RESUMEN
Whilst many with SARS-CoV-2 infection have mild disease, managed in the community, individuals with cardiovascular risk factors experienced often more severe acute disease, requiring hospitalisation. Increasing concern has also developed over long symptom duration in many individuals, including the majority who managed acutely in the community. Risk factors for long symptom duration, including biological variables, are still poorly defined. We examine post-illness metabolomic and gut-microbiome profiles, in community-dwelling participants with SARS-CoV-2, ranging from asymptomatic illness to Post-COVID Syndrome, and participants with prolonged non-COVID-19 illnesses. We also assess a pre-established metabolomic biomarker score for its association with illness duration. We found an atherogenic-dyslipidaemic metabolic profile, and greater biomarker scores, associated with longer illness, both in individuals with and without SARS-CoV-2 infection. We found no association between illness duration and gut microbiome in convalescence. Findings highlight the potential role of cardiometabolic dysfunction to the experience of long illness duration, including after COVID-19.
RESUMEN
High COVID-19 mortality among nursing home (NH) residents led to their prioritization for SARS-CoV-2 vaccination; most NH residents received BNT162b2 mRNA vaccination under the Emergency Use Authorization due to first to market and its availability. With NH residents poor initial vaccine response, the rise of NH breakthrough infections and outbreaks, characterization of the durability of immunity to inform public health policy on the need for boosting is needed. We report on humoral immunity from 2 weeks to 6-months post-vaccination in 120 NH residents and 92 ambulatory healthcare worker controls with and without pre-vaccination SARS-CoV-2 infection. Anti-spike and anti-receptor binding domain (RBD) IgG, and serum neutralization titers, were assessed using a bead-based ELISA method and pseudovirus neutralization assay. Anti-spike, anti-RBD and neutralization levels dropped more than 84% over 6 months time in all groups irrespective of prior SARS-CoV-2 infection. At 6 months post-vaccine, 70% of the infection-naive NH residents had neutralization titers at or below the lower limit of detection compared to 16% at 2 weeks after full vaccination. These data demonstrate a significant reduction in levels of antibody in all groups. In particular, those infection-naive NH residents had lower initial post-vaccination humoral immunity immediately and exhibited the greatest declines 6 months later. Healthcare workers, given their younger age and relative good-health, achieved higher initial antibody levels and better maintained them, yet also experienced significant declines in humoral immunity. Based on the rapid spread of the delta variant and reports of vaccine breakthrough in NH and among younger community populations, boosting NH residents may be warranted.
RESUMEN
ObjectivePoor metabolic health and certain lifestyle factors have been associated with risk and severity of coronavirus disease 2019 (COVID-19), but data for diet are lacking. We aimed to investigate the association of diet quality with risk and severity of COVID-19 and its intersection with socioeconomic deprivation. DesignWe used data from 592,571 participants of the smartphone-based COVID Symptom Study. Diet quality was assessed using a healthful plant-based diet score, which emphasizes healthy plant foods such as fruits or vegetables. Multivariable Cox models were fitted to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for COVID-19 risk and severity defined using a validated symptom-based algorithm or hospitalization with oxygen support, respectively. ResultsOver 3,886,274 person-months of follow-up, 31,815 COVID-19 cases were documented. Compared with individuals in the lowest quartile of the diet score, high diet quality was associated with lower risk of COVID-19 (HR, 0.91; 95% CI, 0.88-0.94) and severe COVID-19 (HR, 0.59; 95% CI, 0.47-0.74). The joint association of low diet quality and increased deprivation on COVID-19 risk was higher than the sum of the risk associated with each factor alone (Pinteraction=0.005). The corresponding absolute excess rate for lowest vs highest quartile of diet score was 22.5 (95% CI, 18.8-26.3) and 40.8 (95% CI, 31.7-49.8; 10,000 person-months) among persons living in areas with low and high deprivation, respectively. ConclusionsA dietary pattern characterized by healthy plant-based foods was associated with lower risk and severity of COVID-19. These association may be particularly evident among individuals living in areas with higher socioeconomic deprivation.
RESUMEN
BackgroundCOVID-19 vaccines show excellent efficacy in clinical trials and real-world data, but some people still contract SARS-CoV-2 despite vaccination. This study sought to identify risk factors associated with SARS-CoV-2 infection post-vaccination and describe characteristics of post-vaccination illness. MethodsAmongst 1,102,192 vaccinated UK adults from the COVID Symptom Study, 2394 (0.2%) cases of post-vaccination SARS-CoV-2 infection were identified between 8th December 2020 and 1st May 2021. Using a control group of vaccinated individuals testing negative, we assessed the associations of age, frailty, comorbidity, area-level deprivation and lifestyle factors with infection. Illness profile post-vaccination was assessed using a second control group of unvaccinated cases. FindingsOlder adults with frailty (OR=2.78, 95% CI=[1.98-3.89], p-value<0.0001) and individuals living in most deprived areas (OR=1.22 vs. intermediate group, CI[1.04-1.43], p-value=0.01) had increased odds of post-vaccination infection. Risk was lower in individuals without obesity (OR=0.6, CI[0.44-0.82], p-value=0.001) and those reporting healthier diet (OR=0.73, CI[0.62-0.86], p-value<0.0001). Vaccination was associated with reduced odds of hospitalisation (OR=0.36, CI[0.28-0.46], p-value<0.0001), and high acute-symptom burden (OR=0.51, CI[0.42-0.61], p-value<0.0001). In older adults, risk of [≥]28 days illness was lower following vaccination (OR=0.72, CI[0.51-1.00], p-value=0.05). Symptoms were reported less in positive-vaccinated vs. positive-unvaccinated individuals, except sneezing, which was more common post-vaccination (OR=1.24, CI[1.05-1.46], p-value=0.01). InterpretationOur findings suggest that older individuals with frailty and those living in most deprived areas are at increased risk of infection post-vaccination. We also showed reduced symptom burden and duration in those infected post-vaccination. Efforts to boost vaccine effectiveness in at-risk populations, and to targeted infection control measures, may still be appropriate to minimise SARS-CoV-2 infection. FundingThis work is supported by UK Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre (BRC) award to Guys & St Thomas NHS Foundation Trust in partnership with Kings College London and Kings College Hospital NHS Foundation Trust and via a grant to ZOE Global; the Wellcome Engineering and Physical Sciences Research Council (EPSRC) Centre for Medical Engineering at Kings College London (WT 203148/Z/16/Z). Investigators also received support from the Chronic Disease Research Foundation, the Medical Research Council (MRC), British Heart Foundation, the UK Research and Innovation London Medical Imaging & Artificial Intelligence Centre for Value Based Healthcare, the Wellcome Flagship Programme (WT213038/Z/18/Z and Alzheimers Society (AS-JF-17-011), and the Massachusetts Consortium on Pathogen Readiness (MassCPR). Research in contextO_ST_ABSEvidence before this studyC_ST_ABSTo identify existing evidence for risk factors and characteristics of SARS-CoV-2 infection post-vaccination, we searched PubMed for peer-reviewed articles published between December 1, 2020 and May 18, 2021 using keywords ("COVID-19" OR "SARS-CoV-2") AND ("Vaccine" OR "vaccination") AND ("infection") AND ("risk factor*" OR "characteristic*"). We did not restrict our search by language or type of publication. Of 202 articles identified, we found no original studies on individual risk and protective factors for COVID-19 infection following vaccination nor on nature and duration of symptoms in vaccinated, community-based individuals. Previous studies in unvaccinated populations have shown that social and occupational factors influence risk of SARS-CoV-2infection, and that personal factors (age, male sex, multiple morbidities and frailty) increased risk for adverse outcomes in COVID-19. Phase III clinical trials have demonstrated good efficacy of BNT162b2 and ChAdOx1 vaccines against SARS-CoV-2 infection, confirmed in published real-world data, which additionally showed reduced risk of adverse outcomes including hospitalisation and death. Added value of this studyThis is the first observational study investigating characteristics of and factors associated with SARS-CoV-2 infection after COVID-19 vaccination. We found that vaccinated individuals with frailty had higher rates of infection after vaccination than those without. Adverse determinants of health such as increased social deprivation, obesity, or a less healthy diet were associated with higher likelihood of infection after vaccination. In comparison with unvaccinated individuals, those with post-vaccination infection had fewer symptoms of COVID-19, and more were entirely asymptomatic. Fewer vaccinated individuals experienced five or more symptoms, required hospitalisation, and, in the older adult group, fewer had prolonged illness duration (symptoms lasting longer than 28 days). Implications of all the available evidenceSome individuals still contract COVID-19 after vaccination and our data suggest that frail older adults and those living in more deprived areas are at higher risk. However, in most individuals illness appears less severe, with reduced need for hospitalisation and lower risk of prolonged illness duration. Our results are relevant for health policy post-vaccination and highlight the need to prioritise those most at risk, whilst also emphasising the balance between the importance of personal protective measures versus adverse effects from ongoing social restrictions. Strategies such as timely prioritisation of booster vaccination and optimised infection control could be considered for at-risk groups. Research is also needed on how to enhance the immune response to vaccination in those at higher risk.
