Association of COVID-19 Vaccination With Risk of Medically Attended Postacute Sequelae of COVID-19 During the Ancestral, Alpha, Delta, and Omicron Variant Eras

Sep 18, 2024Open forum infectious diseases

COVID-19 Vaccination and the Risk of Long-Term COVID Symptoms Needing Medical Care Across Different Variant Periods

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Abstract

6.9% of patients experienced medically attended and diagnosed postacute sequelae of COVID-19 (PASC).

A diagnosis of PASC was associated with older age and female sex.
Patients who were hospitalized for their initial SARS-CoV-2 infection had a higher likelihood of developing PASC.
An increased severity-weighted comorbidity index was linked to a higher risk of PASC.
Infection during the Omicron variant period was associated with a lower risk of developing PASC.
No difference in PASC development was found between unvaccinated patients and those vaccinated with either 2 doses of an mRNA vaccine or more than 2 doses.

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BACKGROUND: Uncertainty exists regarding the effectiveness of COVID-19 vaccine to prevent postacute sequelae of COVID-19 (PASC) following a breakthrough infection. While most studies based on symptom surveys found an association between preinfection vaccination status and PASC symptoms, studies of medically attended PASC are less common and have reported conflicting findings.

METHODS: In this retrospective cohort of patients with an initial SARS-CoV-2 infection who were continually empaneled for primary care in a large US health system, the electronic health record was queried for preinfection vaccination status, demographics, comorbidity index, and diagnosed conditions. Multivariable logistic regression was used to model the outcome of a medically attended PASC diagnosis within 6 months of SARS-CoV-2 infection. Likelihood ratio tests were used to assess the interaction between vaccination status and prevalent variant at the time of infection and between vaccination status and hospitalization for SARS-CoV-2 infection.

RESULTS: During the observation period, 6.9% of patients experienced medically attended and diagnosed PASC. A diagnosis of PASC was associated with older age, female sex, hospitalization for the initial infection, and an increased severity-weighted comorbidity index and was inversely associated with infection during the Omicron period. No difference in the development of diagnosed PASC was observed between unvaccinated patients and those vaccinated with either 2 doses of an mRNA vaccine or >2 doses.

CONCLUSIONS: We found no association between vaccination status at the time of infection and development of medically diagnosed PASC. Vaccine remains an important measure to prevent SARS-CoV-2 infection and severity. Further research is needed to identify effective measures to prevent and treat PASC.

Key numbers

2888 of 41 652

Incidence of Medically Attended PASC

Patients diagnosed with PASC within 6 months of infection

9744 (23.4%) with 2 mRNA doses; 7658 (18.4%) with >2 mRNA doses

Vaccination Status Distribution

Total vaccinated patients at the time of initial infection

1.17 per decade

PASC Association with Age

Adjusted odds ratio for age in relation to PASC diagnosis

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Association of COVID-19 Vaccination With Risk of Medically Attended Postacute Sequelae of COVID-19 During the Ancestral, Alpha, Delta, and Omicron Variant Eras

Abstract

Key numbers

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