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. 2023 Nov 16;23(1):804.
doi: 10.1186/s12879-023-08783-y.

Impact of vaccination and variants of concern on long COVID clinical phenotypes

Grace Kenny  1   2 , Kathleen McCann  3 , Conor O'Brien  4 , Cathal O'Broin  5   3 , Willard Tinago  5 , Obada Yousif  6 , Tessa O'Gorman  5   7 , Aoife G Cotter  5   4   7 , John S Lambert  5   4   7 , Eoin R Feeney  5   3 , Eoghan de Barra  8   9 , Corinna Sadlier  10 , Alan Landay  11 , Peter Doran  12 , Stefano Savinelli  5   3 , Patrick W G Mallon  5   3 ; All Ireland Infectious Diseases Cohort Study
Collaborators, Affiliations

Impact of vaccination and variants of concern on long COVID clinical phenotypes

Grace Kenny et al. BMC Infect Dis. .

Abstract

Background: Defining patterns of symptoms in long COVID is necessary to advance therapies for this heterogeneous condition. Here we aimed to describe clusters of symptoms in individuals with long COVID and explore the impact of the emergence of variants of concern (VOCs) and vaccination on these clusters.

Methods: In a prospective, multi centre cohort study, individuals with symptoms persisting > 4 weeks from acute COVID-19 were divided into two groups based on timing of acute infection; pre-Alpha VOC, denoted wild type (WT) group and post-Alpha VOC (incorporating alpha and delta dominant periods) denoted VOC group. We used multiple correspondence analysis (MCA) and hierarchical clustering in the WT and VOC groups to identify symptom clusters. We then used logistic regression to explore factors associated with individual symptoms.

Results: A total of 417 individuals were included in the analysis, 268 in WT and 149 in VOC groups respectively. In both groups MCA identified three similar clusters; a musculoskeletal (MSK) cluster characterised by joint pain and myalgia, a cardiorespiratory cluster and a less symptomatic cluster. Differences in characteristic symptoms were only seen in the cardiorespiratory cluster where a decrease in the frequency of palpitations (10% vs 34% p = 0.008) and an increase in cough (63% vs 17% p < 0.001) in the VOC compared to WT groups was observed. Analysis of the frequency of individual symptoms showed significantly lower frequency of both chest pain (25% vs 39% p = 0.004) and palpitations (12% vs 32% p < 0.001) in the VOC group compared to the WT group. In adjusted analysis being in the VOC group was significantly associated with a lower odds of both chest pain and palpitations, but vaccination was not associated with these symptoms.

Conclusion: This study suggests changes in long COVID phenotype in individuals infected later in the pandemic, with less palpitations and chest pain reported. Adjusted analyses suggest that these effects are mediated through introduction of variants rather than an effect from vaccination.

Keywords: Long COVID; Post-Acute Sequelae of SARS-CoV-2 infection; SARS-CoV-2 variants.

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Conflict of interest statement

E. F. has received consulting fees from Gilead, ViiV, and Vidacare Ireland, and has been awarded a grant from Science Foundation Ireland, outside the submitted work. E. D. B. has received consulting fees from Sanofi Pasteur and honoraria/travel grant from Pfizer. P. W. G. M. has received honoraria and/or travel grants from Gilead Sciences, MSD, Bristol-Myers Squibb, and ViiV Healthcare, and has been awarded grants by Science Foundation Ireland, outside the submitted work. All other authors report no potential conflicts of interest.

Figures

Fig. 1
Fig. 1
Heatmaps of self-reported symptom clusters and forest plots showing odds of chest pain and palpitations associated with individual symptoms. Legend: A Heatmaps demonstrating hierarchical clustering on self-reported symptoms. WT group (1st March 2020-25th December 2020) is shown on the left and VOC group (26th December 2020- 1st March 2022) on the right. VOC group included 124 individuals with acute infection in the alpha variant dominant period and 25 infected in the delta dominant period. In both groups the top cluster is a musculoskeletal cluster (n = 69 (26%) in WT and n = 23 (15%) in VOC), the middle is a cardiorespiratory cluster (n = 134 (50%) in WT and n = 30 (20%) in VOC) and the bottom is a less symptomatic cluster (n = 65 (24%) in WT and n = 94 (63%) in VOC). B Forest plot showing the unadjusted and adjusted odds ratios for reporting chest pain and palpitations
See this image and copyright information in PMC

References

    1. Kenny G, Mallon PW. COVID19- clinical presentation and therapeutic considerations. Biochem Biophys Res Commun. 2021;538:125–131. doi: 10.1016/j.bbrc.2020.11.021. - DOI - PMC - PubMed
    1. Su Y, Yuan D, Chen DG, et al. Multiple early factors anticipate post-acute COVID-19 sequelae. Cell. 2022;185:881–895e20. doi: 10.1016/j.cell.2022.01.014. - DOI - PMC - PubMed
    1. Kenny G, McCann K, O’Brien C, et al. Identification of distinct long COVID clinical phenotypes through cluster analysis of self-reported symptoms. Open Forum Infect Dis. 2022;9:ofac060. doi: 10.1093/ofid/ofac060. - DOI - PMC - PubMed
    1. Canas LS, Molteni E, Deng J, et al. Profiling post-COVID syndrome across different variants of SARS-CoV-2. MedRxiv. 2022 doi: 10.1101/2022.07.28.22278159. - DOI
    1. Zhang H, Zang C, Xu Z, et al. Machine learning for identifying Data-Driven subphenotypes of Incident Post-acute SARS-CoV-2 Infection conditions with Large Scale Electronic Health Records: findings from the RECOVER Initiative. Public Global Health. 2022. 10.1101/2022.05.21.22275412.