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Associations of COVID-19 symptoms with omicron subvariants BA.2 and BA.5, host status, and clinical outcomes in Japan: a registry-based observational study

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Title: Associations of COVID-19 symptoms with omicron subvariants BA.2 and BA.5, host status, and clinical outcomes in Japan: a registry-based observational study
Authors: Nakakubo, Sho Browse this author
Kishida, Naoki Browse this author
Okuda, Kenichi Browse this author
Kamada, Keisuke Browse this author
Iwama, Masami Browse this author
Suzuki, Masaru Browse this author
Yokota, Isao Browse this author
Ito, Yoichi M. Browse this author
Nasuhara, Yasuyuki Browse this author
Boucher, Richard C. Browse this author
Konno, Satoshi Browse this author →KAKEN DB
Issue Date: Nov-2023
Publisher: Elsevier
Journal Title: Lancet Infectious Diseases
Volume: 23
Issue: 11
Start Page: 1244
End Page: 1256
Publisher DOI: 10.1016/S1473-3099(23)00271-2
Abstract: Background Previous SARS-CoV-2 infection and vaccination, coupled with the rapid evolution of SARS-CoV-2 variants, have modified COVID-19 clinical manifestations. We aimed to characterise the clinical symptoms of COVID-19 individuals in omicron BA.2 and BA.5 Japanese pandemic periods to identify omicron and subvariant associations between symptoms, immune status, and clinical outcomes.Methods In this registry-based observational study, individuals registered in Sapporo's web-based COVID-19 information system entered 12 pre-selected symptoms, days since symptom onset, vaccination history, SARS-CoV-2 infection history, and background. Eligibility criteria included symptomatic individuals who tested positive for SARS-CoV-2 (PCR or antigen test), and individuals who were not tested for SARS-CoV-2 but developed new symptoms after a household member tested positive for SARS-CoV-2. Symptom prevalence, variables associated with symptoms, and symptoms associated with progression to severe disease were analysed. Findings Data were collected and analysed between April 25 and Sept 25, 2022. For 157 861 omicron-infected symptomatic individuals, cough was the most common symptom (99 032 [62 center dot 7%] patients), followed by sore throat (95 838 [60 center dot 7%] patients), nasal discharge (69 968 [44 center dot 3%] patients), and fever (61 218 [38 center dot 8%] patients). Omicron BA.5 infection was associated with a higher prevalence of systemic symptoms than BA.2 in vaccinated and unvaccinated individuals (adjusted odds ratio [OR] for fever: 2 center dot 18 [95% CI 2 center dot 12-2 center dot 25]). Omicron breakthrough -infected individuals with three or more vaccinations or previous infection were less likely to exhibit systemic symptoms (fever 0 center dot 50 [0 center dot 49-0 center dot 51]), but more likely to exhibit upper respiratory symptoms (sore throat 1 center dot 33 [1 center dot 29-1 center dot 36]; nasal discharge 1 center dot 84 [1 center dot 80-1 center dot 89]). Infected older individuals (>= 65 years) had lower odds for all symptoms. However, when symptoms were manifest, systemic symptoms were associated with increased odds for severe disease (dyspnoea 3 center dot 01 [1 center dot 84-4 center dot 91]; fever 2 center dot 93 [1 center dot 89-4 center dot 52]), whereas upper respiratory symptoms were associated with decreased odds (sore throat 0 center dot 38 [0 center dot 24-0 center dot 63]; nasal discharge 0 center dot 48 [0 center dot 28-0 center dot 81]). Interpretation Host immunological status, omicron subvariant, and age were associated with a spectrum of COVID-19 symptoms and outcomes. BA.5 produced a higher systemic symptom prevalence than BA.2. Vaccination and previous infection reduced systemic symptom prevalence and improved outcomes but increased upper respiratory tract symptom prevalence. Systemic, but not upper respiratory, symptoms in older people heralded severe disease. Our findings could serve as a practical guide to use COVID-19 symptoms to appropriately modify health-care strategies and predict clinical outcomes for older patients with omicron infections.
Rights: © 2023. This manuscript version is made available under the CC-BY-NC-ND 4.0 license
Type: article (author version)
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 中久保 祥

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