Real World Evidence of Effectiveness of COVID-19 Vaccines and Anti SARS-CoV-2 Monoclonal Antibodies Against Post-Acute Sequelae of SARS-CoV-2 Infection

Abstract

Background: We evaluated the effectiveness of COVID-19 vaccines and monoclonal antibodies (mAb) against Post-Acute Sequelae of SARS-CoV-2 infection (PASC), an emerging public health problem. Methods and Findings: In a retrospective cohort study, we identified patients with clinically significant PASC using a COVID-19 specific, electronic medical record-based surveillance and outcomes registry from an 8-hospital tertiary healthcare system in the greater Houston metropolitan (primary analyses). Analyses were then replicated across a global research network database. We included all adults (>= 18) who survived beyond 28-days of their index infection. PASC was defined as experiencing constitutional (palpitations, malaise / fatigue, headache) or systemic (sleep disorder, shortness of breath, mood / anxiety disorders, cough, and cognitive impairment) symptoms beyond 28-day post-infection period. Instances of PASC were excluded if the symptoms were present pre-COVID or if they resolved within four weeks of initial infection. We fit multivariable logistic regression models and report estimated likelihood of PASC associated with vaccination or mAb treatment as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Primary analyses included 53,239 subjects (54.9% female), of whom 5,929, 11.1% (CI: 10.9 - 11.4), experienced PASC. Both, vaccinated breakthrough cases (vs. unvaccinated) and mAb treated patients (vs. untreated) had lower likelihoods for developing PASC, aOR (CI): 0.58 (0.52, 0.66), and 0.77 (0.69, 0.86), respectively. Vaccination was associated with decreased odds of developing all constitutional and systemic symptoms except for taste and smell changes. For all symptoms, vaccination was associated with lower likelihood of experiencing PASC compared to mAb treatment. Replication analysis found almost identical frequency of PASC (11.2%) and similar protective effects against PASC for the COVID-19 vaccine: aOR (CI) 0.25 (0.21 - 0.30) and mAb treatment: 0.62 (0.59 - 0.66). Discussion: Although both COVID-19 vaccines and mAbs decreased the likelihood of PASC, at present, vaccination is the most effective tool to potentially prevent long-term clinical and socio-economic consequences of COVID-19.

Post COVID-19 condition after Wildtype, Delta, and Omicron variant SARS-CoV-2 infection and vaccination: pooled analysis of two population-based cohorts

“…There is substantial heterogeneity between existing studies evaluating the effects of vaccination on PCC. 6 Our findings together with those from others imply that vaccination may reduce the risk of PCC by up to 50%, 7–9,12,13,15–17 with an estimated relative risk reduction of 52% among Omicron-infected, and 35% among Delta-infected in our study. Despite important differences in study populations, study designs, analytical methods, and definitions of PCC across existing studies, our estimates are in line with previous evidence, albeit of smaller magnitude compared with one other study simultaneously investigating differences between SARS-CoV-2 variants and prior vaccination among non-hospitalised healthcare workers.…”

“…6 Several studies have been conducted using different study designs and populations, with the majority finding that the risk of PCC is approximately halved in vaccinated compared to non-vaccinated individuals. [7][8][9][10][11][12][13][14][15][16][17] While most studies evaluated symptoms persisting for more than four weeks 8,9,17 or more than 12 weeks 10,12,13,15,16 after SARS-CoV-2 infection, only three assessed symptoms beyond six months and identified a lower 7 or no 11,14 risk reduction with vaccination.…”

Post COVID-19 condition after Wildtype, Delta, and Omicron SARS-CoV-2 infection and prior vaccination: Pooled analysis of two population-based cohorts

“…There is substantial heterogeneity between existing studies evaluating the effects of vaccination on PCC [ 5 ]. Our findings together with those from others imply that vaccination may reduce the risk of PCC by up to 50% [ 6 – 8 , 11 , 12 , 14 – 16 ], with an estimated reduction in the odds of 52% among Omicron-infected, and 35% among Delta-infected in our study. Despite important differences in study populations, study designs, analytical methods, and definitions of PCC across existing studies, our estimates are in line with previous evidence, albeit of smaller magnitude compared with one other study simultaneously investigating differences between SARS-CoV-2 variants and prior vaccination among non-hospitalised healthcare workers [ 8 ].…”

“…Current evidence suggests that the risk of PCC is relevantly reduced by vaccination with SARS-CoV-2 vaccination [5]. Several studies based on different designs and populations found that the risk of PCC is approximately halved in vaccinated compared to non-vaccinated individuals [6][7][8][9][10][11][12][13][14][15][16]. While most evaluated symptoms persisting for more than four [7,8,16] to 12 weeks [9,11,12,14,15] after SARS-CoV-2 infection, few assessed symptoms beyond six months and found a lower [6] or no [10,13] risk reduction with vaccination.…”

Tissue injury and leukocyte changes in post-acute sequelae of SARS-CoV-2: review of 2833 post-acute patient outcomes per immune dysregulation and microbial translocation in long COVID

“…Promoting a fast recovery from these immunological imbalances after SARS-CoV-2 infection resolves or early in PASC, could be crucial to disrupting the foundational steps that lead to long-term PASC outcomes. Indeed, recent studies indicate that SARS-CoV-2 vaccination associated with a faster recovery can reduce the incidence of PASC (144)(145)(146). Likewise, the early use of antivirals might also be used to prevent PASC, given the relationship between high SARS-CoV-2 RNAemia and PASC (147).…”