Long COVID Risk and Pre-COVID Vaccination: An EHR-Based Cohort Study from the RECOVER Program

Abstract

Importance: Characterizing the effect of vaccination on long COVID allows for better healthcare recommendations. Objective: To determine if, and to what degree, vaccination prior to COVID-19 is associated with eventual long COVID onset, among those a documented COVID-19 infection. Design, Settings, and Participants: Retrospective cohort study of adults with evidence of COVID-19 between August 1, 2021 and January 31, 2022 based on electronic health records from eleven healthcare institutions taking part in the NIH Researching COVID to Enhance Recovery (RECOVER) Initiative, a project of the National Covid Cohort Collaborative (N3C). Exposures: Pre-COVID-19 receipt of a complete vaccine series versus no pre-COVID-19 vaccination. Main Outcomes and Measures: Two approaches to the identification of long COVID were used. In the clinical diagnosis cohort (n=47,752), ICD-10 diagnosis codes or evidence of a healthcare encounter at a long COVID clinic were used. In the model-based cohort (n=199,498), a computable phenotype was used. The association between pre-COVID vaccination and long COVID was estimated using IPTW-adjusted logistic regression and Cox proportional hazards. Results: In both cohorts, when adjusting for demographics and medical history, pre-COVID vaccination was associated with a reduced risk of long COVID (clinic-based cohort: HR, 0.66; 95% CI, 0.55-0.80; OR, 0.69; 95% CI, 0.59-0.82; model-based cohort: HR, 0.62; 95% CI, 0.56-0.69; OR, 0.70; 95% CI, 0.65-0.75). Conclusions and Relevance: Long COVID has become a central concern for public health experts. Prior studies have considered the effect of vaccination on the prevalence of future long COVID symptoms, but ours is the first to thoroughly characterize the association between vaccination and clinically diagnosed or computationally derived long COVID. Our results bolster the growing consensus that vaccines retain protective effects against long COVID even in breakthrough infections.

Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection

“…Among participants with a first infection during the Omicron era, PASC frequency was higher among those with recurrent infections, corroborating electronic health record–based studies . Though studies on the effect of vaccination are conflicting, these findings of modest reduction in PASC frequency among fully vaccinated participants align with recent systematic reviews …”

The impact of early therapies for COVID-19 on death, hospitalization and persisting symptoms: a retrospective study

“…Several studies have described a protective association between SARS-CoV-2 vaccination and long COVID symptoms [17,40] and this protection seems to persist also in breakthrough infections [41]. We have not found any effect of vaccination about the risk of long COVID at 3 months onset in any of the adjusted logistic models (any symptoms, neurobehavioral symptoms).…”

Counting Cases and Deaths by Age Tells Us About COVID-19’s Infectious and Lethal Components

“…19,20,21,22 Gompertzian Analysis has found that unlike Gompertzian Lethality, Long COVID occurs at relatively equivalent rates across ages (APPENDIX-FIGURE 40). 23,24 Vaccination has been found to protect against Long COVID , (APPENDIX-FIGURE 41), 25,2627,28 with protection increasing with each additional dose, 29 although the data so are far not sufficient to determine which symptoms are prevented, and most importantly, to what degree pandemic associated excess mortality is reduced, if at all, but vaccination. 30,31 Clearly, this remains a problem of high importance, which should be decipherable by Gompertzian Analysis .…”