Post-Acute Sequelae After Severe Acute Respiratory Syndrome Coronavirus 2 Infection by Viral Variant and Vaccination Status: A Multicenter Cross-Sectional Study

Christian R Kahlert; Carol Strahm; Sabine Güsewell; Alexia Cusini; Angela Brucher; Stephan Goppel; Elisabeth Möller; J Carsten Möller; Manuela Ortner; Markus Ruetti; Reto Stocker; Danielle Vuichard-Gysin; Ulrike Besold; Allison McGeer; Lorenz Risch; Andrée Friedl; Matthias Schlegel; Pietro Vernazza; Stefan P Kuster; Philipp Kohler; SURPRISE (SURveillance of infectious diseases among health PRofessionals In SwitzErland) Study Group

doi:10.1093/cid/ciad143

Post-Acute Sequelae After Severe Acute Respiratory Syndrome Coronavirus 2 Infection by Viral Variant and Vaccination Status: A Multicenter Cross-Sectional Study

Clin Infect Dis. 2023 Jul 26;77(2):194-202. doi: 10.1093/cid/ciad143.

Authors

Christian R Kahlert^{1

2}, Carol Strahm¹, Sabine Güsewell¹, Alexia Cusini³, Angela Brucher⁴, Stephan Goppel⁵, Elisabeth Möller⁶, J Carsten Möller⁷, Manuela Ortner⁸, Markus Ruetti⁹, Reto Stocker¹⁰, Danielle Vuichard-Gysin^{11

12}, Ulrike Besold¹³, Allison McGeer¹⁴, Lorenz Risch^{15

16

17}, Andrée Friedl¹⁸, Matthias Schlegel¹, Pietro Vernazza¹, Stefan P Kuster¹, Philipp Kohler¹; SURPRISE (SURveillance of infectious diseases among health PRofessionals In SwitzErland) Study Group

Collaborators

SURPRISE (SURveillance of infectious diseases among health PRofessionals In SwitzErland) Study Group:
Ulrike Besold, Angela Brucher, Alexia Cusini, Thomas Egger, Andrée Friedl, Stephan Goppel, Fabian Grässli, Christian R Kahlert, Joelle Keller, Simone Kessler, Philipp Kohler, Stefan P Kuster, Onicio Leal, Eva Lemmenmeier, Allison McGeer, Dorette Meier Kleeb, Elisabeth Möller, J Carsten Möller, Maja F Müller, Vaxhid Musa, Manuela Ortner, Philip Rieder, Lorenz Risch, Markus Ruetti, Matthias Schlegel, Hans-Ruedi Schmid, Reto Stocker, Pietro Vernazza, Matthias von Kietzell, Danielle Vuichard-Gysin, Benedikt Wiggli

Affiliations

¹ Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St. Gallen, Switzerland.
² Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
³ Division of Infectious Diseases, Cantonal Hospital of Grisons, Chur, Switzerland.
⁴ Ambulatory Services, Psychiatry Services of the Canton of St. Gallen (South), St. Gallen, Switzerland.
⁵ Ambulatory Services, Psychiatry Services of the Canton of St. Gallen (North), St. Gallen, Switzerland.
⁶ Department of Psychiatry, Clienia Littenheid, Littenheid, Switzerland.
⁷ Center for Neurological Rehabilitation, Zihlschlacht, Switzerland.
⁸ Rheintal Werdenberg Sarganserland Hospital Group, Grabs, Switzerland.
⁹ Fuerstenland Toggenburg Hospital Group, Wil, Switzerland.
¹⁰ Hirslanden Clinic, Zurich, Switzerland.
¹¹ Division of Infectious Diseases and Hospital Epidemiology, Thurgau Hospital Group, Muensterlingen, Switzerland.
¹² Department of Research and Development, Swiss National Centre for Infection Prevention (Swissnoso), Berne, Switzerland.
¹³ Geriatric Clinic St. Gallen, St. Gallen, Switzerland.
¹⁴ Sinai Health System, Toronto, Canada.
¹⁵ Labormedizinisches Zentrum Dr Risch Ostschweiz AG, Buchs, Switzerland.
¹⁶ Private Universität im Fürstentum Liechtenstein, Triesen, Liechtenstein.
¹⁷ Center of Laboratory Medicine, University Institute of Clinical Chemistry, University of Bern, Inselspital, Bern, Switzerland.
¹⁸ Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital Baden, Baden, Switzerland.

Abstract

Background: Disentangling the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and vaccination on the occurrence of post-acute sequelae of SARS-CoV-2 (PASC) is crucial to estimate and reduce the burden of PASC.

Methods: We performed a cross-sectional analysis (May/June 2022) within a prospective multicenter healthcare worker (HCW) cohort in north-eastern Switzerland. HCWs were stratified by viral variant and vaccination status at time of their first positive SARS-CoV-2 nasopharyngeal swab. HCWs without positive swab and with negative serology served as controls. The sum of 18 self-reported PASC symptoms was modeled with univariable and multivariable negative-binomial regression to analyze the association of mean symptom number with viral variant and vaccination status.

Results: Among 2912 participants (median age: 44 years; 81.3% female), PASC symptoms were significantly more frequent after wild-type infection (estimated mean symptom number: 1.12; P < .001; median time since infection: 18.3 months), after Alpha/Delta infection (0.67 symptoms; P < .001; 6.5 months), and after Omicron BA.1 infections (0.52 symptoms; P = .005; 3.1 months) versus uninfected controls (0.39 symptoms). After Omicron BA.1 infection, the estimated mean symptom number was 0.36 for unvaccinated individuals versus 0.71 with 1-2 vaccinations (P = .028) and 0.49 with ≥3 prior vaccinations (P = .30). Adjusting for confounders, only wild-type (adjusted rate ratio [aRR]: 2.81; 95% confidence interval [CI]: 2.08-3.83) and Alpha/Delta infections (aRR: 1.93; 95% CI: 1.10-3.46) were significantly associated with the outcome.

Conclusions: Previous infection with pre-Omicron variants was the strongest risk factor for PASC symptoms among our HCWs. Vaccination before Omicron BA.1 infection was not associated with a clear protective effect against PASC symptoms in this population.

Keywords: healthcare workers; long COVID; post-acute sequelae of SARS-CoV-2; vaccination; viral variant.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
COVID-19* / complications
Cross-Sectional Studies
Disease Progression
Female
Humans
Male
Prospective Studies
SARS-CoV-2
Vaccination

Supplementary concepts

SARS-CoV-2 variants