Absence of self-reported neuropsychiatric and somatic symptoms after Omicron variant SARS-CoV-2 breakthrough infections

Abstract

Persistent somatic and neuropsychiatric symptoms have been frequently described in patients after infection with severe acute respiratory syndrome coronavirus 2 even after a benign clinical course of the acute infection during the early phases of the coronavirus severe acute respiratory syndrome coronavirus 2 pandemic and are part of Long COVID. The Omicron variant emerged in November 2021 and has rapidly become predominant due to its high infectivity and suboptimal vaccine cross-protection. The frequency of neuropsychiatric post-acute sequelae after infection with the severe acute respiratory syndrome coronavirus 2 Omicron and adequate vaccination status is not known. Here, we aimed to characterize post-acute symptoms in individuals with asymptomatic or mildly symptomatic breakthrough infection with severe acute respiratory syndrome coronavirus 2. These individuals had either proven infection with the Omicron variant (n = 157) or their infection occurred in 2022 where Omicron was the predominant variant of severe acute respiratory syndrome coronavirus 2 in Germany (n = 107). This monocentric cross-sectional study was conducted at the University Medical Center Hamburg-Eppendorf between 11 February 2022 and 11 April 2022. We employed questionnaires addressing self-reported somatic symptom burden (Somatic Symptom Scale 8) and neuropsychiatric symptoms including mood (Patient Health Questionnaire 2), anxiety (Generalized Anxiety Disorder 7), attention (Mindful Attention Awareness Scale) and fatigue (Fatigue Assessment Scale) in a cohort of hospital workers. Scores were compared between 175 individuals less than 4 weeks after positive testing for severe acute respiratory syndrome coronavirus 2, 88 individuals more than 4 weeks after positive testing and 87 severe acute respiratory syndrome coronavirus 2 uninfected controls. The majority (n = 313; 89.5%) of included individuals were vaccinated at least three times. After recovery from infection, no significant differences in scores assessing neuropsychiatric and somatic symptoms were detected between the three groups (severe acute respiratory syndrome coronavirus 2 uninfected controls, individuals less and more than 4 weeks after positive testing) independent of age, sex, preconditions and vaccination status. In addition, self-reported symptom burden did not significantly correlate with the number of vaccinations against severe acute respiratory syndrome coronavirus 2, time from recovery or the number of infections. Notably, in all three groups, the mean scores for each item of our questionnaire lay below the pathological threshold. Our data show that persistent neuropsychiatric and somatic symptoms after recovery from severe acute respiratory syndrome coronavirus 2 infection in fully vaccinated hospital workers do not occur more frequently than that in uninfected individuals. This will guide healthcare professionals in the clinical management of patients after recovery from breakthrough infections with severe acute respiratory syndrome coronavirus 2.

Keywords: Long COVID; Omicron; SARS-CoV-2 breakthrough infection; neuropsychiatric deficits.

Graphical Abstract

Figure 1

Flowchart of inclusion criteria and final cohort.

Figure 2

No differences in self-reported somatic and neuropsychiatric deficits after recovery from Omicron. (A–E) Comparison of SSS-8 (A; healthy versus <4 weeks P = 0.27, healthy versus >4 weeks P = 0.091), FAS (B; healthy versus <4 weeks P = 0.76, healthy versus >4 weeks P = 0.69), GAD-7 (C; healthy versus <4 weeks P = 0.46, healthy versus >4 weeks P = 0.9), MAAS (D; healthy versus <4 weeks P = 0.2, healthy versus >4 weeks P = 0.59), PHQ-2 (E; healthy versus <4 weeks P = 0.07, healthy versus >4 weeks P = 0.41) between individuals that did not contract SARS-CoV-2 infection and individuals less and more than 4 weeks after recovery from SARS-CoV-2 infection. Linear regression model with correction for sex and age was used for statistical analysis. (F–J) Correlation analysis of months after recovery and SSS-8 (F; <30 years P = 0.56, 30–39 years P = 0.74, 40–49 years P = 0.11, >50 years P = 0.38), FAS (G; <30 years P = 0.59, 30–39 years P = 0.23, 40–49 years P = 0.75, >50 years P = 0.98), GAD-7 (H; <30 years P = 0.89, 30–39 years P = 0.67, 40–49 years P = 0.96, >50 years P = 0.78), MAAS (I; <30 years P = 0.59, 30–39 years P = 0.97, 40–49 years P = 0.5, >50 years P = 0.29) and PHQ-2 (J; <30 years P = 0.49, 30–39 years P = 0.53, 40–49 years P = 0.99, >50 years P = 0.11) scores. Each data point represents an individual. Statistical analysis was performed by Pearson correlation analysis.