SARS-CoV-2 Infection in Winter 2021/2022: The Association of Varying Clinical Manifestations With and Without Prior Vaccination

Abstract

Importance SARS-CoV-2 is a rapidly evolving virus with many strains. Although vaccines have proven to be effective against earlier strains of the virus, the efficacy of vaccination status against later strains is still an area of active research. Objective To determine if vaccination status was associated with symptomatology due to infection by later strains of SARS-CoV-2. Design This cross-sectional survey was sent to an adult Jewish population from December 2021 to March 2022. Setting This is a population-based study of Jewish communities throughout the tristate area. The subjects were recruited by local Jewish not-for-profit and social service organizations. Participants Surveys were sent to 14,714 adults who were recruited by local Jewish not-for-profit and social service organizations; 966 respondents completed the survey (6.57%). Only participants who received a positive COVID-19 nasal swab 10 weeks since December 1, 2021, were included in the main outcome. Exposure Participants were grouped by vaccine type (i.e., Johnson & Johnson {J&J}, Moderna, or Pfizer) and vaccination status (i.e., unvaccinated, single, full, or booster). Main outcomes and measures The primary study outcome was an association between immunization status and somatological presentation. Symptom severity classes were built using latent class analysis (LCA). Results Out of 14,714 recipients, 966 completed the survey (6.57%). The participants were mainly self-described Ashkenazi Jewish (97%) with a median age of 41. The LCA resulted in four classes: highly symptomatic (HS), less symptomatic (LS), anosmia, and asymptomatic (AS). Vaccinated participants were less likely to be in symptomatic groups than the unvaccinated participants (odds ratio {OR}: 0.326; 95% confidence interval {CI}: 0.157-0.679; p=0.002). Boosted participants were less likely to be in symptomatic groups than fully vaccinated participants (OR: 0.267; 95% CI: 0.122-0.626; p=0.002). Additionally, there was no association between symptomatology and vaccination type (p=0.353). Conclusions and relevance Participants who received COVID-19 vaccinations or booster shots were less likely to be symptomatic after Omicron infection compared to unvaccinated participants and vaccinated participants without boosters, respectively. There's no association between vaccination type and symptomatology. These results enhance our understanding that COVID-19 vaccinations improve clinical symptomatology, even in an unforeseen COVID-19 strain.

Keywords: booster vaccine; covid-19; covid-19 vaccination; latent class analysis; sars-cov-2 immunity.