The prevalence of SARS-CoV-2 infection and long COVID in U.S. adults during the BA.4/BA.5 surge, June–July 2022

Qasmieh, Saba; Robertson, McKaylee; Teasdale, Chloe A; Kulkarni, Sarah; Jones, Heidi E.; McNairy, Margaret L.; Borrell, Luisa N.; Nash, Denis

doi:10.1016/j.ypmed.2023.107461

Cited by 28 publications

(37 citation statements)

References 19 publications

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“…For example, similar to our study, recent NYC-based and national surveys conducted during major surges found high absolute point prevalence of SARS-CoV-2 infection but substantially lower relative point prevalence estimates among older (vs. younger) adults, those with comorbidities (vs. those without), and higher relative point prevalence estimates among those in households with schoolaged children (vs. those without). 53,54 However, in contrast to our study, these surveys found that vaccinated and boosted respondents had similar point prevalence estimates of SARS-CoV-2 infection to unvaccinated respondents. Reasons for this discrepancy could be that the surveys captured self-reported infection (positive point of care test, home test, or symptoms plus close contact) during the two weeks prior to the survey, while our study examined SARS-CoV-2 infection prospectively, as measured by serology over a longer time frame.…”

Section: Discussioncontrasting

confidence: 99%

Seroincidence of SARS-CoV-2 infection prior to and during the rollout of vaccines in a community-based prospective cohort of U.S. adults

Nash,

Srivastava,

Shen

et al. 2023

Preprint

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LONG ABSTRACTBackgroundInfectious disease surveillance systems, which largely rely on diagnosed cases, underestimate the true incidence of SARS-CoV-2 infection, due to under-ascertainment and underreporting. We used repeat serologic testing to measure N-protein seroconversion in a well-characterized cohort of U.S. adults with no serologic evidence of SARS-CoV-2 infection to estimate the incidence of SARS-CoV-2 infection and characterize risk factors, with comparisons before and after the start of the SARS-CoV-2 vaccine and variant eras.MethodsWe assessed the incidence rate of infection and risk factors in two sub-groups (cohorts) that were SARS-CoV-2 N-protein seronegative at the start of each follow-up period: 1) the pre-vaccine/wild-type era cohort (n=3,421), followed from April to November 2020; and 2) the vaccine/variant era cohort (n=2,735), followed from November 2020 to June 2022. Both cohorts underwent repeat serologic testing with an assay for antibodies to the SARS-CoV-2 N protein (Bio-Rad Platelia SARS-CoV-2 total Ab). We estimated crude incidence and sociodemographic/epidemiologic risk factors in both cohorts. We used multivariate Poisson models to compare the risk of SARS-CoV-2 infection in the pre-vaccine/wild-type era cohort (referent group) to that in the vaccine/variant era cohort, within strata of vaccination status and epidemiologic risk factors (essential worker status, child in the household, case in the household, social distancing).FindingsIn the pre-vaccine/wild-type era cohort, only 18 of the 3,421 participants (0.53%) had>1 vaccine dose by the end of follow-up, compared with 2,497/2,735 (91.3%) in the vaccine/variant era cohort. We observed 323 and 815 seroconversions in the pre-vaccine/wild-type era and the vaccine/variant era and cohorts, respectively, with corresponding incidence rates of 9.6 (95% CI: 8.3-11.5) and 25.7 (95% CI: 24.2-27.3) per 100 person-years. Associations of sociodemographic and epidemiologic risk factors with SARS-CoV-2 incidence were largely similar in the pre-vaccine/wild-type and vaccine/variant era cohorts. However, some new epidemiologic risk factors emerged in the vaccine/variant era cohort, including having a child in the household, and never wearing a mask while using public transit. Adjusted incidence rate ratios (aIRR), with the entire pre-vaccine/wild-type era cohort as the referent group, showed markedly higher incidence in the vaccine/variant era cohort, but with more vaccine doses associated with lower incidence: aIRRun/undervaccinated=5.3 (95% CI: 4.2-6.7); aIRRprimaryseriesonly=5.1 (95% CI: 4.2-7.3); aIRRboostedonce=2.5 (95% CI: 2.1-3.0), and aIRRboostedtwice=1.65 (95% CI: 1.3-2.1). These associations were essentially unchanged in risk factor-stratified models.InterpretationIn SARS-CoV-2 N protein seronegative individuals, large increases in incidence and newly emerging epidemiologic risk factors in the vaccine/variant era likely resulted from multiple co-occurring factors, including policy changes, behavior changes, surges in transmission, and changes in SARS-CoV-2 variant properties. While SARS-CoV-2 incidence increased markedly in most groups in the vaccine/variant era, being up to date on vaccines and the use of non-pharmaceutical interventions (NPIs), such as masking and social distancing, remained reliable strategies to mitigate the risk of SARS-CoV-2 infection, even through major surges due to immune evasive variants. Repeat serologic testing in cohort studies is a useful and complementary strategy to characterize SARS-CoV-2 incidence and risk factors.SHORT ABSTRACTThis study used repeat serologic testing to estimate infection rates and risk factors in two overlapping cohorts of SARS-CoV-2 N protein seronegative U.S. adults. One mostly unvaccinated sub-cohort was tracked from April to November 2020 (pre-vaccine/wild-type era, n=3,421), and the other, mostly vaccinated cohort, from November 2020 to June 2022 (vaccine/variant era, n=2,735). Vaccine uptake was from 0.53% and 91.3% in the pre-vaccine and vaccine/variant cohorts, respectively. Corresponding seroconversion rates were 9.6 and 25.7 per 100 person-years. In both cohorts, sociodemographic and epidemiologic risk factors for infection were similar, though new risks emerged in the vaccine/variant era, such as having a child in the household. Despite higher incidence rates in the vaccine/variant cohort, vaccine boosters, masking, and distancing likely reduced infection risk, even through major variant surges. Repeat serologic testing in cohorts is a useful and complementary strategy to characterize incidence and risk factors.FundingThe work was supported by the CUNY Institute for Implementation Science in Population Health, the U.S. National Institutes of Allergy and Infectious Diseases (NIAID), Pfizer, Inc., and the U.S. National Institute of Mental Health (NIMH).

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Section: Discussioncontrasting

confidence: 99%

Seroincidence of SARS-CoV-2 infection prior to and during the rollout of vaccines in a community-based prospective cohort of U.S. adults

Nash,

Srivastava,

Shen

et al. 2023

Preprint

Self Cite

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“…In this study, 26.5% (95% CI:20.0-33.9) of patients who received three vaccinations and were infected during the Omicron BA.5-predominate wave experienced long COVID, which is somewhat higher the proportion among US adults who were infected with Omicron BA.4/BA.5 after receiving the third vaccine dose (20.9%, 95% CI:16.4-26.2). 21 We found no association between pre-infection antibody titers and the risk of long COVID. An Itarian study reported that anti-spike IgG titers measured during the acute infection phase did not predict long COVID in vaccinated patients with or without hospitalization.…”

Section: Discussioncontrasting

confidence: 59%

“…22 Evidence for the association between vaccination status and long COVID risk is also inconsistent. 21,23 Our results and previous reports [21][22][23] suggest that vaccine-induced immunity has no apparent protective role against post-COVID-19 symptoms.…”

Section: Discussionmentioning

confidence: 49%

Pre-infection neutralizing antibodies, Omicron BA.5 breakthrough infection, and long COVID: a propensity score-matched analysis

Yamamoto

Matsuda

Maeda

et al. 2023

Preprint

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Importance Investigating the role of pre–infection humoral immunity against Omicron BA.5 infection risk and long COVID development is critical to inform public health guidance. Objective To investigate the association between pre–infection immunogenicity after the third vaccine dose and the risks of Omicron BA.5 infection and long coronavirus disease. Design, Setting, and Participants This nested case–control analysis was conducted among tertiary hospital staff in Tokyo, Japan who donated blood samples in June 2022 (1 month before Omicron BA.5 dominant wave onset [July–September 2022]) approximately 6 months after receiving the third dose of the historical monovalent coronavirus disease 2019 mRNA vaccine. Exposures Live virus–neutralizing antibody titers against Wuhan and Omicron BA.5 (NT50) and anti–SARS–CoV–2 spike protein antibody titers with Abbott (AU/mL) and Roche (U/mL) assays at pre–infection. Main Outcomes and Measures Symptomatic SARS–CoV–2 breakthrough infections during the Omicron BA.5 dominant wave vs. undiagnosed controls matched using a propensity score. Incidence of long COVID (persistent symptoms ≥4 weeks after infection) among breakthrough infection cases. Results Anti–spike antibody titers were compared between 243 breakthrough infection cases and their matched controls among the 2360 staff members who met the criteria. Neutralizing antibodies in 50 randomly selected matched pairs were measured and compared. Pre–infection anti-spike and neutralizing antibody titers were lower in breakthrough cases than in undiagnosed controls. Neutralizing antibody titers against Wuhan and Omicron BA.5 were 64% (95% CI: 42–77) and 72% (95% CI: 53–83) lower, respectively, in breakthrough cases than in undiagnosed controls. Individuals with previous SARS-CoV-2 infections were more frequent among undiagnosed controls than breakthrough cases (19.3% vs. 4.1%), and their neutralizing antibody titers were higher than those of infection–naive individuals. Among the breakthrough cases, pre–infection antibody titers were not associated with the incidence of long COVID. Conclusions and Relevance Pre–infection immunogenicity against SARS–CoV–2 may play a role in protecting against the Omicron BA.5 infection, but not in preventing long COVID.

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“…For example, a controlled study from the Netherlands found that 12% of patients developed long COVID 19 but did not study symptoms of cognition such as memory loss and brain fog 20 . In another recent study from the City University of New York, researchers found as many as 21% of COVID-19 survivors had persistent symptoms 4 weeks or more after their acute infection 21 . The United Kingdom’s census data found 45% of patients who self-reported long COVID had their acute infection at least 1 year previously 22 .…”

Section: Long Covidmentioning

confidence: 99%

Frontline Worker Safety in the Age of COVID-19: A Global Perspective

Kavanagh

Maiwald²,

Pontus³

et al. 2023

J Patient Saf

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The third annual Health Watch USA sm webinar conference assembled 16 speakers from 4 continents who shared information regarding frontline worker safety in the age of COVID-19. The U.S. Bureau of Labor Statistics reported a nearly 4000% increase in workplace illness in 2020 compared with 2019. It is estimated that 2% of the U.S. workforce is not working because of long COVID. In addition, the impact is growing with each surge. After the acute illness, patients are often described as recovered, when in fact many have only survived and are coping with the multisystem impacts of long COVID. Long COVID, including its late cognitive, cardiovascular, embolic, and diabetic complications, disproportionately impacts frontline workers, many of whom are of lower socioeconomic status and represented by ethnic minorities.Natural infection and current vaccines do not provide durable protection for reinfection. Herd immunity is not possible at this time. Although SARS-CoV-2 is unlikely to be eliminated, decreasing spread is imperative to slow the rate of mutations, decrease the number of reinfections, and lower the chances of developing long COVID. The primary mode of spread is through aerosolization. Both routine breathing and talking aerosolizes the virus. With the extremely high infectivity of SARS-CoV-2, it is unlikely that central building ventilation alone will be enough to satisfactorily mitigate spread. Additional safe active air cleaning technology, such as upper-room germicidal UV-C lighting, needs to be deployed.Misinformation and disinformation have inhibited response effectiveness. Examples include downplaying the benefit of well-fitted masks and the risks that COVID-19 and long COVID pose to children, along with believing children cannot spread the disease. The engagement of local community leaders is essential to educate the community and drive social change to accept vaccinations and other public health interventions. Vaccinations and natural immunity alone are unlikely to adequately prevent community spread and do not provide durable protection against the risk of long COVID.Frontline workers must keep their immunity as high as possible and work in settings with clean air, along with wearing N95 masks when they are in contact with the public. Finally, there needs to be a financial safety net for frontline workers and their families in the event of incapacitation or death from COVID-19.

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The prevalence of SARS-CoV-2 infection and long COVID in U.S. adults during the BA.4/BA.5 surge, June–July 2022

Cited by 28 publications

References 19 publications

Seroincidence of SARS-CoV-2 infection prior to and during the rollout of vaccines in a community-based prospective cohort of U.S. adults

Seroincidence of SARS-CoV-2 infection prior to and during the rollout of vaccines in a community-based prospective cohort of U.S. adults

Pre-infection neutralizing antibodies, Omicron BA.5 breakthrough infection, and long COVID: a propensity score-matched analysis

Frontline Worker Safety in the Age of COVID-19: A Global Perspective

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