Acute and Postacute COVID-19 Outcomes Among Immunologically Naive Adults During Delta vs Omicron Waves.
Acute and Postacute COVID-19 Outcomes Among Immunologically Naive Adults During Delta vs Omicron Waves.
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DOI：
10.1001/jamanetworkopen.2023.1181
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发表时间：
2023-02-01
影响因子：
13.8
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中科院分区：
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在Omicron（BA.1/BA.2）波期间感染SARS-CoV-2的先前未感染和未接种疫苗的成年人的急性和急性后结果是什么，这些与Delta波期间的感染相比如何？在这项队列研究中，274名年龄在30岁至65岁以下的免疫学初治成年人中，61%感染了SARS-CoV-2，6%的感染者无症状。与Delta波期间的感染相比，Omicron波期间感染的人在医疗保健使用方面的相对风险降低了79%，急性后症状的相对风险降低了56%，急性后症状的相对比率降低了79%。这些研究结果表明，无症状感染可能是相对罕见的免疫幼稚的成年人，并在三角洲波感染相比，在Omicron波感染的个人有较低的可能性，严重的疾病和急性后症状。这项队列研究检查了SARS-CoV-2感染的急性和急性后临床结果在三角洲和Omicron波在以前的免疫幼稚的成年人。Omicron变异体抵达美国导致SARS-CoV-2感染迅速增加。虽然许多研究报告了接种疫苗的个体或既往感染者中Omicron感染的特征，但缺乏描述免疫学幼稚成人感染的全面数据。在Omicron（BA.1/BA.2）激增期间感染SARS-CoV-2的未接种疫苗和先前未感染的成年人中，检查COVID-19急性和急性后临床结局，并将结局与Delta波期间发生的感染进行比较。这项前瞻性多中心队列研究包括2021年6月至2022年9月期间在美国8个州接受高分辨率症状和病毒学监测的社区居民成年人。招募了年龄在30岁至65岁以下、无SARS-CoV-2免疫史、感染风险高的未接种疫苗的成年人。参与者被随访长达48周，定期提交COVID-19症状调查和鼻拭子进行SARS-CoV-2聚合酶链反应（PCR）检测。数据分析时间为2022年5月至10月。Omicron（BA.1/BA.2谱系）vs Delta SARS-CoV-2感染，定义为在参与者所在地理区域内，当该变体代表至少50%的流行SARS-CoV-2变体时，PCR检测结果呈阳性。检查的主要结局是急性（发病后≤28天）和急性后（发病后≥5周）症状的患病率和严重程度。在274名免疫学未接受过治疗的参与者中（平均[SD]年龄，49 [9.7]岁; 186名[68%]女性; 19名[7%]西班牙裔参与者; 242名[88%]白色参与者），166名（61%）感染了SARS-CoV-2。其中，137例感染（83%）发生在Omicron占主导地位的时期，29例感染（17%）发生在Delta占主导地位的时期。无症状感染发生率为7%（95%CI，3%-12%）的O波感染和0%（95%CI，0%-12%）的Delta波感染。O波感染者的医疗保健使用率比Delta波感染者低79%（95%CI，43%-92%）（P = 0.001）。与Delta波期间感染的个体相比，Omicron波期间感染的个体也经历了56%（95%CI，26%-74%，P = 0.004）的急性后症状风险相对降低和79%（95%CI，54%-91%，P <0.001）的急性后症状率相对降低。这些发现表明，在以前免疫学上幼稚的成年人中，很少有O-波（BA.1/BA.2）和Δ-波感染是无症状的。与Delta波感染的个体相比，Omicron波感染的个体不太可能寻求医疗保健和经历急性期后症状。
What are acute and postacute outcomes among adults previously uninfected and unvaccinated who were infected with SARS-CoV-2 during the Omicron (BA.1/BA.2) wave, and how do these compare with infections during the Delta wave? In this cohort study of 274 immunologically naive adults aged 30 to less than 65 years, 61% contracted SARS-CoV-2, with 6% of infections being asymptomatic. Compared with infections during the Delta wave, people infected during the Omicron wave experienced a 79% relative risk reduction in health care use, 56% reduction in the relative risk of postacute symptoms, and 79% reduction in the relative rate of postacute symptoms. These findings suggest that asymptomatic infection may have been relatively rare among immunologically naive adults and that, compared with infections during the Delta wave, individuals infected during the Omicron wave had lower likelihoods of severe illness and postacute symptoms. This cohort study examines acute and postacute clinical outcomes of SARS-CoV-2 infection during the Delta and Omicron waves among previously immunologically naive adults. The US arrival of the Omicron variant led to a rapid increase in SARS-CoV-2 infections. While numerous studies report characteristics of Omicron infections among vaccinated individuals or persons with previous infection, comprehensive data describing infections among adults who are immunologically naive are lacking. To examine COVID-19 acute and postacute clinical outcomes among a well-characterized cohort of unvaccinated and previously uninfected adults who contracted SARS-CoV-2 during the Omicron (BA.1/BA.2) surge, and to compare outcomes with infections that occurred during the Delta wave. This prospective multisite cohort study included community-dwelling adults undergoing high-resolution symptom and virologic monitoring in 8 US states between June 2021 and September 2022. Unvaccinated adults aged 30 to less than 65 years without an immunological history of SARS-CoV-2 who were at high risk of infection were recruited. Participants were followed for up to 48 weeks, submitting regular COVID-19 symptom surveys and nasal swabs for SARS-CoV-2 polymerase chain reaction (PCR) testing. Data were analyzed from May to October 2022. Omicron (BA.1/BA.2 lineages) vs Delta SARS-CoV-2 infection, defined as a positive PCR test result that occurred during a period when the variant represented at least 50% of circulating SARS-CoV-2 variants in the participant’s geographic region. The main outcomes examined were the prevalence and severity of acute (≤28 days after onset) and postacute (≥5 weeks after onset) symptoms. Among 274 participants who were immunologically naive (mean [SD] age, 49 [9.7] years; 186 [68%] female; 19 [7%] Hispanic participants; 242 [88%] White participants), 166 (61%) contracted SARS-CoV-2. Of these, 137 infections (83%) occurred during the Omicron-predominant period and 29 infections (17%) occurred during the Delta-predominant period. Asymptomatic infections occurred among 7% (95% CI, 3%-12%) of Omicron-wave infections and 0% (95% CI, 0%-12%) of Delta-wave infections. Health care use among individuals with Omicron-wave infections was 79% (95% CI, 43%-92%) lower relative to individuals with Delta-wave infections (P = .001). Compared with individuals infected during the Delta wave, individuals infected during the Omicron wave also experienced a 56% (95% CI, 26%-74%, P = .004) relative reduction in the risk of postacute symptoms and a 79% (95% CI, 54%-91%, P < .001) relative reduction in the rate of postacute symptoms. These findings suggest that among adults who were previously immunologically naive, few Omicron-wave (BA.1/BA.2) and Delta-wave infections were asymptomatic. Compared with individuals with Delta-wave infections, individuals with Omicron-wave infections were less likely to seek health care and experience postacute symptoms.
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DOI：
10.15585/mmwr.mm7117e3
发表时间：
2022-04-29
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
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作者：
通讯作者：
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DOI：
10.1016/s0140-6736(22)00462-7
发表时间：
2022-04-02
期刊：
Lancet (London, England)
影响因子：
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作者：
Nyberg T;Ferguson NM;Nash SG;Webster HH;Flaxman S;Andrews N;Hinsley W;Bernal JL;Kall M;Bhatt S;Blomquist P;Zaidi A;Volz E;Aziz NA;Harman K;Funk S;Abbott S;COVID-19 Genomics UK (COG-UK) consortium;Hope R;Charlett A;Chand M;Ghani AC;Seaman SR;Dabrera G;De Angelis D;Presanis AM;Thelwall S
通讯作者：
Thelwall S
DOI：
10.1016/s0140-6736(22)00327-0
发表时间：
2022-04-23
期刊：
Lancet (London, England)
影响因子：
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作者：
Menni C;Valdes AM;Polidori L;Antonelli M;Penamakuri S;Nogal A;Louca P;May A;Figueiredo JC;Hu C;Molteni E;Canas L;Österdahl MF;Modat M;Sudre CH;Fox B;Hammers A;Wolf J;Capdevila J;Chan AT;David SP;Steves CJ;Ourselin S;Spector TD
通讯作者：
Spector TD
DOI：
10.1038/s41577-022-00678-4
发表时间：
2022-03
期刊：
Nature reviews. Immunology
影响因子：
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作者：
Sigal A
通讯作者：
Sigal A
DOI：
10.1016/j.ajpath.2022.01.007
发表时间：
2022-04
期刊：
The American journal of pathology
影响因子：
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作者：
Christensen PA;Olsen RJ;Long SW;Snehal R;Davis JJ;Ojeda Saavedra M;Reppond K;Shyer MN;Cambric J;Gadd R;Thakur RM;Batajoo A;Mangham R;Pena S;Trinh T;Kinskey JC;Williams G;Olson R;Gollihar J;Musser JM
通讯作者：
Musser JM