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. 2023 Jan 3;6(1):e2251360.
doi: 10.1001/jamanetworkopen.2022.51360.

Persistent COVID-19 Symptoms at 6 Months After Onset and the Role of Vaccination Before or After SARS-CoV-2 Infection

Stephanie A Richard  1   2 , Simon D Pollett  1   2 , Anthony C Fries  3 , Catherine M Berjohn  1   4   5 , Ryan C Maves  1   4 , Tahaniyat Lalani  1   2   6 , Alfred G Smith  6 , Rupal M Mody  7 , Anuradha Ganesan  1   2   8 , Rhonda E Colombo  1   2   5   9 , David A Lindholm  5   10 , Michael J Morris  10 , Nikhil Huprikar  5   8 , Christopher J Colombo  5   9 , Cristian Madar  11 , Milissa Jones  11   12 , Derek T Larson  5   13 , Samantha E Bazan  14 , Katrin Mende  1   2   10 , David Saunders  5 , Jeffrey Livezey  12 , Charlotte A Lanteri  1 , Ann I Scher, Celia Byrne, Jennifer Rusiecki, Evan Ewers  1   13 , Nusrat J Epsi  1   2 , Julia S Rozman  1   2 , Caroline English  1   2 , Mark P Simons  1 , David R Tribble  1   15 , Brian K Agan  1   2 , Timothy H Burgess  1 ; Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases With Pandemic Potential (EPICC) COVID-19 Cohort Study Group
Collaborators, Affiliations

Persistent COVID-19 Symptoms at 6 Months After Onset and the Role of Vaccination Before or After SARS-CoV-2 Infection

Stephanie A Richard et al. JAMA Netw Open. .

Erratum in

  • Error in Figure 2B.
    [No authors listed] [No authors listed] JAMA Netw Open. 2023 Feb 1;6(2):e230734. doi: 10.1001/jamanetworkopen.2023.0734. JAMA Netw Open. 2023. PMID: 36757701 Free PMC article. No abstract available.

Abstract

Importance: Understanding the factors associated with post-COVID conditions is important for prevention.

Objective: To identify characteristics associated with persistent post-COVID-19 symptoms and to describe post-COVID-19 medical encounters.

Design, setting, and participants: This cohort study used data from the Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases With Pandemic Potential (EPICC) study implemented in the US military health system (MHS); MHS beneficiaries aged 18 years or older who tested positive for SARS-CoV-2 from February 28, 2020, through December 31, 2021, were analyzed, with 1-year follow-up.

Exposures: SARS-CoV-2 infection.

Main outcomes and measures: The outcomes analyzed included survey-reported symptoms through 6 months after SARS-CoV-2 infection and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis categories reported in medical records 6 months following SARS-CoV-2 infection vs 3 months before infection.

Results: More than half of the 1832 participants in these analyses were aged 18 to 44 years (1226 [66.9%]; mean [SD] age, 40.5 [13.7] years), were male (1118 [61.0%]), were unvaccinated at the time of their infection (1413 [77.1%]), and had no comorbidities (1290 [70.4%]). A total of 728 participants (39.7%) had illness that lasted 28 days or longer (28-89 days: 364 [19.9%]; ≥90 days: 364 [19.9%]). Participants who were unvaccinated prior to infection (risk ratio [RR], 1.39; 95% CI, 1.04-1.85), reported moderate (RR, 1.80; 95% CI, 1.47-2.22) or severe (RR, 2.25; 95% CI, 1.80-2.81) initial illnesses, had more hospitalized days (RR per each day of hospitalization, 1.02; 95% CI, 1.00-1.03), and had a Charlson Comorbidity Index score of 5 or greater (RR, 1.55; 95% CI, 1.01-2.37) were more likely to report 28 or more days of symptoms. Among unvaccinated participants, postinfection vaccination was associated with a 41% lower risk of reporting symptoms at 6 months (RR, 0.59; 95% CI, 0.40-0.89). Participants had higher risk of pulmonary (RR, 2.00; 95% CI, 1.40-2.84), diabetes (RR, 1.46; 95% CI, 1.00-2.13), neurological (RR, 1.29; 95% CI, 1.02-1.64), and mental health-related medical encounters (RR, 1.28; 95% CI, 1.01-1.62) at 6 months after symptom onset than at baseline (before SARS-CoV-2 infection).

Conclusions and relevance: In this cohort study, more severe acute illness, a higher Charlson Comorbidity Index score, and being unvaccinated were associated with a higher risk of reporting COVID-19 symptoms lasting 28 days or more. Participants with COVID-19 were more likely to seek medical care for diabetes, pulmonary, neurological, and mental health-related illness for at least 6 months after onset compared with their pre-COVID baseline health care use patterns. These findings may inform the risk-benefit ratio of COVID-19 vaccination policy.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Pollett, Dr Simons, Ms Rozman, and Dr Burgess reported that their institutions received funding under a Cooperative Research and Development Agreement from AstraZeneca to the Uniformed Services University of the Health Sciences Infectious Diseases Clinical Research Program (IDCRP) and the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc outside the submitted work. Dr Maves reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study and from AstraZeneca to his institution outside the submitted work. Dr Ganesan reported receiving grants from the Defense Health Program and the National Institute of Allergy and Infectious Disease (NIAID), NIH during the conduct of the study. Dr Lindholm reported receiving grants from the Defense Health Program and the NIAID, NIH during the conduct of the study and serving as an investigator for the Adaptive COVID-19 Treatment Trial, sponsored and primarily funded by the NIAID, NIH. Dr Morris reported being a paid speaker for Janssen outside the submitted work. Dr Byrne reported receiving grants from the Congressionally Directed Medical Research Program outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Percentage of Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases With Pandemic Potential (EPICC) Study Participants Who Endorsed Specific Symptoms on Surveys Conducted at 1, 3, 6, 9, and 12 Months
Figure 2.
Figure 2.. Health Care Encounters Before and After SARS-CoV-2 Infection
Filled circles indicate P < .05; open circles, P > .05; and whiskers, 95% CIs.
See this image and copyright information in PMC

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