Clinical outcomes associated with SARS-CoV-2 Omicron (B.1.1.529) variant and BA.1/BA.1.1 or BA.2 subvariant infection in Southern California.
Clinical outcomes associated with SARS-CoV-2 Omicron (B.1.1.529) variant and BA.1/BA.1.1 or BA.2 subvariant infection in Southern California.
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DOI：
10.1038/s41591-022-01887-z
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发表时间：
2022-09
期刊：
影响因子：
82.9
通讯作者：
Tartof, Sara Y.
中科院分区：
文献类型：
--
作者：
Lewnard, Joseph A.;Hong, Vennis X.;Patel, Manish M.;Kahn, Rebecca;Lipsitch, Marc;Tartof, Sara Y.
SARS-CoV-2的Omicron （B.1.1.529）变体自2021年11月在南部非洲出现后迅速实现了全球传播。流行病学监测显示，在Omicron变体出现后，COVID-19病例与住院率和病例与死亡率发生了变化，尽管对这些变化的解释存在挑战，因为对Omicron或Delta （B.1.617.2）变体SARS-CoV-2感染的不同保护与先前的疫苗衍生性和自然获得性免疫有关，以及检测和医疗保健实践的长期变化。在这里，我们报告了在Kaiser Permanente南加州医疗保健系统中222,688例Omicron变异感染和23,305例Delta变异感染的临床结果，这些患者在2021年12月15日至2022年1月17日期间进行了纵向随访，当时Omicron病例几乎完全为BA.1或其亚谱系。在欧米克隆与德尔塔变异感染病例中，进展到任何住院、有症状住院、重症监护病房住院、机械通气和死亡的调整风险比分别为0.59（95%可信区间：0.51-0.69）、0.59（0.51-0.68）、0.50（0.29-0.87）、0.36（0.18-0.72）和0.21（0.10-0.44）。相比之下，在2022年2月3日至3月17日期间通过门诊检测确定的14,661例Omicron病例中，BA.2或BA.1/BA.1.1亚变体感染没有显示出严重结局的差异风险的证据。在将Omicron变体确定为全球主要流行的SARS-CoV-2谱系的背景下，在规划卫生保健能力需求时，应考虑到Omicron变体感染病例严重临床结局的较低风险，并应为病例和医院监测数据的解释提供信息。
The Omicron (B.1.1.529) variant of SARS-CoV-2 rapidly achieved global dissemination following its emergence in southern Africa in November, 2021. Epidemiologic surveillance has revealed changes in COVID-19 case-to-hospitalization and case-to-mortality ratios following Omicron variant emergence, although interpretation of these changes presents challenges due to differential protection against Omicron or Delta (B.1.617.2) variant SARS-CoV-2 infections associated with prior vaccine-derived and naturally-acquired immunity, as well as longer-term changes in testing and healthcare practices. Here we report clinical outcomes among 222,688 cases with Omicron variant infections and 23,305 time-matched cases with Delta variant infections within the Kaiser Permanente Southern California healthcare system, who were followed longitudinally following positive outpatient tests between 15 December, 2021 and 17 January, 2022, when Omicron cases were almost exclusively BA.1 or its sublineages. Adjusted hazard ratios of progression to any hospital admission, symptomatic hospital admission, intensive care unit admission, mechanical ventilation, and death were 0.59 (95% confidence interval: 0.51-0.69), 0.59 (0.51-0.68), 0.50 (0.29-0.87), 0.36 (0.18-0.72), and 0.21 (0.10-0.44) respectively, for cases with Omicron versus Delta variant infections. In contrast, among 14,661 Omicron cases ascertained by outpatient testing between 3 February and 17 March, 2022, infection with the BA.2 or BA.1/BA.1.1 subvariants did not show evidence of differential risk of severe outcomes. Lower risk of severe clinical outcomes among cases with Omicron variant infection merits consideration in planning of healthcare capacity needs amid establishment of the Omicron variant as the dominant circulating SARS-CoV-2 lineage globally, and should inform the interpretation of both case- and hospital-based surveillance data.
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2022-04-21
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发表时间：
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影响因子：
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Veesler, David