Sex Differences in COVID-19 Outcomes

Aidaoui, Karim El; Benhamou, Rita Ait; Haoudar, Amal; Ziati, Jihane; Kantri, Aziza; Agrad, Khalid; Kettani, Chafik El

doi:10.7759/cureus.25760

Cited by 4 publications

(5 citation statements)

References 29 publications

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“…Females were more likely to report AE compared to males, which was similar to other studies [15,20,22]. Females have demonstrated more robust immune systems and greater immune responses following vaccine receipt than males at all stages of life [23,24]. There may have been underreporting of AE from the males due to the poor health-seeking behavior demonstrated by males in this region [25]; however, the scope of this study could not evaluate this characteristic.…”

Section: Discussionsupporting

confidence: 75%

Safety of Janssen Ad26.COV.S and Astra Zeneca AZD1222 COVID-19 Vaccines among Mobile Phone Users in Malawi: Findings from a National Mobile-Based Syndromic Surveillance Survey, July 2021 to December 2021

Makonokaya,

Kapanda,

Woelk

et al. 2023

IJERPH

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The safety profiles of the Ad26.COV2.S and AZD1222 COVID-19 vaccines have not been described in the general population in Malawi. We present self-reported adverse events (AE) following the receipt of these vaccines in Malawi as part of a national syndromic surveillance survey. We conducted phone-based syndromic surveillance surveys among adults (≥18 years) with verbal consent. We used secure tablets through random digit dialing to select mobile phone numbers and collected data electronically. Survey questions included whether the respondent had received the COVID-19 vaccines, whether they had experienced any AE following vaccination, and the severity of the AE. We used multivariable analysis to identify factors associated with self-reported AE post-COVID-19 vaccination. A total of 11,924 (36.0%) out of 33,150 respondents reported receiving at least one dose of either Ad26.COV2.S or AZD1222 between July–December 2021; of those, 65.1% were female. About 49.2% of the vaccine recipients reported at least one AE, 90.6% of which were mild, and 2.6% were severe. Higher education level and concern about the safety of COVID-19 vaccines were associated with AE self-report (Adjusted Odds Ratio [AOR] 2.63 [95% CI 1.96–3.53] and 1.44, [95% CI 1.30–1.61], respectively), while male gender and older age were associated with reduced likelihood of AE self-report (AORs 0.81, [95% CI 0.75–0.88], 0.62 [95% CI 0.50–0.77], respectively). Ad26.COV2.S and AZD1222 vaccines are well-tolerated, with primarily mild and few severe AE among adults living in Malawi. Self-reporting of AE following COVID-19 vaccination is associated with gender, age, education, and concern about the safety of the vaccines. Recognizing these associations is key when designing and implementing COVID-19 vaccination communication messages to increase vaccination coverage.

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Section: Discussionsupporting

confidence: 75%

Safety of Janssen Ad26.COV.S and Astra Zeneca AZD1222 COVID-19 Vaccines among Mobile Phone Users in Malawi: Findings from a National Mobile-Based Syndromic Surveillance Survey, July 2021 to December 2021

Makonokaya,

Kapanda,

Woelk

et al. 2023

IJERPH

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“…It is well known that women are better at producing autoantibodies than men and are at higher risk for most autoimmune diseases. However, there is a sex difference in COVID‐19 severity that men tend to be more severe compared to women, 27,28 which may not be explained by autoantibody‐mediated COVID‐19 severity.…”

Section: Discussionmentioning

confidence: 99%

COVID‐19 is associated with bystander polyclonal autoreactive B cell activation as reflected by a broad autoantibody production, but none is linked to disease severity

Jiang

Johnson

Adekunle

et al. 2022

Journal of Medical Virology

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Coronavirus disease 2019 (COVID‐19) is associated with autoimmune features and autoantibody production in a small subset of the population. Pre‐existing neutralizing antitype I interferons (IFNs) autoantibodies are related to the severity of COVID‐19. Plasma levels of IgG and IgM against 12 viral antigens and 103 self‐antigens were evaluated using an antibody protein array in patients with severe/critical or mild/moderate COVID‐19 disease and uninfected controls. Patients exhibited increased IgGs against Severe acute respiratory syndrome coronavirus‐2 proteins compared to controls, but no difference was observed in the two patient groups. 78% autoreactive IgGs and 93% autoreactive IgMs were increased in patients versus controls. There was no difference in the plasma levels of anti‐type I IFN autoantibodies or neutralizing anti‐type I IFN activity of plasma samples from the two patient groups. Increased anti‐type I IFN IgGs were correlated with higher lymphocyte accounts, suggesting a role of nonpathogenic autoantibodies. Notably, among the 115 antibodies tested, only plasma levels of IgGs against human coronavirus (HCOV)‐229E and HCOV‐NL63 spike proteins were associated with mild disease outcome. COVID‐19 was associated with a bystander polyclonal autoreactive B cell activation, but none of the autoantibody levels were linked to disease severity. Long‐term humoral immunity against HCOV‐22E and HCOV‐NL63 spike protein was associated with mild disease outcome. Understanding the mechanism of life‐threatening COVID‐19 is critical to reducing mortality and morbidity.

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“…As previously described, there is a clear impact of sex and gender on the cardiovascular systems of women and men, which not only implies different susceptibility, clinical e20 Journal of Cardiovascular Medicine 2023, Vol 24 (suppl 1) course and outcomes of numerous chronic diseases, but also, as demonstrated, in the case of infections, even during COVID-19. 7,8 In fact, some related aspects have been identified that explain the differences observed in the clinical evolution of COVID-19 that characterize the two sexes 7,8,92 ; some features are related to gender (highrisk behaviours, nutrition and access to healthcare), others related to sex (influence of sex hormones, variability in the function of the immune system and in the regulation of the inflammatory response, expression of genes and receptors). As noted, significant changes in ACE2 gene expression, immune response and pathophysiology of cardiovascular risk factors and comorbidities help reduce susceptibility to an infection and better survival in women and, conversely, make men more at risk of hospitalization and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, whether the incidence of COVID-19 related myocardial injury is sex-dependent remains not fully elucidated. [7][8][9] Since the onset of the pandemic, men have appeared to suffer from a respiratory and cardiovascular poorer prognosis, exhibiting more severe and long-lasting disease and symptoms. 10,11 The exact mechanisms of these differences are not completely understood and likely represent a complex mosaic of multiple factors.…”

Section: Introductionmentioning

confidence: 99%

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Impact of COVID-19 on the cardiovascular health of women: a review by the Italian Society of Cardiology Working Group on ‘gender cardiovascular diseases’

Moscucci

Gallina

Bucciarelli

et al. 2022

Journal of Cardiovascular Medicine

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The coronavirus disease 19 (COVID-19), due to coronavirus 2 (SARS-CoV-2) infection, presents with an extremely heterogeneous spectrum of symptoms and signs. COVID-19 susceptibility and mortality show a significant sex imbalance, with men being more prone to infection and showing a higher rate of hospitalization and mortality than women. In particular, cardiovascular diseases (preexistent or arising upon infection) play a central role in COVID-19 outcomes, differently in men and women. This review will discuss the potential mechanisms accounting for sex/gender influence in vulnerability to COVID-19. Such variability can be ascribed to both sex-related biological factors and sex-related behavioural traits. Sex differences in cardiovascular disease and COVID-19 involve the endothelial dysfunction, the innate immune system and the renin-angiotensin system (RAS). Furthermore, the angiotensin-converting enzyme 2 (ACE2) is involved in disease pathogenesis in cardiovascular disease and COVID-19 and it shows hormone-dependent actions. The incidence of myocardial injury during COVID-19 is sex-dependent, predominantly in association with a greater degree of inflammation and coagulation disorders among men. Its pathogenesis is not fully elucidated, but the main theories foresee a direct role for the ACE2 receptor, the hyperimmune response and the RAS imbalance, which may also lead to isolated presentation of COVID-19-mediated myopericarditis. Moreover, the latest evidence on cardiovascular diseases and their relationship with COVID-19 during pregnancy will be discussed. Finally, authors will analyse the prevalence of the long-covid syndrome between the two sexes and its impact on the quality of life and cardiovascular health.

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Sex Differences in COVID-19 Outcomes

Cited by 4 publications

References 29 publications

Safety of Janssen Ad26.COV.S and Astra Zeneca AZD1222 COVID-19 Vaccines among Mobile Phone Users in Malawi: Findings from a National Mobile-Based Syndromic Surveillance Survey, July 2021 to December 2021

Safety of Janssen Ad26.COV.S and Astra Zeneca AZD1222 COVID-19 Vaccines among Mobile Phone Users in Malawi: Findings from a National Mobile-Based Syndromic Surveillance Survey, July 2021 to December 2021

COVID‐19 is associated with bystander polyclonal autoreactive B cell activation as reflected by a broad autoantibody production, but none is linked to disease severity

Impact of COVID-19 on the cardiovascular health of women: a review by the Italian Society of Cardiology Working Group on ‘gender cardiovascular diseases’

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