Impact of COVID-19 and effects of booster vaccination with BNT162b2 on six-month long COVID symptoms, quality of life, work productivity and activity impairment during Omicron

Abstract

Background Longitudinal estimates of long COVID burden during Omicron remain limited. This study characterized long-term impacts of COVID-19 and booster vaccination on symptoms, Health-Related Quality of Life (HRQoL), and Work Productivity Activity Impairment (WPAI). Methods Outpatients with ≥ 1 self-reported symptom and positive SARS-CoV-2 test at CVS Health United States test sites were recruited between 01/31 and 04/30/2022. Symptoms, EQ-5D and WPAI were collected via online surveys until 6 months following infection. Both observed and model-based estimates were analyzed. Effect sizes based on Cohen’s d quantified the magnitude of outcome changes over time, within and between vaccination groups. Mixed models for repeated measures were conducted for multivariable analyses, adjusting for covariates. Logistic regression assessed odds ratio (OR) of long COVID between vaccination groups. Results At long COVID start (Week 4), 328 participants included 87 (27%) Boosted with BNT162b2, 86 (26%) with a BNT162b2 primary series (Primed), and 155 (47%) Unvaccinated. Mean age was 42.0 years, 73.8% were female, 26.5% had ≥ 1 comorbidity, 36.9% prior infection, and 39.6% reported ≥ 3 symptoms (mean: 3.1 symptoms). At Month 6, among 260 participants, Boosted reported a mean of 1.1 symptoms versus 3.4 and 2.8 in Unvaccinated and Primed, respectively (p < 0.001). Boosted had reduced risks of ≥ 3 symptoms versus Unvaccinated (observed: OR 0.22, 95% CI 0.10–0.47, p < 0.001; model-based: OR 0.36, 95% CI 0.15–0.87, p = 0.019) and Primed (observed: OR 0.29, 95% CI 0.13–0.67, p = 0.003; model-based: OR 0.59, 95% CI 0.21–1.65, p = 0.459). Results were consistent using ≥ 2 symptoms. Regarding HRQoL, among those with long COVID, Boosted had higher EQ-5D Utility Index (UI) than Unvaccinated (observed: 0.922 vs. 0.731, p = 0.014; model-based: 0.910 vs. 0.758, p-value = 0.038) and Primed (0.922 vs. 0.648, p = 0.014; model-based: 0.910 vs. 0.708, p-value = 0.008). Observed and model-based estimates for EQ-VAS and UI among Boosted were comparable with pre-COVID since Month 3. Subjects vaccinated generally reported better WPAI scores. Conclusions Long COVID negatively impacted HRQoL and WPAI. The BNT162b2 booster could have a beneficial effect in reducing the risk and burden of long COVID. Boosted participants reported fewer and less durable symptoms, which contributed to improve HRQoL and maintain WPAI levels. Limitations included self-reported data and small sample size for WPAI.

Effectiveness of BNT162b2 BA.4/5 Bivalent COVID-19 Vaccine against Long COVID Symptoms: A US Nationwide Study

“…While side-by-side comparisons with other studies are impaired by design and methodological differences, our results are generally in line with prior work on long COVID. Our observed prevalence rates of long COVID are in line with published estimates among non-hospitalized US patients [ 2 , 3 , 4 , 5 , 6 , 7 , 15 , 25 , 26 ]. Four weeks after the initial infection, approximately 30% of study participants reported experiencing at least three symptoms consistent with long COVID, and 40% reported experiencing at least two symptoms.…”

“…The observed differences in long COVID symptoms outcomes by vaccination status support other investigations suggesting that vaccination is associated with reduced risk for long COVID [2][3][4][5][6][7]15,26]. In this study, we found that six months after the initial infection, the bivalent cohort had approximately a 40% lower risk of long COVID, defined as either the presence of at least two or three symptoms.…”

“…Of the 504 participants, 12% discontinued at Month 6, possibly because of survey burden. While this drop-off rate was relatively consistent with similar survey-based studies [ 5 , 26 ], this study did not employ validated methods to assess self-report bias. As such, bias could not be controlled for nor adjusted in the analyses, potentially affecting data accuracy and the interpretation of data variance.…”

“…Despite differences in long COVID symptom lists across similar studies, our observed mean symptom count is also in line with published work: the study participants reported a mean of 2.6 symptoms at Week 4 following the initial infection, declining to 2.2 symptoms six months following infection. Other studies reported a mean or median of three to four symptoms [ 2 , 3 , 4 , 5 , 6 , 7 , 15 , 26 ].…”

Burden and Impact of Reactogenicity among Adults Receiving COVID-19 Vaccines in the United States and Canada: Results from a Prospective Observational Study

“…In a study comparing ChAdOx with mRNA vaccines, an inability to work was reported most frequently after a first dose of ChAdOx (33.6% over days 1–2; 10% over ≥3 days) and a second dose of mRNA-1273 (29.6% over days 1–2; 9.2% over ≥3 days) [ 35 ]. Although COVID-19 and long COVID have a greater impact on local and systemic events and work productivity than vaccines [ 45 , 46 ], a vaccine of limited reactogenicity is critical for reducing the impact on work and daily activities.…”