Long COVID risk and pre-COVID vaccination in an EHR-based cohort study from the RECOVER program

Brannock, M. Daniel; Chew, Rob; Preiss, Alexander; Hadley, Emily; Redfield, Signe; McMurry, Julie A.; Leese, Peter J.; Girvin, Andrew T.; Crosskey, Miles; Zhou, Andrea; Moffitt, Richard A.; Funk, Michele Jönsson; Pfaff, Emily R.; Haendel, Melissa; Chute, Christopher G; Stürmer, Til; Loomba, Johanna; Koraishy, Farrukh M.; Divers, Jasmin; Thorpe, Lorna E.; Horwitz, Leora I.; Katz, Stuart D.

doi:10.1038/s41467-023-38388-7

Cited by 60 publications

(43 citation statements)

References 41 publications

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“…For this study, we used an updated version better suited for the later phase of the pandemic. 22,61 We followed patients for 180 days following their COVID-19 index date. PASC date was defined as the date of the maximum computable phenotype prediction above a threshold of 0.9, or, if present, the date of U09.9 diagnosis, whichever was earlier.…”

Section: Treatment and Outcomementioning

confidence: 99%

Effect of Paxlovid Treatment During Acute COVID-19 on Long COVID Onset: An EHR-Based Target Trial Emulation from the N3C and RECOVER Consortia

Preiss,

Bhatia,

Aragon

et al. 2024

Preprint

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Preventing and treating post-acute sequelae of SARS-CoV-2 infection (PASC), commonly known as Long COVID, has become a public health priority. In this study, we examined whether treatment with Paxlovid in the acute phase of COVID-19 helps prevent the onset of PASC. We used electronic health records from the National Covid Cohort Collaborative (N3C) to define a cohort of 426,461 patients who had COVID-19 since April 1, 2022, and were eligible for Paxlovid treatment due to risk for progression to severe COVID-19. We used the target trial emulation (TTE) framework to estimate the effect of Paxlovid treatment on PASC incidence. Our primary outcome measure was a PASC computable phenotype. Secondary outcomes were the onset of novel cognitive, fatigue, and respiratory symptoms in the post-acute period. Paxlovid treatment did not have a significant effect on overall PASC incidence (relative risk [RR] = 0.99, 95% confidence interval [CI] 0.96-1.01). However, its effect varied across the cognitive (RR = 0.85, 95% CI 0.79-0.90), fatigue (RR = 0.93, 95% CI 0.89-0.96), and respiratory (RR = 0.99, 95% CI 0.95-1.02) symptom clusters, suggesting that Paxlovid treatment may help prevent post-acute cognitive and fatigue symptoms more than others.

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Section: Treatment and Outcomementioning

confidence: 99%

Effect of Paxlovid Treatment During Acute COVID-19 on Long COVID Onset: An EHR-Based Target Trial Emulation from the N3C and RECOVER Consortia

Preiss,

Bhatia,

Aragon

et al. 2024

Preprint

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“…The association between PCC and COVID-19 vaccination before COVID-19 was assessed in 18 studies, including 9 prospective cohorts, 5 retrospective cohorts, 1 case-control study, and 3 cross-sectional studies (Table 1). Fifteen studies stratified their analyses by dosespecific vaccination status (one dose, n = 4; two doses, n = 11; three doses, n = 3) (Supplementary Table S3) and 12 contributed to the meta-analyses (Figures 2 and 3) [23,[28][29][30][31][32][33][34][35][36][37][38].…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

A systematic review of the evidence on the associations and safety of COVID-19 vaccination and post COVID-19 condition

Jennings,

Corrin,

Waddell

2023

Epidemiol. Infect.

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Post COVID-19 condition (PCC) refers to persistent or recurring symptoms (>8 weeks) occurring ≤12 weeks following acute COVID-19. The objective of this systematic review was to assess the evidence on the risk of PCC with vaccination before or after COVID-19 or after developing PCC, and the safety of vaccination among those already experiencing PCC. A search was conducted up to 13 December 2022 and standard systematic review methodology was followed. Thirty-one observational studies were included. There is moderate confidence that two doses of vaccine given pre-infection reduced the odds of PCC (pooled OR (pOR) 0.67, 95% CI 0.60-0.74, I2 = 59.9%), but low confidence that one dose may not reduce the odds (pOR 0.64, 95% CI 0.31#x2013;1.31, I2 = 99.2%), and the evidence is very uncertain about the effect of three doses (pOR 0.45, 95% CI 0.10#x2013;1.99, I2 = 30.9%). One of three studies suggested vaccination shortly after COVID-19 may offer additional protection from developing PCC compared to unvaccinated individuals, but this evidence was very uncertain. For those with PCC, vaccination was not associated with worsening PCC symptoms (10 studies) and appears safe (3 studies), but it is unclear if vaccination may change established PCC symptoms.

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“…4 Nonetheless, most recent studies show that vaccination is indeed associated with lower rates of long COVID-19 diagnosis. 9,10 In the study by Amorin et al, 5 the absence of this association may be attributed to the high percentage of fully vaccinated participants (85%). The limited number of individuals who were not fully vaccinated, and even fewer who received no vaccine at all, might not have been sufficient to detect an association.…”

mentioning

confidence: 92%

“…In particular, being admitted to the hospital and having symptoms during the acute phase 7 are major actionable risk factors. The body of literature on long COVID-19 underscores the critical importance of vaccination 9,10 as a key strategy to mitigate the impact of COVID-19, including its long-term effects, particularly on transplant recipients. Further research and targeted interventions are warranted to address these findings and improve the outcomes for vulnerable transplant recipients in the face of evolving COVID-19 variants.…”

mentioning

confidence: 99%

The Other Pandemic From the Pandemic: A Higher Frequency of Long COVID After Omicron in Kidney Transplant Recipients

Berto,

Kotton

2023

Transplantation

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S ince it was first described, long coronavirus disease 2019 (COVID-19) has posed a vexing challenge for patients and healthcare providers, with significant lingering morbidity. 1 The absence of a consistent clinical definition has led to varying prevalence estimates. These estimates range from 8% of organ recipients with persistent symptoms 6 mo after infection, when self-reported symptoms are periodically assessed, up to 70% when the definition includes dyspnea and symptoms are only evaluated once. 2,3 One intriguing aspect amid the evolving dynamics of the severe acute respiratory syndrome coronavirus 2 strains has been the relationship between the virus variant and the risk of long COVID-19. In addition to its reduced clinical severity, Omicron was associated with lower rates of long COVID-19 in the general population. 4 Whether this trend extended to solid organ transplant recipients remained uncertain until this study by Amorin et al. 5 This prospective, single-center, cohort study was conducted at the Hospital do Rim, Fundação Oswaldo Ramos, in São Paulo, Brazil from January 5, 2022, to July 18, 2022. The study revealed that of 602 kidney transplant recipients who contracted COVID-19 and subsequently responded to their telephone survey (39% of the 1529 total), a staggering 52% had long COVID-19 symptoms, which included weakness, myalgia, dizziness, and headaches among the most frequent complaints. Interestingly, the authors reported that being admitted to the hospital (hazard ratio [HR] 1.7) or having symptoms such as fatigue and myalgia during the acute phase of infection (HR 2.32 and 1.48, respectively) were independent risk factors for long COVID-19; however, the authors did not find an association between the risk of long COVID-19 and previous vaccination. Although we often assume that immunity from prior infection may be

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Long COVID risk and pre-COVID vaccination in an EHR-based cohort study from the RECOVER program

Cited by 60 publications

References 41 publications

Effect of Paxlovid Treatment During Acute COVID-19 on Long COVID Onset: An EHR-Based Target Trial Emulation from the N3C and RECOVER Consortia

Effect of Paxlovid Treatment During Acute COVID-19 on Long COVID Onset: An EHR-Based Target Trial Emulation from the N3C and RECOVER Consortia

A systematic review of the evidence on the associations and safety of COVID-19 vaccination and post COVID-19 condition

The Other Pandemic From the Pandemic: A Higher Frequency of Long COVID After Omicron in Kidney Transplant Recipients

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