Disease severity and efficacy of homologous vaccination among patients infected with SARS-CoV-2 Delta or Omicron VOCs, compared to unvaccinated using main biomarkers

Abstract

From March 2021, various countries including Iraq issued prompted recommendations for increased COVID-19 vaccine protection in individuals especially those at risk of catching the virus (i.e., lifestyle, health sector workers, and chronic diseases). It is critically important to understand the impact of COVID-19 vaccinations with the most commonly used vaccines (Pfizer and AstraZeneca) among populations either on the severity of the disease or the transmissibility of SARS-CoV-2 variants of concern (VOCs) and in sequential waves. This study was conducted to establish the clinical severity of COVID-19 caused by Delta and Omicron SARS-CoV-2 variants among patients who either attended or were admitted to hospitals and to compare the effectiveness of Pfizer and AstraZeneca COVID-19 vaccines (single or double doses) at least to prevent hospitalizations if not eradicating the pandemic. A case-control study was done of 570 hospitalized patients; including 328 COVID-19 confirmed patients (166 males, 160 females) who received homologous vaccinations and 242 unvaccinated patients (128 males, 114 females) during the studied waves. The study showed that unvaccinated COVID-19 patients in both waves had expressed significantly a higher number and longer periods of symptoms than vaccinated ones. Additionally, there was no significant effect of vaccine types, Pfizer and AstraZeneca or vaccine shot numbers on the PCR-Ct in the last (Omicron) wave of the pandemic. However, in the previous (Delta) wave of the pandemic, fully vaccinated (double doses) COVID-19 patients had higher PCR-Ct values. Whether among vaccinated or unvaccinated patients, lower CRP levels recorded during the Omicron wave than that of the Delta wave, and regardless of the vaccine type or shot numbers, there were no significant differences between the two waves. Lower WBCs were observed in patients (vaccinated and unvaccinated) infected with the Delta variant in comparison to those infected with the Omicron variant and without any remarkable effect of the vaccine type or shot numbers. This is the first molecular and investigational study of the Delta variant and circulated Omicron in Iraq, regarding the severity of these two waves of SARS-CoV-2 pandemic and the efficacy of homologous vaccination, indicating the insufficiency of two doses and the demand for booster dose(s) as the most effective way of keeping on the safe-side against SARS-CoV-2.

Keywords: AstraZeneca; Delta variant; Omicron variant; Pfizer; SARS-CoV-2; homologous vaccination.

Figure 1

Comparison between vaccinated (V) and unvaccinated (UV) COVID‐19 patients during the 3rd wave (W3) and 4th wave (W4) in patients PCR‐Ct value, polymerase chain reaction–cycle threshold (A), CRP, C‐reactive protein (B), WBC, white blood cell (C), symptom numbers (D) and symptom duration (E).

Figure 2

Comparison between both gender, male (M) and female (F) during the 3rd wave (W3) and 4th wave (W4) in unvaccinated (A–E) and vaccinated (F–J) COVID‐19 patients in their PCR‐Ct value, polymerase chain reaction–cycle threshold (A, F), CRP, C‐reactive protein (B, G), WBC, white blood cell (C, H), symptom numbers (D, I), and symptom duration (E, J).

Figure 3

Comparison between both COVID‐19 vaccinated (AstraZeneca [A] and Pfizer [P] in COVID‐19 patients who received a single dose [1D] and double dose [2D] during) the 3rd wave (W3) (A–E) and 4th wave (W4) (F–J) in their PCR‐Ct, polymerase chain reaction–cycle threshold (A, F), CRP, C‐reactive protein (B, G), WBC, white blood cell (C, H), symptom numbers (D, I), and symptom duration (E, J).

Figure 4

Principal component analysis in COVID‐19 patients groups (V_W3) vaccinated 3rd wave, (V_W4) vaccinated 4th wave, (UV_W3) unvaccinated 3rd wave, and (UV_4W) unvaccinated 4th wave for possible confounding factors (comorbidities; cardiac disease, diabetics, hypertension and renal disease) and treatments (antibiotics, cough suppressant, paracetamol, and oxygen therapy) used.