ABSTRACT
Since the emergence of Omicron variant of SARS-CoV-2 in late 2021, a number of sub-lineages have arisen and circulated internationally. Little is known about the relative severity of Omicron sub-lineages BA.2.75, BA.4.6 and BQ.1. We undertook a case-control analysis to determine the clinical severity of these lineages relative to BA.5, using whole genome sequenced, PCR-confirmed infections, between 1 August 2022 to 27 November 2022, among those who presented to emergency care in England 14 days after and up to one day prior to the positive specimen. A total of 10,375 episodes were included in the analysis, of which 5,207 (50.2%) were admitted to hospital or died. Multivariable conditional regression analyses found no evidence for greater odds of hospital admission or death among those with BA.2.75 (OR= 0.96, 95% CI: 0.84 to 1.09), and BA.4.6 (OR= 1.02, 95% CI: 0.88 to 1.17) or BQ.1 (OR= 1.03, 95 % CI: 0.94 to 1.13) compared to BA.5. Future lineages may not follow the same trend and there remains a need for continued surveillance of COVID-19 variants and their clinical outcomes to inform the public health response.
Subject(s)
Death , COVID-19ABSTRACT
Background Reinfection after primary SARS-CoV-2 infection is uncommon in adults, but little is known about the risks, characteristics, severity or outcomes of reinfection in children. Methods We used national SARS-CoV-2 testing data in England to estimate the risk of reinfection >90 days after primary infection from 01 January 2020 to 31 July 2021, which encompassed both the Alpha and Delta waves in England. Disease severity was assessed by linking reinfection cases to national hospitalisation, intensive care admission and death registrations datasets. Findings Reinfection rates closely followed community infection rates, with a small peak during the Alpha wave and a larger peak during the Delta wave. In children aged <16 years, there were 688,418 primary infections and 2,343 reinfections. The overall reinfection rate was 66.88/100,000 population, being higher in adults (72.53/100,000) than in children (21.53/100,000). Reinfection rates after primary infection were 0.68% overall, 0.73% in adults and 0.34% in children. Of the 109 reinfections in children admitted to hospital, 78 (72%) had underlying comorbidities. Hospitalisation rates were similar for the first (64/2343, 2.73%) and second episode (57/2343, 2.43%). Intensive care admission was rare after primary infection (n=7) or reinfection (n=4), mainly in children with comorbidities. 44 deaths occurred after primary infection within 28 days of diagnosis (44/688,418, 0.01%), none after possible reinfections. Interpretation The risk of SARS-CoV-2 reinfection is strongly related to exposure due to community infection rates, especially during the Delta variant wave. Children had a lower risk of reinfection than adults, but reinfections were not associated with more severe disease or fatal outcomes. Funding PHE/UKHSA
Subject(s)
COVID-19 , von Willebrand Disease, Type 3 , DeathABSTRACT
Background: Identifying mild cognitive impairment (MCI) at early stages is of importance both for research and for clinical practice. The Preclinical Alzheimer Cognitive Composite (PACC) is a composite score which can detect the first signs of cognitive impairment. It is designed to be administered in person, by a trained research psychologist or nurse, however, in-person assessments are costly, and are difficult during the current COVID-19 pandemic. The aims of this study are to assess the feasibility of performing the PACC assessment with videoconferencing, and to compare the validity of this remote PACC score with the in-person PACC score obtained previously.Methods: Participants from the HEalth and Ageing Data IN the Game of football (HEADING) Study who had already undergone an in-person assessment were re-contacted and re-assessed remotely. The correlation between the two PACC scores was estimated. The difference between the two PACC scores was calculated and used in multiple linear regression to assess which variables were associated with a difference in PACC scores.Findings: Of the 43 participants who were invited to this external study, 28 were re-assessed. The median duration in days between the in-person and the remote assessments was 236·5 days (7·9 months) (IQR 62·5). There was a strong positive correlation between the two assessments for the PACC score, with a Spearman correlation coefficient of 0·75 (95% CI 0·56, 0·95). The multiple linear regression found that the only predictor of the PACC difference was the time between assessments.Interpretation: This study provides evidence on the feasibility of performing cognitive tests online, with all four tests comprising the PACC being successfully administered through videoconferencing. This is relevant, especially during times when face-to-face assessments cannot be performed.Funding Statement: This study was funded by the Drake Foundation as part of the BRAIN study funded to London School of Hygiene and Tropical Medicine (EPMSZO61) in collaboration with Queen Mary University of London and the Institute of Occupational Health.Declaration of Interests: We declare that we have no conflict of interests. Ethics Approval Statement: The HEADING Study was approved by the London School of Hygiene & Tropical Medicine’s Ethical Committee (16282).