; 153:e40. [PMID: 39901510 PMCID: PMC11869074 DOI: 10.1017/s0950268825000093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 12/19/2024] [Accepted: 01/21/2025] [Indexed: 02/05/2025] Open
Abstract
Although SARS-CoV-2 vaccination reduces hospitalization and mortality, its long-term impact on Long-COVID remains to be elucidated. The aim of the study was to evaluate the different development of Long-COVID clinical phenotypes according to the vaccination status of patients. Clinical and demographic characteristics were assessed for each patient, while Long-COVID symptoms were self-reported and later stratified into distinct clinical phenotypes. Vaccination was significantly associated with the avoidance of hospitalization, less invasive respiratory support, and less alterations of cardiopulmonary functions, as well as reduced lasting lung parenchymal damage. However, no association between vaccination status and the development of at least one Long-COVID symptom was found. Nevertheless, clinical phenotypes were differently associated with vaccination status, as neuropsychiatric were more frequent in unvaccinated patients and cardiorespiratory symptoms were reported mostly in vaccinated patients. Different progression of disease could be at play in the different development of specific Long-COVID clinical phenotypes, as shown by the different serological responses between unvaccinated and vaccinated patients. A higher anti-Spike (S) antibody titre was protective for vaccinated patients, while it was detrimental for unvaccinated patients. A better understanding of the mechanism underlying the development of Long-COVID symptoms might be reached by standardized methodologies and symptom classification.
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Affiliation(s)
- Patrizia Pasculli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Michele Antonacci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Federica Dominelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Federica Ciccone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Francesco Pandolfi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Giorgio Maria Masci
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Roberta Campagna
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Franco Iafrate
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Gioacchino Galardo
- Medical Emergency Unit, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Paolo Palange
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Crawford JM, Penberthy L, Pinto LA, Althoff KN, Assimon MM, Cohen O, Gillim L, Hammonds TL, Kapur S, Kaufman HW, Kwasny D, Liew JW, Meyer WA, Reynolds SL, Schleicher CB, Subbiah S, Theruviparampil C, Wallace ZS, Warner JL, Yoon S, Ziemba YC. Coronavirus Disease 2019 (COVID-19) Real World Data Infrastructure: A Big-Data Resource for Study of the Impact of COVID-19 in Patient Populations With Immunocompromising Conditions. Open Forum Infect Dis 2025; 12:ofaf021. [PMID: 39850579 PMCID: PMC11756308 DOI: 10.1093/ofid/ofaf021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 01/09/2025] [Indexed: 01/25/2025] Open
Abstract
Background We developed a United States-based real-world data resource to better understand the continued impact of the coronavirus disease 2019 (COVID-19) pandemic on immunocompromised patients, who are typically underrepresented in prospective studies and clinical trials. Methods The COVID-19 Real World Data infrastructure (CRWDi) was created by linking and harmonizing de-identified HealthVerity medical and pharmacy claims data from 1 December 2018 to 31 December 2023, with severe acute respiratory syndrome coronavirus 2 virologic and serologic laboratory data from major commercial laboratories and Northwell Health; COVID-19 vaccination data; and, for patients with cancer, 2010 to 2021 National Cancer Institute Surveillance, Epidemiology, and End Results registry data. Results The CRWDi contains 4 cohorts: patients with cancer; patients with rheumatic diseases receiving pharmacotherapy; noncancer solid organ and hematopoietic stem cell transplant recipients; and people from the general population including adults and pediatric patients. The project successfully linked and harmonized longitudinal, de-identified data on 5.2 million unique patients using privacy-preserving record lineage techniques. The system was developed in early 2024 and rapidly deployed, enabling longitudinal analysis of patient healthcare over the full geography of delivery settings and exploration of novel questions for populations at high risk for adverse outcomes. Conclusions The successful development of the CRWDi enables researchers to address unanswered questions that have arisen during the COVID-19 pandemic. By making the data broadly and freely available to academic researchers, this real-world data system represents an important complement to existing consortia and clinical trials that have emerged during the healthcare crisis and is readily reproducible for future purposing.
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Affiliation(s)
- James M Crawford
- Northwell, Department of Pathology and Laboratory Medicine, New Hyde Park, New York, USA
| | - Lynne Penberthy
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ligia A Pinto
- Vaccine, Immunity and Cancer Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Keri N Althoff
- John Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | | | - Oren Cohen
- Laboratory Corporation of America, Burlington, North Carolina, USA
| | - Laura Gillim
- Laboratory Corporation of America, Burlington, North Carolina, USA
| | | | - Shilpa Kapur
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Jean W Liew
- Boston University Chobanian and Avedisian School of Medicine, Section of Rheumatology, Boston, Massachusetts, USA
| | | | | | - Cheryl B Schleicher
- Northwell, Department of Pathology and Laboratory Medicine, New Hyde Park, New York, USA
| | - Suki Subbiah
- Louisiana State University Health Sciences Center, Section of Hematology/Oncology, New Orleans, Louisiana, USA
| | | | - Zachary S Wallace
- Massachusetts General Hospital, Division of Rheumatology, Allergy, and Immunology, Boston, Massachusetts, USA
| | - Jeremy L Warner
- Brown University, Department of Medicine, Providence, Rhode Island, USA
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - Suhyeon Yoon
- Integrated Data Sciences Section, Research Technologies Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Yonah C Ziemba
- Northwell, Department of Pathology and Laboratory Medicine, New Hyde Park, New York, USA
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10
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Debbag R, Rudin D, Ceddia F, Watkins J. The Impact of Vaccination on COVID-19, Influenza, and Respiratory Syncytial Virus-Related Outcomes: A Narrative Review. Infect Dis Ther 2025; 14:63-97. [PMID: 39739199 PMCID: PMC11724835 DOI: 10.1007/s40121-024-01079-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 11/06/2024] [Indexed: 01/02/2025] Open
Abstract
Vaccination represents a core preventive strategy for public health, with interrelated and multifaceted effects across health and socioeconomic domains. Beyond immediate disease prevention, immunization positively influences downstream health outcomes by mitigating complications of preexisting comorbidities and promoting healthy aging. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza virus, and respiratory syncytial virus (RSV) are common respiratory viruses responsible for broad societal cost and substantial morbidity and mortality, particularly among at-risk individuals, including older adults and people with frailty or certain comorbid conditions. In this narrative review, we summarize the overall impact of vaccination for these 3 viruses, focusing on mRNA vaccines, each of which exhibits unique patterns of infection, risk, and transmission dynamics, but collectively represent a target for preventive strategies. Vaccines for COVID-19 (caused by SARS-CoV-2) and influenza are effective against the most severe outcomes, such as hospitalization and death; these vaccines represent the most potent and cost-effective interventions for the protection of population and individual health against COVID-19 and influenza, particularly for older adults and those with comorbid conditions. Based on promising results of efficacy for the prevention of RSV-associated lower respiratory tract disease, the first RSV vaccines were approved in 2023. Immunization strategies should account for various factors leading to poor uptake, including vaccine hesitancy, socioeconomic barriers to access, cultural beliefs, and lack of knowledge of vaccines and disease states. Coadministration of vaccines and combination vaccines, such as multicomponent mRNA vaccines, offer potential advantages in logistics and delivery, thus improving uptake and reducing barriers to adoption of new vaccines. The success of the mRNA vaccine platform was powerfully demonstrated during the COVID-19 pandemic; these and other new approaches show promise as a means to overcome existing challenges in vaccine development and to sustain protection against viral changes over time.A graphical abstract and video abstract is available with this article.
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Affiliation(s)
- Roberto Debbag
- Latin American Vaccinology Society, Buenos Aires, Argentina
| | | | | | - John Watkins
- Department of Population Medicine, Cardiff University, Cardiff, UK.
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11
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Silver SR, Li J, Ford ND, Shi D, Saydah SH. Prevalence of COVID-19 and Long COVID by Industry and Occupation: Behavioral Risk Factor Surveillance System 2022. Am J Ind Med 2025; 68:26-52. [PMID: 39392098 DOI: 10.1002/ajim.23665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 09/06/2024] [Accepted: 09/16/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND Workers in healthcare and other essential occupations had elevated risks for COVID-19 infection early in the pandemic. No survey of U.S. workers to date has comprehensively assessed the prevalence of both COVID-19 and Long COVID across industries and occupations (I&O) at a detailed level. METHODS Behavioral Risk Factor Surveillance System data for 2022 from 39 states, Guam, and the U.S. Virgin Islands were used to estimate prevalence of self-reported history of COVID-19 and Long COVID, as well as the prevalence of Long COVID among those reporting prior COVID-19, by broad and detailed I&O. Adjusted prevalence ratios were used to compare outcome prevalence in each I&O to prevalence among all other workers combined. RESULTS By broad I&O, workers in healthcare, protective services, and education had elevated prevalences of COVID-19. The prevalence of Long COVID was elevated in healthcare and protective service but not education workers. Detailed I&O with significantly elevated prevalences of COVID-19 but not Long COVID included Dairy Product Manufacturing industry workers and subsets of mining workers. Both COVID-19 and Long COVID were elevated among bartenders/drinking places and personal care and appearance workers. The prevalence of Long COVID was elevated among farmworkers who reported having had COVID-19. CONCLUSIONS Industries and occupations with elevated levels of COVID-19 or Long COVID in this study may warrant increased measures to prevent transmission of airborne respiratory viruses. Accommodations are a key component for supporting workers in all workplaces. This new information about the distribution of Long COVID by I&O suggests where employer understanding and implementation of tailored workplace supports and accommodations are most needed to support continued employment of affected workers.
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Affiliation(s)
- S R Silver
- National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Health Informatics Branch, Cincinnati, Ohio, USA
| | - J Li
- National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Health Informatics Branch, Cincinnati, Ohio, USA
| | - N D Ford
- Centers for Disease Control and Prevention, Coronaviruses and Other Respiratory Viruses Division, Epidemiology Branch, Atlanta, Georgia, USA
| | - D Shi
- National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Hazard Evaluations and Technical Assistance Branch, Cincinnati, OH, USA
| | - S H Saydah
- Centers for Disease Control and Prevention, Coronaviruses and Other Respiratory Viruses Division, Epidemiology Branch, Atlanta, Georgia, USA
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12
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MacEwan SR, Rahurkar S, Tarver WL, Gaughan AA, Rush LJ, Schamess A, McAlearney AS. COVID-19 vaccination perspectives among patients with Long COVID: A qualitative study. Hum Vaccin Immunother 2024; 20:2327663. [PMID: 38532547 PMCID: PMC10978020 DOI: 10.1080/21645515.2024.2327663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
Individuals who have Long COVID may have unique perspectives about COVID-19 vaccination due to the significant impact that COVID-19 has had on their lives. However, little is known about the specific vaccination perspectives among this patient population. The goal of our study was to improve our understanding of perspectives about COVID-19 vaccines among individuals with Long COVID. Interviews were conducted with patients receiving care at a post-COVID recovery clinic. Deductive thematic analysis was used to characterize participant perspectives according to the vaccine acceptance continuum framework, which recognizes a spectrum from vaccine acceptance to refusal. From interviews with 21 patients, we identified perspectives across the continuum of vaccine acceptance. These perspectives included acceptance of vaccines to prevent future illness, concerns about vaccine side effects on Long COVID symptoms, and refusal of vaccines due to perceived natural immunity. A limitation of our study is that these perspectives are specific to individuals receiving care at one post-COVID recovery clinic. In conclusion, our study demonstrates that some patients with Long COVID are uncertain about COVID-19 vaccines and boosters but may also be amenable to conversations that impact future vaccination acceptance. Patient perspectives should be considered when communicating recommendations for COVID-19 vaccinations to this population.
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Affiliation(s)
- Sarah R. MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
| | - Saurabh Rahurkar
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Willi L. Tarver
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, The Ohio State University, Columbus, OH, USA
| | - Alice A. Gaughan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
| | - Laura J. Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
| | - Andrew Schamess
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ann Scheck McAlearney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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13
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Lee A, Davido B, Beck E, Demont C, Joshi K, Kohli M, Maschio M, Uhart M, El Mouaddin N. Substantial reduction in the clinical and economic burden of disease following variant-adapted mRNA COVID-19 vaccines in immunocompromised patients in France. Hum Vaccin Immunother 2024; 20:2423474. [PMID: 39540209 PMCID: PMC11572258 DOI: 10.1080/21645515.2024.2423474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 10/07/2024] [Accepted: 10/28/2024] [Indexed: 11/16/2024] Open
Abstract
An evaluation was conducted to predict the economic and clinical burden of vaccinating all immunocompromised (IC) individuals aged ≥30 years with mRNA-1273 variant-adapted COVID-19 vaccines versus BNT162b2 variant-adapted vaccines in Fall 2023 and Spring 2024 in France. The number of symptomatic SARS-CoV-2 infections, hospitalizations or deaths due to COVID-19, and long COVID cases, costs and quality-adjusted life years (QALYs) were estimated using a static decision-analytic model. Predicted vaccine effectiveness (VE) were based on real-world data from the original and BA.4/5 variant-adapted vaccines, suggesting higher protection against infection and hospitalization with mRNA-1273 vaccines. VE estimates were combined with COVID-19 incidence and probability of COVID-19 severe outcomes. Uncertainty surrounding VE, vaccine coverage, infection incidence, hospitalization and mortality rates, costs and QALYs were evaluated in sensitivity analyses. In an ideal situation where 100% coverage is achieved, the mRNA-1273 variant-adapted vaccine is predicted to prevent an additional 3,882 infections, 357 hospitalizations, 81 deaths, and 326 long COVID cases when compared to BNT162b2 variant-adapted vaccines in 230,000 IC individuals. This translates to €10.1 million cost-savings from a societal perspective and 645 QALYs gained. Results were consistent across all analyses and most sensitive to variations surrounding VE and coverage. These findings highlight the importance of increasing vaccine coverage, and ability to induce higher levels of protection with mRNA-1273 formulations in this vulnerable population.
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Affiliation(s)
- Amy Lee
- Quadrant Health Economics Inc, Cambridge, Ontario, Canada
| | - Benjamin Davido
- Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP Université Paris Saclay, Garches, France
| | - Ekkehard Beck
- Health Economics and Outcomes Research, Moderna Inc, Cambridge, MA, USA
| | - Clarisse Demont
- Health Economics and Outcomes Research, Moderna France, Paris, France
| | - Keya Joshi
- Health Economics and Outcomes Research, Moderna Inc, Cambridge, MA, USA
| | - Michele Kohli
- Quadrant Health Economics Inc, Cambridge, Ontario, Canada
| | | | - Mathieu Uhart
- Health Economics and Outcomes Research, Moderna France, Paris, France
| | - Nadia El Mouaddin
- Health Economics and Outcomes Research, Moderna France, Paris, France
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14
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Degli Antoni M, Maifredi G, Storti S, Tiecco G, Di Gregorio M, Rossi B, Gasparotti C, Focà E, Castelli F, Quiros-Roldan E. Long-term symptoms after SARS-CoV-2 infection in a cohort of people living with HIV. Infection 2024; 52:2339-2350. [PMID: 38700658 PMCID: PMC11621153 DOI: 10.1007/s15010-024-02288-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/26/2024] [Indexed: 12/07/2024]
Abstract
BACKGROUND Our Hospital in Northern Italy assists 3817 people living with HIV (PLWH) and has faced the impact of COVID-19. Little is known about the impact of HIV infection on the risk of post-COVID-19 conditions (PCCs) onset. We aim to assess the incidence of PCC in PLWH and the factors associated with its occurrence. METHODS We performed a retrospective, observational study including all PLWH > 18 years registered in the Brescia Health Protection Agency database, assessing SARS-CoV-2 burden, vaccination status, socio-demographic, and viro-immunological parameters from February 2020 until May 2022. Persistence of self-reported symptoms (clustered into gastrointestinal, respiratory, osteo-muscular, and neuro-behavioral symptoms) was evaluated after 3 months by a telephone-administered questionnaire. We estimated the associations between all variables and outcomes through univariate and multivariable logistic models. RESULTS In the study period, 653 PLWH were diagnosed with SARS-CoV-2 infection (17.1%). We observed 19 (2.9%) reinfections, 71 (10.9%) hospitalizations, and 3 (0.5%) deaths. We interviewed 510/653 PLWH (78%), and 178 (PCCs prevalence 34.9%; CI 95% 30.7-39.2) reported persistent symptoms. Asthenia/fatigue was the most reported symptom (60/178), followed by muscular pain (54/178). In the multivariate regression model, there was a lower risk of PCCs in males respect to females (adjusted OR = 0.64; CI 95% 0.99-3.66), while hospitalization during acute infection was associated with an increased the risk of PCCs (adjusted OR = 1.9; CI 95% 0.99-3.66). Notably, no viro-immunological variable modified the PCCs risk onset. CONCLUSIONS Our study highlights a substantial prevalence of PCCs among PLWH, three months post-SARS-CoV-2 infection, independent of viro-immunological features or vaccination status.
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Affiliation(s)
- Melania Degli Antoni
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali Civili Di Brescia and University of Brescia, Brescia, Italy
| | | | - Samuele Storti
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali Civili Di Brescia and University of Brescia, Brescia, Italy
| | - Giorgio Tiecco
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali Civili Di Brescia and University of Brescia, Brescia, Italy
| | - Marco Di Gregorio
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali Civili Di Brescia and University of Brescia, Brescia, Italy
| | - Benedetta Rossi
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali Civili Di Brescia and University of Brescia, Brescia, Italy
| | | | - Emanuele Focà
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali Civili Di Brescia and University of Brescia, Brescia, Italy
| | - Francesco Castelli
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali Civili Di Brescia and University of Brescia, Brescia, Italy
| | - Eugenia Quiros-Roldan
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali Civili Di Brescia and University of Brescia, Brescia, Italy.
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15
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Blondeau JM. Long COVID: a consequence of chronic post-infectious inflammation! Expert Rev Respir Med 2024; 18:939-945. [PMID: 39625700 DOI: 10.1080/17476348.2024.2438104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 12/02/2024] [Indexed: 12/07/2024]
Abstract
INTRODUCTION Long COVID defines persistence of symptoms in patients that recovered from acute COVID-19 infections. This manuscript is a brief update on current thinking on long COVID and potential causes and consequences. AREAS COVERED The extent of long COVID varies between patients with some 200 symptoms described and of different severities. Persistent inflammatory or persistent viral infections or both may be the cause of long COVID but sorting this out will take years. EXPERT OPINION Long COVID is an unfortunate consequence of COVID-19 infection and it remains uncertain why some people are afflicted and others not and as with other infectious diseases, it may be both a function of the virus strain, the host or both. Direct organ damage during acute infection versus inflammatory mediated damage over time are important questions to address. The disease outcome and chronic sequelae are likely related to the strains of infectious agent and/or host immunity and genetic predisposition.
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Affiliation(s)
- Joseph M Blondeau
- Division of Clinical Microbiology, Royal University Hospital and Saskatchewan Health Authority, Saskatoon, SK, Canada
- Departments of Biochemistry, Microbiology and Immunology
- Pathology and Laboratory Medicine and Ophthalmology, University of Saskatchewan, Saskatoon, SK, Canada
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16
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Wojczewski S, Mayrhofer M, Szabo N, Rabady S, Hoffmann K. "A bit of a cough, tired, not very resilient - is that already Long-COVID?" perceptions and experiences of GPs with Long-COVID in year three of the pandemic. a qualitative interview study in Austria. BMC Public Health 2024; 24:3078. [PMID: 39511549 PMCID: PMC11542353 DOI: 10.1186/s12889-024-20475-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/21/2024] [Indexed: 11/15/2024] Open
Abstract
BACKGROUND Long-COVID is a new multisectoral healthcare challenge. This study aims at understanding experiences, knowledge, attitudes and (information) needs that GPs had and have in relation to Long-COVID and how these evolved since the beginning of the COVID-19 pandemic. METHODS The study used an exploratory qualitative research design using semistructured interviews. A total of 30 semistructured interviews with GPs in different primary care settings (single practices, group practices, primary care centres) were conducted between February and July 2022. The data were analysed using qualitative thematic content analysis with the software Atlas.ti. RESULTS This is the first study that empirically investigated Long-COVID management by GPs in Austria during the third year of the pandemic. All GPs indicated having experience with Long-COVID. In cities, GPs tended to have slightly better networks with specialists. The GPs who already worked in teams tended to find the management of Long-COVID easier. The symptoms that the physicians described as Long-COVID symptoms corresponded to those described in the international literature, but it is unclear whether syndromes and symptomes such as Post-Exertional-Malaise, autonomic dysfunction such as postural tachycardia syndrome or Mast-Cell-Overactivation-Syndrom, and cognitive dysfunctions were also recognized and correctly classified since they were never mentioned. Most GPs reacted quickly by granting the needed sick leaves and by seeing and discussing with the patients often.The treatment of the patients is described as an enormous challenge and frustrating for patient and GP if the treatment does not yield to significantly improved health also due to the high costs for the patient. CONCLUSION Long-COVID will continue to preoccupy our health care systems for a long time to come, as new variants of COVID-19 will continue to produce new patients without adequate prevention strategies. Therefore, it is not a question of if but when good support for GPs and adequate care pathways for people with Long-COVID will be implemented. Specific contact points that are familiar with therapy-refractory postacute infection syndromes like the postacute COVID condition as a subgroup of Long-COVID are urgently needed.
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Affiliation(s)
- Silvia Wojczewski
- Department of Primary Care Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, Vienna, 1090, Austria.
| | - Mira Mayrhofer
- Department of Communication, University of Vienna, Vienna, Austria
| | - Nathalie Szabo
- Department of Primary Care Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, Vienna, 1090, Austria
| | - Susanne Rabady
- Department of General Health Studies, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Kathryn Hoffmann
- Department of Primary Care Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, Vienna, 1090, Austria
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Park H, Lim E, Jun S, Lee H, Lee HA, Park H, Choi NK, Park B. Reported Adverse Events and Associated Factors in Korean Coronavirus Disease 2019 Vaccinations. J Korean Med Sci 2024; 39:e274. [PMID: 39497564 PMCID: PMC11538574 DOI: 10.3346/jkms.2024.39.e274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/07/2024] [Indexed: 11/07/2024] Open
Abstract
BACKGROUND Despite their effectiveness, coronavirus disease 2019 (COVID-19) vaccines have been associated with adverse effects, underscoring the importance of continuous surveillance to ensure vaccine safety and effective management of public health. Herein, the characteristics and risk factors of vaccine-related adverse events (AEs) were identified to gain an in-depth understanding of vaccine safety by investigating the impact of the vaccination dose on changes in post-vaccination AEs. METHODS Herein, a linked database of COVID-19 vaccination records from the Korea Disease Control and Prevention Agency, AE reports from the COVID-19 Vaccination Management System, and healthcare claims from the National Health Insurance Service, targeting ≥ 5-year-old individuals, was utilized (study duration = February 26, 2021, to January 31, 2023). The frequency and severity of reported post-vaccination AEs were evaluated. Furthermore, we specifically explored AEs in relation to the cumulative dosage of vaccines administered while evaluating associated risk factors. RESULTS During the observation period, 42,804,523 individuals completed the COVID-19 vaccination series, with 365,900 reporting AEs, with headache, muscle pain, and fever being the most frequently reported. Notably, the AE reports were approximately twice as high for women than for men, which was further exacerbated following both doses. Analysis by age group revealed that AE reports were lower among children, adolescents, and older adults than in the middle-aged cohort (age = 50-64 years), with higher reports observed for 18-49-year-old individuals. Additionally, a higher risk of reporting was identified among individuals with lower socioeconomic status compared with those of middle socioeconomic status. Excluding dementia, the risk of reporting AEs was high in individuals with underlying diseases compared with those without, for instance, the risk of reporting AEs following two-dose vaccinations was approximately twice as high in individuals with chronic obstructive pulmonary disease and asthma. CONCLUSION These findings indicate that women, younger people, those with a lower socioeconomic status, and those with underlying health conditions reported a higher incidence of AEs following COVID-19 vaccinations. This emphasizes the need for continued monitoring to ensure safe vaccination and address vaccine-related anxiety and fear, especially within the aforementioned groups.
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Affiliation(s)
- Hyunjin Park
- COVID-19 Vaccine Safety Research Center, Seoul, Korea
- Department of Preventive Medicine, College of Medicine, Graduate Program in System Health Science & Engineering, Ewha Womans University, Seoul, Korea
| | - Eunsun Lim
- COVID-19 Vaccine Safety Research Center, Seoul, Korea
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, Seoul, Korea
| | - Seunghee Jun
- COVID-19 Vaccine Safety Research Center, Seoul, Korea
- Department of Preventive Medicine, College of Medicine, Graduate Program in System Health Science & Engineering, Ewha Womans University, Seoul, Korea
| | - Hyelim Lee
- COVID-19 Vaccine Safety Research Center, Seoul, Korea
- Department of Preventive Medicine, College of Medicine, Graduate Program in System Health Science & Engineering, Ewha Womans University, Seoul, Korea
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hyesook Park
- COVID-19 Vaccine Safety Research Center, Seoul, Korea
- Department of Preventive Medicine, College of Medicine, Graduate Program in System Health Science & Engineering, Ewha Womans University, Seoul, Korea
- National Academy of Medicine of Korea, Seoul, Korea
| | - Nam-Kyong Choi
- COVID-19 Vaccine Safety Research Center, Seoul, Korea
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, Seoul, Korea
- Graduate School of Industrial Pharmaceutical Science of Pharmacy, Ewha Womans University, Seoul, Korea.
| | - Bomi Park
- COVID-19 Vaccine Safety Research Center, Seoul, Korea
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, Korea.
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Caffrey AR, Appaneal HJ, Lopes VV, Puzniak L, Zasowski EJ, Jodar L, LaPlante KL, McLaughlin JM. Effectiveness of BNT162b2 XBB vaccine in the US Veterans Affairs Healthcare System. Nat Commun 2024; 15:9490. [PMID: 39488521 PMCID: PMC11531596 DOI: 10.1038/s41467-024-53842-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 10/23/2024] [Indexed: 11/04/2024] Open
Abstract
Data evaluating effectiveness of XBB.1.5-adapted vaccines against JN.1-related endpoints are scarce. This nationwide test-negative case-control study within the US Veterans Affairs Healthcare System aims to estimate vaccine effectiveness (VE) of BNT162b2 XBB.1.5-adapted vaccine compared to not receiving an XBB vaccine of any kind against COVID-19 hospitalization, emergency department or urgent care visits (ED/UC), and outpatient visits. Between September 25, 2023 and January 31, 2024, effectiveness was 24-35% during a period of JN.1 predominance and 50-61% during XBB predominance across all outcomes. VE within 60 days of vaccination during the likely JN.1 period was 32% (95% confidence interval 3-52%) against hospitalization, 41% (23-54%) against ED/UC visits, and 31% (1-52%) against outpatient visits. Corresponding VE during the likely XBB period was 62% (44-74%), 52% (37-63%), and 50% (25-66%) by setting, respectively. Here, we show the importance of strain match to maximize the public health impact of COVID-19 vaccination.
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Affiliation(s)
- Aisling R Caffrey
- Infectious Diseases Research Program, Providence Veterans Affairs Healthcare System, Providence, RI, USA.
- Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Healthcare System, Providence, RI, USA.
- College of Pharmacy, University of Rhode Island, Kingston, RI, USA.
- School of Public Health, Brown University, Providence, RI, USA.
| | - Haley J Appaneal
- Infectious Diseases Research Program, Providence Veterans Affairs Healthcare System, Providence, RI, USA
- Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Healthcare System, Providence, RI, USA
- College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Vrishali V Lopes
- Infectious Diseases Research Program, Providence Veterans Affairs Healthcare System, Providence, RI, USA
| | | | | | | | - Kerry L LaPlante
- Infectious Diseases Research Program, Providence Veterans Affairs Healthcare System, Providence, RI, USA
- Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Healthcare System, Providence, RI, USA
- College of Pharmacy, University of Rhode Island, Kingston, RI, USA
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Kundi M. A short story of long COVID. Wien Klin Wochenschr 2024; 136:587-589. [PMID: 39436440 DOI: 10.1007/s00508-024-02453-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2024] [Indexed: 10/23/2024]
Affiliation(s)
- Michael Kundi
- Center for Public Health, Department of Environmental Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria.
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20
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Gopalaswamy R, Aravindhan V, Subbian S. The Ambivalence of Post COVID-19 Vaccination Responses in Humans. Biomolecules 2024; 14:1320. [PMID: 39456253 PMCID: PMC11506738 DOI: 10.3390/biom14101320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 10/09/2024] [Accepted: 10/14/2024] [Indexed: 10/28/2024] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has prompted a massive global vaccination campaign, leading to the rapid development and deployment of several vaccines. Various COVID-19 vaccines are under different phases of clinical trials and include the whole virus or its parts like DNA, mRNA, or protein subunits administered directly or through vectors. Beginning in 2020, a few mRNA (Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273) and adenovirus-based (AstraZeneca ChAdOx1-S and the Janssen Ad26.COV2.S) vaccines were recommended by WHO for emergency use before the completion of the phase 3 and 4 trials. These vaccines were mostly administered in two or three doses at a defined frequency between the two doses. While these vaccines, mainly based on viral nucleic acids or protein conferred protection against the progression of SARS-CoV-2 infection into severe COVID-19, and prevented death due to the disease, their use has also been accompanied by a plethora of side effects. Common side effects include localized reactions such as pain at the injection site, as well as systemic reactions like fever, fatigue, and headache. These symptoms are generally mild to moderate and resolve within a few days. However, rare but more serious side effects have been reported, including allergic reactions such as anaphylaxis and, in some cases, myocarditis or pericarditis, particularly in younger males. Ongoing surveillance and research efforts continue to refine the understanding of these adverse effects, providing critical insights into the risk-benefit profile of COVID-19 vaccines. Nonetheless, the overall safety profile supports the continued use of these vaccines in combating the pandemic, with regulatory agencies and health organizations emphasizing the importance of vaccination in preventing COVID-19's severe outcomes. In this review, we describe different types of COVID-19 vaccines and summarize various adverse effects due to autoimmune and inflammatory response(s) manifesting predominantly as cardiac, hematological, neurological, and psychological dysfunctions. The incidence, clinical presentation, risk factors, diagnosis, and management of different adverse effects and possible mechanisms contributing to these effects are discussed. The review highlights the potential ambivalence of human response post-COVID-19 vaccination and necessitates the need to mitigate the adverse side effects.
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Affiliation(s)
- Radha Gopalaswamy
- Directorate of Distance Education, Madurai Kamaraj University, Madurai 625021, India;
| | - Vivekanandhan Aravindhan
- Department of Genetics, Dr Arcot Lakshmanasamy Mudaliyar Post Graduate Institute of Basic Medical Sciences (Dr ALM PG IBMS), University of Madras, Taramani, Chennai 600005, India;
| | - Selvakumar Subbian
- Public Health Research Institute, New Jersey Medical School, Rutgers University, Newark, NJ 07103, USA
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21
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Camporesi A, Morello R, La Rocca A, Zampino G, Vezzulli F, Munblit D, Raffaelli F, Valentini P, Buonsenso D. Characteristics and predictors of Long Covid in children: a 3-year prospective cohort study. EClinicalMedicine 2024; 76:102815. [PMID: 39296584 PMCID: PMC11408803 DOI: 10.1016/j.eclinm.2024.102815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 08/19/2024] [Accepted: 08/21/2024] [Indexed: 09/21/2024] Open
Abstract
Background Children can develop Long Covid, however long term outcomes and their predictors are poorly described in these patients. The primary aim is to describe characteristics and predictors of Long Covid in children assessed in-clinics up to 36 months post-SARS-CoV-2 infection, as well as investigate the role of vaccines in preventing Long Covid, risk of reinfections and development of autoimmune diseases. Methods Children aged 0-18 years old with confirmed SARS-CoV-2 infection were invited for a prospective follow-up assessment at a peadiatric post-covid clinic in Rome, Italy, at serial intervals (3-, 6-, 12-, 18-, 24- and 36-months post-infection onset, between 01/02/2020 and 28/02/2024). Long Covid was defined as persistence of otherwise unexplained symptoms for at least three months after initial infection. Findings 1319 patients were initially included, 1296 reached the 3 months follow-up or more. Of the patients who underwent multiple follow-ups, 23.2% (301), 169 (13.2%), 89 (7.9%), 67 (6.1%), 47 (7.1%) were diagnosed with Long Covid at 3-6-12-18-24 months, respectively For the primary outcome of Long Covid at three months, age >12 years (P < 0.001, OR 11.33, 95% CI 4.2; 15.15), comorbidities (P = 0.008, OR 1.83, 95% CI 1.06; 2.44), being infected with original variants (P < 0.001, OR 4.77, 95% CI 2.46; 14.47), female sex (P < 0.001, OR 1.62, 95% CI 1.02; 1.89) were statistically significant risk factors. Age >12 years (P = 0.002, OR 9.37, 95% CI 1.58; 8.64), and infection with original (P = 0.012, OR 3.52, 95% CI 1.32; 8.64) and alfa (P < 0.001, OR 4.09, 95% CI 2.01; 8.3) SARS-CoV-2 variants remained statistically significant risk factors for Long Covid duration for at least 18 months. Vaccination was associated with a lower risk of long covid at 3, 6 and 12 months for older children and a lower risk of reinfections. Being infected with the original SARS-CoV-2 variant was associated with a higher risk of new-onset autoimmune diseases ((P = 0.035, 95% CI 1.12; 2.4). One patient was diagnosed with Long Covid after a re-infection. Interpretation This is the longest follow-up study of children with SARS-CoV-2 infection, showing a significant and long-lasting burden of Long Covid in the pediatric population. Our findings highlight the urgent need of investing in pediatric Long Covid in order to find effective diagnostic and therapeutic approaches, as well can inform preventive strategies in case of future pandemics. Funding This study has been funde by Pfizer non-competitive grant, granted to DB (#65925795).
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Affiliation(s)
- Anna Camporesi
- Pediatric Anesthesia and Intensive Care, V. Buzzi Children's Hospital, Milano, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anna La Rocca
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Medicine ans Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Zampino
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federico Vezzulli
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
| | - Daniel Munblit
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Francesca Raffaelli
- UOC Malattie Infettive - Dipartimento Scienze Mediche e Chirurgiche -. Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy
- Area Pediatrica, Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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22
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See KC. Enhancing COVID-19 Vaccination Awareness and Uptake in the Post-PHEIC Era: A Narrative Review of Physician-Level and System-Level Strategies. Vaccines (Basel) 2024; 12:1038. [PMID: 39340068 PMCID: PMC11435511 DOI: 10.3390/vaccines12091038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Revised: 09/02/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open
Abstract
Following the World Health Organization's declaration that the COVID-19 pandemic is no longer a public health emergency of international concern (PHEIC), COVID-19 remains an ongoing threat to human health and healthcare systems. Vaccination plays a crucial role in reducing the disease's incidence, mitigating its severity, and limiting transmission, contributing to long-term public health resilience. However, incomplete vaccination coverage and vaccine hesitancy exist. This narrative review investigates strategies at the system and physician levels aimed at sustaining awareness and uptake of COVID-19 vaccination in a post-PHEIC era. Through an examination of the existing literature, this review explores the effectiveness of diverse approaches utilized by healthcare systems and individual providers. These approaches address every component of the 5C model of vaccine hesitancy: confidence, complacency, constraints/convenience, calculation, and collective responsibility. Physician-level approaches include appropriate message framing, persuasive communication containing safety and personal/social benefit information, sharing of personal stories, creating a safe space for discussion, harnessing co-administration with annual influenza vaccines, and use of decision aids and visual messages. System-level approaches include messaging, mass media for health communication, on-site vaccine availability, pharmacist delivery, healthcare protocol integration, incentives, and chatbot use.
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Affiliation(s)
- Kay Choong See
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore 119074, Singapore
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23
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Hoffmann K, Stingl M, O'Mahony L, Untersmayr E. A Practical Approach to Tailor the Term Long COVID for Diagnostics, Therapy and Epidemiological Research for Improved Long COVID Patient Care. Infect Dis Ther 2024; 13:1921-1928. [PMID: 39127990 PMCID: PMC11343936 DOI: 10.1007/s40121-024-01025-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
The term long COVID (LC) effectively describes the broad long-term disease burden of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections, encompassing individual suffering and significant socioeconomic impacts. However, its general use hampers precise epidemiological research, diagnostics and therapeutic strategies. Misinterpretations occur, for example, when population surveys are compared to studies using health record data, because both refer to these data as LC. This also emphasizes the need for different terminology. The National Institute for Health and Care Excellence (NICE) rapid guideline differentiates ongoing symptomatic COVID-19 from post-COVID conditions, yet real-world observations challenge these two subgroup definitions. We propose refining the term LC into three subgroups: ongoing symptomatic COVID-19, SARS-CoV-2 induced or exacerbated diseases and post-acute COVID condition. This stratification aids targeted diagnostics, treatment and epidemiological research. Subgroup-specific documentation using the International Classification of Diseases, Tenth Revision (ICD-10) codes ensures accurate tracking and understanding of long-term effects. The subgroup of post-acute COVID condition again includes various symptoms, syndromes and diseases like post-exertional malaise (PEM), dysautonomia or cognitive dysfunctions. In this regard, differentiation, especially considering PEM, is crucial for effective diagnostics and treatment.
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Affiliation(s)
- Kathryn Hoffmann
- Department of Primary Care Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090, Vienna, Austria.
| | | | - Liam O'Mahony
- Departments of Medicine and Microbiology, APC Microbiome Ireland, National University of Ireland, Cork, Ireland
| | - Eva Untersmayr
- Institute for Pathophysiology und Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
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24
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Griffin DO. Postacute Sequelae of COVID (PASC or Long COVID): An Evidenced-Based Approach. Open Forum Infect Dis 2024; 11:ofae462. [PMID: 39220656 PMCID: PMC11363684 DOI: 10.1093/ofid/ofae462] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
While the acute manifestations of infectious diseases are well known, in some individuals, symptoms can either persist or appear after the acute period. Postviral fatigue syndromes are recognized with other viral infections and are described after coronavirus disease 2019 (COVID-19). We have a growing number of individuals with symptoms that persist for weeks, months, and years. Here, we share the evidence regarding the abnormalities associated with postacute sequelae of COVID-19 (PASC) and therapeutics. We describe physiological and biochemical abnormalities seen in individuals reporting PASC. We describe the several evidence-based interventions to offer patients. It is expected that this growing understanding of the mechanisms driving PASC and the benefits seen with certain therapeutics may not only lead to better outcomes for those with PASC but may also have the potential for understanding and treating other postinfectious sequelae.
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Affiliation(s)
- Daniel O Griffin
- Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York, USA
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25
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Azambuja P, Bastos LS, Batista-da-Silva AA, Ramos GV, Kurtz P, Dias CM, da Silva EP, Arouca LE, Soares J, Sejvar JJ, Sigfrid L, Ranzani OT, Hamacher S, Bozza FA. Prevalence, risk factors, and impact of long COVID in a socially vulnerable community in Brazil: a prospective cohort study. LANCET REGIONAL HEALTH. AMERICAS 2024; 37:100839. [PMID: 39100241 PMCID: PMC11295704 DOI: 10.1016/j.lana.2024.100839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 05/24/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024]
Abstract
Background Long COVID is an emerging global public health issue. Socially vulnerable communities in low- and-middle-income countries were severely impacted by the pandemic and are underrepresented in research. This prospective study aimed to determine the prevalence of long COVID, its impact on health, and associated risk factors in one such community in Rio de Janeiro, Brazil. Methods A total of 710 individuals aged 18 and older, with confirmed SARS-CoV-2 infection at least three months prior, were enrolled between November 25, 2021, and May 5, 2022. Participants were assessed via telephone or in person using a standardized questionnaire to evaluate their perception of recovery, symptoms, quality of life, and functional status. Findings Twenty percent of participants did not feel fully recovered, 22% experienced new or persistent symptoms, 26% had worsened functional status, 18% had increased dyspnoea, and 32% reported a worse quality of life. Persistent symptoms included headache, cough, fatigue, muscle pain, and shortness of breath. Dyspnoea during the acute phase was the strongest independent predictor of worsening outcomes. Females and individuals with comorbidities were more likely to report worse recovery, functioning, dyspnoea, and quality of life. Interpretation Our findings reveal a high burden of severe and persistent physical and mental health sequelae in a socially vulnerable community following COVID-19. Funding UK Foreign, Commonwealth and Development Office and Wellcome Trust Grant (222048/Z/20/Z), Fundação Oswaldo Cruz (FIOCRUZ), Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), and the Centers for Disease Control and Prevention (CDC).
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Affiliation(s)
- Pedro Azambuja
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation (INI-FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Leonardo S.L. Bastos
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
- Tecgraf Institute, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Amanda A. Batista-da-Silva
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
- Tecgraf Institute, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | | | - Pedro Kurtz
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
- Hospital Copa Star, Rio de Janeiro, RJ, Brazil
- Paulo Niemeyer State Brain Institute (IECPN), Rio de Janeiro, RJ, Brazil
| | | | | | - Luna E. Arouca
- Associação de Desenvolvimento Redes da Maré, Rio de Janeiro, RJ, Brazil
| | - Jesus Soares
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James J. Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Louise Sigfrid
- ISARIC Global Support Centre, Policy and Practice Research Group, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Otavio T. Ranzani
- Barcelona Institute for Global Health, ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Silvio Hamacher
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
- Tecgraf Institute, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Fernando A. Bozza
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation (INI-FIOCRUZ), Rio de Janeiro, RJ, Brazil
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
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26
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Greenhalgh T, Sivan M, Perlowski A, Nikolich JŽ. Long COVID: a clinical update. Lancet 2024; 404:707-724. [PMID: 39096925 DOI: 10.1016/s0140-6736(24)01136-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 05/07/2024] [Accepted: 05/30/2024] [Indexed: 08/05/2024]
Abstract
Post-COVID-19 condition (also known as long COVID) is generally defined as symptoms persisting for 3 months or more after acute COVID-19. Long COVID can affect multiple organ systems and lead to severe and protracted impairment of function as a result of organ damage. The burden of this disease, both on the individual and on health systems and national economies, is high. In this interdisciplinary Review, with a coauthor with lived experience of severe long COVID, we sought to bring together multiple streams of literature on the epidemiology, pathophysiology (including the hypothesised mechanisms of organ damage), lived experience and clinical manifestations, and clinical investigation and management of long COVID. Although current approaches to long COVID care are largely symptomatic and supportive, recent advances in clinical phenotyping, deep molecular profiling, and biomarker identification might herald a more mechanism-informed and personally tailored approach to clinical care. We also cover the organisation of services for long COVID, approaches to preventing long COVID, and suggestions for future research.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK.
| | - Manoj Sivan
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds, Leeds General Infirmary, Leeds, UK
| | | | - Janko Ž Nikolich
- Department of Immunobiology and University of Arizona Center on Aging, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA; The Aegis Consortium for Pandemic-Free Future, University of Arizona Health Sciences, Tucson, AZ, USA
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27
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Finamore P, Arena E, Lupoi D, Savito L, Di Nunzio F, Furbatto M, Dragonieri S, Antonelli Incalzi R, Scarlata S. Long COVID Syndrome: A Narrative Review on Burden of Age and Vaccination. J Clin Med 2024; 13:4756. [PMID: 39200898 PMCID: PMC11355827 DOI: 10.3390/jcm13164756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/30/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objective: The COVID-19 pandemic has led to the emergence of post-acute COVID-19 syndrome, also known as long COVID, which presents a significant challenge due to its varied symptoms and unpredictable course, particularly in older adults. Similar to COVID-19 infections, factors such as age, pre-existing health conditions, and vaccination status may influence the occurrence and severity of long COVID. The objective is to analyze the role of aging in the context of long COVID and to investigate prevalence rates and vaccination efficacy to improve prevention strategies and treatment in this age group. Methods: Four researchers independently conducted a literature search of the PubMed database to trace studies published between July 2020 and July 2024. Results: Aging influences both the likelihood of developing long COVID and the recovery process, due to age-related physiological changes, immune system alterations, and the presence of comorbidities. Vaccination plays a key role in reducing the risk of long COVID by attenuating the inflammatory responses associated with its symptoms. Conclusions: Despite the protection vaccines offer against severe infection, hospitalization, and post-infection sequelae, vaccine hesitancy remains a major obstacle, worsening the impact of long COVID. Promising treatments for this condition include antivirals although further research is needed.
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Affiliation(s)
- Panaiotis Finamore
- Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio Medico, 00128 Rome, Italy; (P.F.); (E.A.); (D.L.); (L.S.); (F.D.N.); (M.F.)
- Research Unit of Internal Medicine, Università Campus Bio-Medico, 00128 Rome, Italy
| | - Elena Arena
- Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio Medico, 00128 Rome, Italy; (P.F.); (E.A.); (D.L.); (L.S.); (F.D.N.); (M.F.)
- Research Unit of Internal Medicine, Università Campus Bio-Medico, 00128 Rome, Italy
| | - Domenica Lupoi
- Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio Medico, 00128 Rome, Italy; (P.F.); (E.A.); (D.L.); (L.S.); (F.D.N.); (M.F.)
- Research Unit of Internal Medicine, Università Campus Bio-Medico, 00128 Rome, Italy
| | - Luisa Savito
- Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio Medico, 00128 Rome, Italy; (P.F.); (E.A.); (D.L.); (L.S.); (F.D.N.); (M.F.)
- Research Unit of Internal Medicine, Università Campus Bio-Medico, 00128 Rome, Italy
| | - Francesca Di Nunzio
- Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio Medico, 00128 Rome, Italy; (P.F.); (E.A.); (D.L.); (L.S.); (F.D.N.); (M.F.)
- Research Unit of Internal Medicine, Università Campus Bio-Medico, 00128 Rome, Italy
| | - Michela Furbatto
- Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio Medico, 00128 Rome, Italy; (P.F.); (E.A.); (D.L.); (L.S.); (F.D.N.); (M.F.)
- Research Unit of Internal Medicine, Università Campus Bio-Medico, 00128 Rome, Italy
| | - Silvano Dragonieri
- Department of Respiratory Diseases, University of Bari, 70124 Bari, Italy;
| | - Raffaele Antonelli Incalzi
- Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio Medico, 00128 Rome, Italy; (P.F.); (E.A.); (D.L.); (L.S.); (F.D.N.); (M.F.)
- Research Unit of Internal Medicine, Università Campus Bio-Medico, 00128 Rome, Italy
| | - Simone Scarlata
- Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio Medico, 00128 Rome, Italy; (P.F.); (E.A.); (D.L.); (L.S.); (F.D.N.); (M.F.)
- Research Unit of Internal Medicine, Università Campus Bio-Medico, 00128 Rome, Italy
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28
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Al-Aly Z, Davis H, McCorkell L, Soares L, Wulf-Hanson S, Iwasaki A, Topol EJ. Long COVID science, research and policy. Nat Med 2024; 30:2148-2164. [PMID: 39122965 DOI: 10.1038/s41591-024-03173-6] [Citation(s) in RCA: 88] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/02/2024] [Indexed: 08/12/2024]
Abstract
Long COVID represents the constellation of post-acute and long-term health effects caused by SARS-CoV-2 infection; it is a complex, multisystem disorder that can affect nearly every organ system and can be severely disabling. The cumulative global incidence of long COVID is around 400 million individuals, which is estimated to have an annual economic impact of approximately $1 trillion-equivalent to about 1% of the global economy. Several mechanistic pathways are implicated in long COVID, including viral persistence, immune dysregulation, mitochondrial dysfunction, complement dysregulation, endothelial inflammation and microbiome dysbiosis. Long COVID can have devastating impacts on individual lives and, due to its complexity and prevalence, it also has major ramifications for health systems and economies, even threatening progress toward achieving the Sustainable Development Goals. Addressing the challenge of long COVID requires an ambitious and coordinated-but so far absent-global research and policy response strategy. In this interdisciplinary review, we provide a synthesis of the state of scientific evidence on long COVID, assess the impacts of long COVID on human health, health systems, the economy and global health metrics, and provide a forward-looking research and policy roadmap.
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Affiliation(s)
- Ziyad Al-Aly
- VA St. Louis Health Care System, Saint Louis, MO, USA.
- Washington University in St. Louis, Saint Louis, MO, USA.
| | - Hannah Davis
- Patient-led Research Collaborative, Calabasas, CA, USA
| | | | | | | | - Akiko Iwasaki
- Yale University, New Haven, CT, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Eric J Topol
- Scripps Institute, San Diego, California, CA, USA
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29
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Rzymski P, Niedziela J, Poniedziałek B, Rosińska J, Zarębska-Michaluk D, Sobala-Szczygieł B, Flisiak R, Gąsior M, Jaroszewicz J. Humoral anti-SARS-CoV-2 response in patients with different long COVID phenotypes. Virology 2024; 596:110118. [PMID: 38805803 DOI: 10.1016/j.virol.2024.110118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 05/30/2024]
Abstract
Long COVID (LC) is characterized by persistent symptoms following SARS-CoV-2 infection, with various mechanisms offered to explain its pathogenesis. This study explored whether adaptive humoral anti-SARS-CoV-2 responses differ in LC. Unvaccinated COVID-19 convalescents (n = 200) were enrolled, with 21.5% (n = 43) presenting LC three months post-infection. LC diagnosis was based on persistent symptom(s) and alterations in biochemical/clinical markers; three phenotypes were distinguished: cardiological, pulmonary, and psychiatric LC. All three phenotypes were characterized by significantly decreased seroprevalence of IgG antibodies against nucleocapsid (anti-NP). LC was associated with decreased odds of testing positive for anti-NP (OR = 0.35, 95%CI: 0.16-0.78, p = 0.001). Seropositive LC patients had lower anti-S1 and anti-S2 levels than individuals without LC, and those with pulmonary and psychological phenotypes also revealed decreased anti-RBD concentrations. The results indicate that LC can be characterized by diminished humoral response to SARS-CoV-2. The potential implication of this phenomenon in post-acute viral sequelae is discussed.
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Affiliation(s)
- Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, Poznań, Poland.
| | - Jacek Niedziela
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Barbara Poniedziałek
- Department of Environmental Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Joanna Rosińska
- Department of Environmental Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | | | | | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Bialystok, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Jerzy Jaroszewicz
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, Bytom, Poland
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30
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Slurink IAL, van den Houdt SCM, Mertens G. Who develops long COVID? Longitudinal pre-pandemic predictors of long COVID and symptom clusters in a representative Dutch population. Int J Infect Dis 2024; 144:107048. [PMID: 38609036 DOI: 10.1016/j.ijid.2024.107048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVES Prior studies show that long COVID has a heterogeneous presentation. Whether specific risk factors are related to subclusters of long COVID remains unknown. This study aimed to determine pre-pandemic predictors of long COVID and symptom clustering. METHODS A total of 3,022 participants of a panel representative of the Dutch population completed an online survey about long COVID symptoms. Data was merged into 2018/2019 panel data covering sociodemographic, medical, and psychosocial predictors. A total of 415 participants were classified as having long COVID. K-means clustering was used to identify patient clusters. Multivariate and lasso regression was used to identify relevant predictors compared to a COVID-19 positive control group. RESULTS Predictors of long-term COVID included older age, Western ethnicity, BMI, chronic disease, COVID-19 reinfections, severity, and symptoms, lower self-esteem, and higher positive affect (AUC = 0.79, 95%CI 0.73-0.86). Four clusters were identified: a low and a high symptom severity cluster, a smell-taste and respiratory symptoms cluster, and a neuro-cognitive, psychosocial, and inflammatory symptom cluster. Predictors for the different clusters included regular health complaints, healthcare use, fear of COVID-19, anxiety, depressive symptoms, and neuroticism. CONCLUSIONS A combination of sociodemographic, medical, and psychosocial factors predicted long COVID. Heterogenous symptom clusters suggest that there are different phenotypes of long COVID-19 presentation.
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Affiliation(s)
- Isabel A L Slurink
- Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, 5000LE Tilburg, the Netherlands
| | - Sophie C M van den Houdt
- Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, 5000LE Tilburg, the Netherlands
| | - Gaëtan Mertens
- Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, 5000LE Tilburg, the Netherlands.
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31
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Romeiser JL, Schoeneck K. COVID-19 Booster Vaccination Status and Long COVID in the United States: A Nationally Representative Cross-Sectional Study. Vaccines (Basel) 2024; 12:688. [PMID: 38932418 PMCID: PMC11209278 DOI: 10.3390/vaccines12060688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Early studies have found that the initial COVID-19 vaccination series was protective against severe symptoms and long COVID. However, few studies have explored the association of booster doses on severe disease outcomes and long COVID. This cross-sectional analysis used data from the 2022 US National Health Interview Survey data to investigate how vaccination status correlates with COVID-19 infection severity and long COVID among previously infected individuals. Participants were categorized into three groups: those who had received at least one booster, those with only the initial complete vaccination series, and those with either an incomplete series or no vaccinations. Out of 9521 survey respondents who reported a past positive COVID-19 test, 51.2% experienced moderate/severe infections, and 17.6% experienced long COVID. Multivariable regression models revealed that receiving at least one booster shot was associated with lower odds of experiencing moderate/severe symptoms (aOR = 0.78, p < 0.001) compared to those unvaccinated or with an incomplete series. Additionally, having at least one booster reduced long COVID odds by 24% (aOR = 0.76, p = 0.003). Completing only the primary vaccine series did not significantly decrease the likelihood of severe illness or long COVID. These findings support the continued promotion of booster vaccinations to mitigate long COVID risks in vulnerable populations.
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Affiliation(s)
- Jamie L. Romeiser
- Department of Public Health and Preventive Medicine, Upstate Medical University, 766 Irving Ave., Syracuse, NY 13210, USA;
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Lupi L, Vitiello A, Parolin C, Calistri A, Garzino-Demo A. The Potential Role of Viral Persistence in the Post-Acute Sequelae of SARS-CoV-2 Infection (PASC). Pathogens 2024; 13:388. [PMID: 38787240 PMCID: PMC11123686 DOI: 10.3390/pathogens13050388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 04/26/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
The infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated not only with the development of acute disease but also with long-term symptoms or post-acute sequelae of SARS-CoV-2 (PASC). Multiple lines of evidence support that some viral antigens and RNA can persist for up to 15 months in multiple organs in the body, often after apparent clearance from the upper respiratory system, possibly leading to the persistence of symptoms. Activation of the immune system to viral antigens is observed for a prolonged time, providing indirect evidence of the persistence of viral elements after acute infection. In the gastrointestinal tract, the persistence of some antigens could stimulate the immune system, shaping the local microbiota with potential systemic effects. All of these interactions need to be investigated, taking into account predisposing factors, multiplicity of pathogenic mechanisms, and stratifying populations of vulnerable individuals, particularly women, children, and immunocompromised individuals, where SARS-CoV-2 may present additional challenges.
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Affiliation(s)
- Lorenzo Lupi
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (L.L.); (A.V.); (C.P.); (A.C.)
| | - Adriana Vitiello
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (L.L.); (A.V.); (C.P.); (A.C.)
| | - Cristina Parolin
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (L.L.); (A.V.); (C.P.); (A.C.)
| | - Arianna Calistri
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (L.L.); (A.V.); (C.P.); (A.C.)
| | - Alfredo Garzino-Demo
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (L.L.); (A.V.); (C.P.); (A.C.)
- Department of Microbial Pathogenesis, School of Dentistry, University of Maryland, Baltimore, MD 21201, USA
- Department of Microbiology and Immunology, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
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Huh K, Kim YE, Bae GH, Moon JY, Kang JM, Lee J, Bae JW, Peck KR, Jung J. Vaccination and the risk of post-acute sequelae after COVID-19 in the Omicron-predominant period. Clin Microbiol Infect 2024; 30:666-673. [PMID: 38331252 DOI: 10.1016/j.cmi.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES To assess the association of primary and third doses of vaccination with the risk of post-acute sequelae of COVID-19. METHODS This retrospective cohort study utilized a combined database of nationwide health care claims data, COVID-19 patient registry, and vaccination records from South Korea. Individuals diagnosed with COVID-19 in the Omicron variant-dominant period of January-March 2022 were tracked for 30-120 days post-infection. The exposure of interest was the receipt of primary and third doses of the SARS-CoV-2 vaccine. The occurrence of 26 specific conditions in eight domains was compared using Cox regression with inverse probability of treatment weighting. RESULTS This study included 394 773 unvaccinated individuals and 7 604 081 individuals receiving ≥2 doses of vaccine. Compared with unvaccinated individuals, vaccination with at least two doses was associated with a reduced risk (adjusted hazard ratio; 95% CI) of several conditions, including ischaemic heart disease (0.73; 0.57-0.94), heart failure (0.55; 0.48-0.63), cardiac dysrhythmia (0.72; 0.61-0.85), cardiac arrest (0.41; 0.33-0.51), pulmonary embolism (0.66; 0.52-0.84), venous thromboembolism (0.54; 0.44-0.66), acute renal failure (0.56; 0.46-0.67), new dialysis (0.45; 0.34-0.59), chronic obstructive pulmonary disease (0.74; 0.65-0.84), acute pancreatitis (0.64; 0.51-0.80), and diabetes (0.82; 0.71-0.95). The risks of heart failure, cardiac dysrhythmias, cardiac arrest, pulmonary embolism, and new dialysis were lower in those who were vaccinated with three doses compared with those who were vaccinated with two doses. DISCUSSION Vaccination was associated with a decreased risk of post-acute sequelae of COVID-19, suggesting its potential role in mitigating the indirect impacts of COVID-19.
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Affiliation(s)
- Kyungmin Huh
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Eun Kim
- Department of Bigdata Strategy, National Health Insurance Service, Wonju, South Korea
| | - Gi Hwan Bae
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Jong Youn Moon
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, South Korea; Center for Public Healthcare, Gachon University Gil Medical Center, Incheon, South Korea
| | - Ji-Man Kang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea; Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - Jacob Lee
- Division of Infectious Disease, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea; Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jaehun Jung
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea; Department of Preventive Medicine, Gachon University College of Medicine, Incheon, South Korea.
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Gutfreund MC, Kobayashi T, Callado GY, Pardo I, Hsieh MK, Lin V, Perencevich EN, Salinas JL, Edmond MB, Mendonça E, Rizzo LV, Marra AR. The effectiveness of the COVID-19 vaccines in the prevention of post-COVID conditions in children and adolescents: a systematic literature review and meta-analysis. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e54. [PMID: 38655026 PMCID: PMC11036435 DOI: 10.1017/ash.2024.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 04/26/2024]
Abstract
Objective We performed a systematic literature review and meta-analysis on the effectiveness of coronavirus disease 2019 (COVID-19) vaccination against post-COVID conditions (long COVID) in the pediatric population. Design Systematic literature review/meta-analysis. Methods We searched PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science from December 1, 2019, to August 14, 2023, for studies evaluating the COVID-19 vaccine effectiveness against post-COVID conditions among vaccinated individuals < 21 years old who received at least 1 dose of COVID-19 vaccine. A post-COVID condition was defined as any symptom that was present 4 or more weeks after COVID-19 infection. We calculated the pooled diagnostic odds ratio (DOR) (95% CI) for post-COVID conditions between vaccinated and unvaccinated individuals. Results Eight studies with 23,995 individuals evaluated the effect of vaccination on post-COVID conditions, of which 5 observational studies were included in the meta-analysis. The prevalence of children who did not receive COVID-19 vaccines ranged from 65% to 97%. The pooled prevalence of post-COVID conditions was 21.3% among those unvaccinated and 20.3% among those vaccinated at least once. The pooled DOR for post-COVID conditions among individuals vaccinated with at least 1 dose and those vaccinated with 2 doses were 1.07 (95% CI, 0.77-1.49) and 0.82 (95% CI, 0.63-1.08), respectively. Conclusions A significant proportion of children and adolescents were unvaccinated, and the prevalence of post-COVID conditions was higher than reported in adults. While vaccination did not appear protective, conclusions were limited by the lack of randomized trials and selection bias inherent in observational studies.
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Affiliation(s)
- Maria Celidonio Gutfreund
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Gustavo Yano Callado
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Isabele Pardo
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Mariana Kim Hsieh
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Vivian Lin
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Eli N. Perencevich
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Jorge L. Salinas
- Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Michael B. Edmond
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Eneida Mendonça
- Department of Biomedical Informatics, University of Cincinnati, Cincinnati, OH, USA
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Luiz Vicente Rizzo
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Alexandre R. Marra
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
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MacCallum-Bridges C, Hirschtick JL, Patel A, Orellana RC, Elliott MR, Fleischer NL. The impact of COVID-19 vaccination prior to SARS-CoV-2 infection on prevalence of long COVID among a population-based probability sample of Michiganders, 2020-2022. Ann Epidemiol 2024; 92:17-24. [PMID: 38382771 DOI: 10.1016/j.annepidem.2024.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE To estimate the association between COVID-19 vaccination status at the time of COVID-19 onset and long COVID prevalence. METHODS We used data from the Michigan COVID-19 Recovery Surveillance Study, a population-based probability sample of adults with COVID-19 (n = 4695). We considered 30-day and 90-day long COVID (illness duration ≥30 or ≥90 days, respectively), using Poisson regression to estimate prevalence ratios (PRs) comparing vaccinated (completed an initial series ≥14 days before COVID-19 onset) to unvaccinated individuals (received 0 doses before COVID-19 onset), accounting for differences in age, sex, race and ethnicity, education, employment, health insurance, and rurality/urbanicity. The full unvaccinated comparison group was further divided into historic and concurrent comparison groups based on timing of COVID-19 onset relative to vaccine availability. We used inverse probability of treatment weights to account for sociodemographic differences between groups. RESULTS Compared to the full unvaccinated comparison group, the adjusted prevalence of 30-day and 90-day long COVID were lower among vaccinated individuals [PR30-day= 0.57(95%CI:0.49,0.66); PR90-day= 0.42(95%CI:0.34,0.53)]. Estimates were consistent across comparison groups (full, historic, and concurrent). CONCLUSIONS Long COVID prevalence was 40-60% lower among adults vaccinated (vs. unvaccinated) prior to their COVID-19 onset. COVID-19 vaccination may be an important tool to reduce the burden of long COVID.
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Affiliation(s)
- Colleen MacCallum-Bridges
- University of Michigan Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
| | - Jana L Hirschtick
- University of Michigan Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, United States
| | - Akash Patel
- University of Michigan Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, United States
| | - Robert C Orellana
- CDC Foundation., 600 Peachtree Street NE #1000, Atlanta, GA 30308, United States; Michigan Department of Health and Human Services, 333 South Grand Avenue, Lansing, MI 48933, United States
| | - Michael R Elliott
- University of Michigan Department of Biostatistics, 1415 Washington Heights, Ann Arbor, MI 48109, United States; University of Michigan Survey Research Center, 426 Thompson Street, Ann Arbor, MI 48104, United States
| | - Nancy L Fleischer
- University of Michigan Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, United States
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Kavanagh KT, Cormier LE, Pontus C, Bergman A, Webley W. Long COVID's Impact on Patients, Workers, & Society: A review. Medicine (Baltimore) 2024; 103:e37502. [PMID: 38518038 PMCID: PMC10957027 DOI: 10.1097/md.0000000000037502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/14/2024] [Indexed: 03/24/2024] Open
Abstract
The incidence of long COVID in adult survivors of an acute SARS-CoV-2 infection is approximately 11%. Of those afflicted, 26% have difficulty with day-to-day activities. The majority of long COIVD cases occur after mild or asymptomatic acute infection. Children can spread SARS-CoV-2 infections and can also develop long-term neurological, endocrine (type I diabetes), and immunological sequelae. Immunological hypofunction is exemplified by the recent large outbreaks of respiratory syncytial virus and streptococcal infections. Neurological manifestations are associated with anatomical brain damage demonstrated on brain scans and autopsy studies. The prefrontal cortex is particularly susceptible. Common symptoms include brain fog, memory loss, executive dysfunction, and personality changes. The impact on society has been profound. Fewer than half of previously employed adults who develop long COVID are working full-time, and 42% of patients reported food insecurity and 20% reported difficulties paying rent. Vaccination not only helps prevent severe COVID-19, but numerous studies have found beneficial effects in preventing and mitigating long COVID. There is also evidence that vaccination after an acute infection can lessen the symptoms of long COVID. Physical and occupational therapy can also help patients regain function, but the approach must be "low and slow." Too much physical or mental activity can result in post-exertional malaise and set back the recovery process by days or weeks. The complexity of long COVID presentations coupled with rampant organized disinformation, have caused significant segments of the public to ignore sound public health advice. Further research is needed regarding treatment and effective public communication.
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Affiliation(s)
| | | | | | | | - Wilmore Webley
- Department of Microbiology, University of Massachusetts Amherst, Amherst, MA
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Nagano M, Kamei K, Matsuda H, Takahashi C, Yang J, Wada K, Yonemoto N. Cost-effectiveness analysis of COVID-19 booster vaccination with BNT162b2 in Japan. Expert Rev Vaccines 2024; 23:349-361. [PMID: 38411109 DOI: 10.1080/14760584.2024.2323133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND The aim of this study was to evaluate the public health and economic impact of the COVID-19 booster vaccination with BNT162b2 in Japan during an Omicron-dominant period from early 2022. RESEARCH DESIGN AND METHODS A combined cohort Markov decision tree model estimated the cost-effectiveness of annual or biannual booster vaccination strategies compared to no booster vaccination for those aged 65 years and above, and those aged 60-64 years at high risk as the base case. The societal perspective was primarily considered. We also examined other target populations with different age and risk groups. Sensitivity and scenario analyses with alternative inputs were performed. RESULTS Annual and biannual vaccination strategies were dominant from the societal perspective in the base case. Incremental Cost Effectiveness Ratios (ICERs) from the payer perspective were JPY 1,752,499/Quality Adjusted Life Year (QALY) for annual vaccination and JPY 2,831,878/QALY for biannual vaccination, both less than the threshold value in Japan (JPY 5 million/QALY). The results were consistent even when examining other target age and risk groups. All sensitivity and scenario analyses indicated that ICERs were below JPY 5 million/QALY. CONCLUSIONS Booster vaccination with the COVID-19 vaccine BNT162b2 is a dominant strategy and beneficial to public health in Japan.
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Affiliation(s)
| | | | | | | | - Jingyan Yang
- Global Access and Value, Pfizer Inc., New York, NY, USA
- Institute for Social and Economic Research and Policy, Columbia University, New York, NY, USA
| | - Koji Wada
- mRNA & Antiviral Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
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