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Long COVID after breakthrough SARS-CoV-2 infection
Ziyad Al-Aly1,2,3,4,5, Benjamin Bowe6,7, Yan Xie6,7,8
1Clinical Epidemiology Center, Research and Development Service, VA Saint Louis Health Care System, St. Louis, MO, USA. zalaly@gmail.com.
Nature Medicine
|May 25, 2022
Summary
Breakthrough SARS-CoV-2 infection (BTI) in vaccinated individuals increases the risk of death and long COVID sequelae. Vaccination offers partial protection, highlighting the need for enhanced prevention and care strategies.
Area of Science:
- Infectious Diseases
- Public Health
- Epidemiology
Background:
- Post-acute sequelae of SARS-CoV-2 infection, or Long COVID, are recognized.
- The impact of breakthrough SARS-CoV-2 infection (BTI) on long-term health in vaccinated individuals remains unclear.
Purpose of the Study:
- To investigate the risk of death and incident post-acute sequelae following BTI in a large cohort.
- To compare outcomes of BTI with various control groups, including unvaccinated SARS-CoV-2 infected individuals.
Main Methods:
- Utilized US Department of Veterans Affairs national healthcare databases.
- Constructed a cohort of 33,940 individuals with BTI and compared them to over 13 million contemporary, historical, and vaccinated controls.
- Analyzed outcomes at 6 months post-infection, including mortality and a wide range of sequelae.
Main Results:
- BTI was associated with a significantly higher risk of death (HR=1.75) and incident post-acute sequelae (HR=1.50) compared to contemporary controls.
- These increased risks extended to cardiovascular, metabolic, neurologic, and other disorders.
- Compared to unvaccinated SARS-CoV-2 infection, BTI showed lower risks of death (HR=0.66) and sequelae (HR=0.85).
Conclusions:
- Vaccination before infection provides only partial protection against post-acute sequelae.
- Relying solely on vaccination may not fully mitigate long-term health consequences of SARS-CoV-2 infection.
- Findings underscore the necessity for optimizing primary BTI prevention and developing specialized post-acute care pathways.
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