Clinical severity of COVID-19 in patients admitted to hospital during the omicron wave in South Africa: a retrospective observational study.
Clinical severity of COVID-19 in patients admitted to hospital during the omicron wave in South Africa: a retrospective observational study.
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DOI：
10.1016/s2214-109x(22)00114-0
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发表时间：
2022-07
影响因子：
34.3
通讯作者：
Cohen, Cheryl
中科院分区：
文献类型：
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作者：
Jassat, Waasila;Karim, Salim S. Abdool;Mudara, Caroline;Welch, Richard;Ozougwu, Lovelyn;Groome, Michelle J.;Govender, Nevashan;von Gottberg, Anne;Wolter, Nicole;Wolmarans, Milani;Rousseau, Petro;Blumberg, Lucille;Cohen, Cheryl
截至 2022 年 1 月底，南非已经经历了四波可识别的 COVID-19 大流行浪潮，每一波主要由一种令人担忧的变体主导：第一波期间具有 Asp614Gly 突变的祖先菌株，第二波期间的 beta 变体 (B.1.351)，第三波期间的 delta 变体 (B.1.617.2)，最后是第三波期间的 omicron 变体 (B.1.1.529)。第四波。我们的目的是评估 omicron 波期间因 SARS-CoV-2 感染入院的患者的临床疾病严重程度，并将结果与南非前三波大流行的结果进行比较。我们将每次大流行浪潮的开始和结束定义为每 10 万人口中每周出现 30 例实验室确诊的 SARS-CoV-2 病例的发病阈值。入院数据是通过一项活跃的国家 COVID-19 特定监测计划收集的。我们通过插补后随机效应多变量逻辑回归模型比较了不同波次的疾病严重程度。严重疾病被定义为以下一种或多种情况：急性呼吸窘迫、接受补充氧气或机械通气、接受重症监护或死亡。我们分析了 335~219 例实验室确诊的 SARS-CoV-2 入院病例，结果已知，占四波期间记录的 3~216~179 例病例的 10·4%。在 omicron 波期间，629 617 例中有 52 038 例 (8·3%) 入院，而 Asp614Gly 波中 553 530 例中有 71 411 (12·9%) 入院，β 波中 726 772 例中有 91 843 (12·6%) 入院， δ 波中 1 306 260 的 131 083 (10·0%) (p<0·0001)。在omicron波期间，45 927名入院患者中有15 421名(33·6%)患有严重疾病，而在Asp614Gly波中70 424名患者中有36 837名(52·3%)，在β波中90 310名中57 247名(63·4%)，以及δ 波中 128 558 中的 81 040 (63·0%) (p<0·0001)。 omicron 波期间的院内病死率为 10·7%，而 Asp614Gly 波期间为 21·5%，β 波期间为 28·8%，Delta 波期间为 26·4% (p<0·0001)。与 omicron 波期间入院的患者相比，其他 3 波期间入院的患者临床表现更为严重（调整后的比值比，Asp614Gly 波中为 2·07 [95% CI 2·01–2·13]，β 波中为 3·59 [3·49–3·70]，δ 波中为 3·47 [3·38–3·57]）。南非前三波病例和入院人数的增长趋势在omicron波中发生了转变，与前三波相比，峰值更高、更快，但入院患者更少，临床重症病例更少，病死率更低。 Omicron 标志着南非 SARS-CoV-2 流行曲线、临床特征和死亡人数的变化。外推到其他人群时应考虑不同的疫苗接种和既往感染水平。国家传染病研究所。
Up to the end of January, 2022, South Africa has had four recognisable COVID-19 pandemic waves, each predominantly dominated by one variant of concern: the ancestral strain with an Asp614Gly mutation during the first wave, the beta variant (B.1.351) during the second wave, the delta variant (B.1.617.2) during the third wave, and lastly, the omicron variant (B.1.1.529) during the fourth wave. We aimed to assess the clinical disease severity of patients admitted to hospital with SARS-CoV-2 infection during the omicron wave and compare the findings with those of the preceding three pandemic waves in South Africa. We defined the start and end of each pandemic wave as the crossing of the threshold of weekly incidence of 30 laboratory-confirmed SARS-CoV-2 cases per 100 000 population. Hospital admission data were collected through an active national COVID-19-specific surveillance programme. We compared disease severity across waves by post-imputation random effect multivariable logistic regression models. Severe disease was defined as one or more of the following: acute respiratory distress, receipt of supplemental oxygen or mechanical ventilation, admission to intensive care, or death. We analysed 335 219 laboratory-confirmed SARS-CoV-2 hospital admissions with a known outcome, constituting 10·4% of 3 216 179 cases recorded during the four waves. During the omicron wave, 52 038 (8·3%) of 629 617 cases were admitted to hospital, compared with 71 411 (12·9%) of 553 530 in the Asp614Gly wave, 91 843 (12·6%) of 726 772 in the beta wave, and 131 083 (10·0%) of 1 306 260 in the delta wave (p<0·0001). During the omicron wave, 15 421 (33·6%) of 45 927 patients admitted to hospital had severe disease, compared with 36 837 (52·3%) of 70 424 in the Asp614Gly wave, 57 247 (63·4%) of 90 310 in the beta wave, and 81 040 (63·0%) of 128 558 in the delta wave (p<0·0001). The in-hospital case-fatality ratio during the omicron wave was 10·7%, compared with 21·5% during the Asp614Gly wave, 28·8% during the beta wave, and 26·4% during the delta wave (p<0·0001). Compared with those admitted to hospital during the omicron wave, patients admitted during the other three waves had more severe clinical presentations (adjusted odds ratio 2·07 [95% CI 2·01–2·13] in the Asp614Gly wave, 3·59 [3·49–3·70] in the beta wave, and 3·47 [3·38–3·57] in the delta wave). The trend of increasing cases and admissions across South Africa's first three waves shifted in the omicron wave, with a higher and quicker peak but fewer patients admitted to hospital, less clinically severe illness, and a lower case-fatality ratio compared with the preceding three waves. Omicron marked a change in the SARS-CoV-2 epidemic curve, clinical profile, and deaths in South Africa. Extrapolations to other populations should factor in differing vaccination and previous infection levels. National Institute for Communicable Diseases.