Protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against the omicron variant and severe disease: a systematic review and meta-regression

The Lancet Infectious Diseases, Journal Year: 2023, Volume and Issue: 23(5), P. 556 - 567

Published: Jan. 18, 2023

BackgroundThe global surge in the omicron (B.1.1.529) variant has resulted many individuals with hybrid immunity (immunity developed through a combination of SARS-CoV-2 infection and vaccination). We aimed to systematically review magnitude duration protective effectiveness previous against severe disease caused by variant.MethodsFor this systematic meta-regression, we searched for cohort, cross-sectional, case–control studies MEDLINE, Embase, Web Science, ClinicalTrials.gov, Cochrane Central Register Controlled Trials, WHO COVID-19 database, Europe PubMed from Jan 1, 2020, June 2022, using keywords related SARS-CoV-2, reinfection, effectiveness, infection, presence antibodies, immunity. The main outcomes were reinfection hospital admission or immunity, relative alone, vaccination fewer vaccine doses. Risk bias was assessed Bias In Non-Randomized Studies Interventions Tool. used log-odds random-effects meta-regression estimate protection at 1-month intervals. This study registered PROSPERO (CRD42022318605).Findings11 reporting 15 included. For there 97 estimates (27 moderate risk 70 serious bias). 74·6% (95% CI 63·1–83·5) 12 months. waned 24·7% 16·4–35·5) 153 (78 75 97·4% 91·4–99·2) months primary series 95·3% (81·9–98·9) 6 first booster after most recent vaccination. Against following 41·8% 31·5–52·8) months, while 46·5% (36·0–57·3) months.InterpretationAll within but remained high sustained disease. Individuals had highest durability protection, as result might be able extend period before vaccinations are needed compared who have never been infected.FundingWHO Solidarity Response Fund Coalition Epidemic Preparedness Innovations.

Language: Английский

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Distinguishing features of long COVID identified through immune profiling

Nature, Journal Year: 2023, Volume and Issue: 623(7985), P. 139 - 148

Published: Sept. 25, 2023

Abstract Post-acute infection syndromes may develop after acute viral disease 1 . Infection with SARS-CoV-2 can result in the development of a post-acute syndrome known as long COVID. Individuals COVID frequently report unremitting fatigue, post-exertional malaise, and variety cognitive autonomic dysfunctions 2–4 However, biological processes that are associated persistence these symptoms unclear. Here 275 individuals or without were enrolled cross-sectional study included multidimensional immune phenotyping unbiased machine learning methods to identify features Marked differences noted circulating myeloid lymphocyte populations relative matched controls, well evidence exaggerated humoral responses directed against among participants Furthermore, higher antibody non-SARS-CoV-2 pathogens observed COVID, particularly Epstein–Barr virus. Levels soluble mediators hormones varied groups, cortisol levels being lower Integration data into models identified key most strongly status. Collectively, findings help guide future studies pathobiology developing relevant biomarkers.

Language: Английский

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Acute and postacute sequelae associated with SARS-CoV-2 reinfection

Nature Medicine, Journal Year: 2022, Volume and Issue: 28(11), P. 2398 - 2405

Published: Nov. 1, 2022

Abstract First infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated increased risk of and postacute death sequelae in various organ systems. Whether reinfection adds to risks incurred after first unclear. Here we used the US Department Veterans Affairs’ national healthcare database build a cohort individuals one SARS-CoV-2 ( n = 443,588), (two or more infections, 40,947) noninfected control 5,334,729). We inverse probability-weighted survival models estimate 6-month burdens death, hospitalization incident sequelae. Compared no reinfection, contributed additional (hazard ratio (HR) 2.17, 95% confidence intervals (CI) 1.93–2.45), (HR 3.32, CI 3.13–3.51) including pulmonary, cardiovascular, hematological, diabetes, gastrointestinal, kidney, mental health, musculoskeletal neurological disorders. The were evident regardless vaccination status. most pronounced phase but persisted at 6 months. controls, cumulative repeat according number infections. Limitations included mostly white males. evidence shows that further increases multiple systems phase. Reducing overall burden disease due will require strategies for prevention.

Language: Английский

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The neurobiology of long COVID

Neuron, Journal Year: 2022, Volume and Issue: 110(21), P. 3484 - 3496

Published: Oct. 7, 2022

Persistent neurological and neuropsychiatric symptoms affect a substantial fraction of people after COVID-19 represent major component the post-acute syndrome, also known as long COVID. Here, we review what is understood about pathobiology impact on CNS discuss possible neurobiological underpinnings cognitive affecting survivors. We propose chief mechanisms that may contribute to this emerging health crisis.

Language: Английский

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The immunology of long COVID

Nature reviews. Immunology, Journal Year: 2023, Volume and Issue: 23(10), P. 618 - 634

Published: July 11, 2023

Language: Английский

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Postacute sequelae of COVID-19 at 2 years

Nature Medicine, Journal Year: 2023, Volume and Issue: 29(9), P. 2347 - 2357

Published: Aug. 21, 2023

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to postacute sequelae in multiple organ systems, but evidence is mostly limited the first year postinfection. We built a cohort of 138,818 individuals with SARS-CoV-2 and 5,985,227 noninfected control group from US Department Veterans Affairs followed them for years estimate risks death 80 prespecified COVID-19 (PASC) according care setting during phase infection. The increased risk was not significant beyond 6 months after among nonhospitalized remained significantly elevated through hospitalized individuals. Within sequelae, 69% 35% became at individuals, respectively. Cumulatively years, PASC contributed 80.4 (95% confidence interval (CI): 71.6-89.6) 642.8 CI: 596.9-689.3) disability-adjusted life (DALYs) per 1,000 persons individuals; 25.3% (18.9-31.0%) 21.3% (18.2-24.5%) cumulative 2-year DALYs were second year. In sum, while many declined infection, substantial burden health loss due calls attention needs people long-term effects

Language: Английский

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Association of Treatment With Nirmatrelvir and the Risk of Post–COVID-19 Condition

JAMA Internal Medicine, Journal Year: 2023, Volume and Issue: 183(6), P. 554 - 554

Published: March 23, 2023

Importance Post–COVID-19 condition (PCC), also known as long COVID, affects many individuals. Prevention of PCC is an urgent public health priority. Objective To examine whether treatment with nirmatrelvir in the acute phase COVID-19 associated reduced risk PCC. Design, Setting, and Participants This cohort study used care databases US Department Veterans Affairs (VA) to identify patients who had a SARS-CoV-2 positive test result between January 3, 2022, December 31, were not hospitalized on day result, at least 1 factor for progression severe illness, survived first 30 days after diagnosis. Those treated oral within 5 (n = 35 717) those received no antiviral or antibody during infection (control group, n 246 076) identified. Exposures Treatment receipt based prescription records. Main Outcomes Measures Inverse probability weighted survival models estimate association (vs control) post–acute death, hospitalization, prespecified panel 13 sequelae (components PCC) reported relative scale (RR) hazard ratio (HR) absolute reduction percentage 180 (ARR). Results A total 281 793 (mean [SD] age, 61.99 [14.96]; 242 383 [86.01%] male) illness studied. Among them, 076 infection, 717 result. Compared control was (RR, 0.74; 95% CI, 0.72-0.77; ARR, 4.51%; 4.01-4.99), including 10 cardiovascular system (dysrhythmia ischemic heart disease), coagulation hematologic disorders (pulmonary embolism deep vein thrombosis), fatigue malaise, kidney disease, muscle pain, neurologic (neurocognitive impairment dysautonomia), shortness breath. Nirmatrelvir death (HR, 0.53; 0.46-0.61); 0.65%; 0.54-0.77), hospitalization 0.76; 0.73-0.80; 1.72%; 1.42-2.01). people unvaccinated, vaccinated, boosted, primary reinfection. Conclusions Relevance found that across spectrum this regardless vaccination status history prior infection; totality findings suggests may reduce adverse outcomes.

Language: Английский

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Data-driven identification of post-acute SARS-CoV-2 infection subphenotypes

Nature Medicine, Journal Year: 2022, Volume and Issue: 29(1), P. 226 - 235

Published: Dec. 1, 2022

Abstract The post-acute sequelae of SARS-CoV-2 infection (PASC) refers to a broad spectrum symptoms and signs that are persistent, exacerbated or newly incident in the period after acute infection. Most studies have examined these conditions individually without providing evidence on co-occurring conditions. In this study, we leveraged electronic health record data two large cohorts, INSIGHT OneFlorida+, from national Patient-Centered Clinical Research Network. We created development cohort validation OneFlorida+ including 20,881 13,724 patients, respectively, who were infected, investigated their diagnoses 30–180 days documented Through machine learning analysis over 137 conditions, identified four reproducible PASC subphenotypes, dominated by cardiac renal (including 33.75% 25.43% patients cohorts); respiratory, sleep anxiety (32.75% 38.48%); musculoskeletal nervous system (23.37% 23.35%); digestive respiratory (10.14% 12.74%) sequelae. These subphenotypes associated with distinct patient demographics, underlying before phase severity. Our study provides insights into heterogeneity may inform stratified decision-making management

Language: Английский

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SARS-CoV-2 Spike protein induces TLR4-mediated long-term cognitive dysfunction recapitulating post-COVID-19 syndrome in mice

Cell Reports, Journal Year: 2023, Volume and Issue: 42(3), P. 112189 - 112189

Published: Feb. 17, 2023

Cognitive dysfunction is often reported in patients with post-coronavirus disease 2019 (COVID-19) syndrome, but its underlying mechanisms are not completely understood. Evidence suggests that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Spike protein or fragments released from cells during infection, reaching different tissues, including the CNS, irrespective of presence viral RNA. Here, we demonstrate brain infusion mice has a late impact on cognitive function, recapitulating post-COVID-19 syndrome. We also show neuroinflammation and hippocampal microgliosis mediate Spike-induced memory via complement-dependent engulfment synapses. Genetic pharmacological blockage Toll-like receptor 4 (TLR4) signaling protects animals against synapse elimination induced by infusion. Accordingly, cohort 86 who recovered mild COVID-19, genotype GG TLR4-2604G>A (rs10759931) associated poor outcome. These results identify TLR4 as key target to investigate long-term after COVID-19 infection humans rodents.

Language: Английский

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Long COVID science, research and policy

Nature Medicine, Journal Year: 2024, Volume and Issue: 30(8), P. 2148 - 2164

Published: Aug. 1, 2024

Long COVID represents the constellation of post-acute and long-term health effects caused by SARS-CoV-2 infection; it is a complex, multisystem disorder that can affect nearly every organ system be severely disabling. The cumulative global incidence long around 400 million individuals, which estimated to have an annual economic impact approximately $1 trillion-equivalent about 1% economy. Several mechanistic pathways are implicated in COVID, including viral persistence, immune dysregulation, mitochondrial dysfunction, complement endothelial inflammation microbiome dysbiosis. devastating impacts on individual lives and, due its complexity prevalence, also has major ramifications for systems economies, even threatening progress toward achieving Sustainable Development Goals. Addressing challenge requires ambitious coordinated-but so far absent-global research policy response strategy. In this interdisciplinary review, we provide synthesis state scientific evidence assess human health, systems, economy metrics, forward-looking roadmap.

Language: Английский

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