Likelihood of Post-COVID Condition in people with hybrid immunity; data from the German National Cohort (NAKO) - 16/07/24

Doi : 10.1016/j.jinf.2024.106206

Rafael Mikolajczyk ^a,^⁎,^{^{1
These authors contributed equally.}} , Sophie Diexer ^a,^{^{1
These authors contributed equally.}}, Bianca Klee ^a, Laura Pfrommer ^a, Oliver Purschke ^a, Julia Fricke ^b, Peter Ahnert ^c, Sabine Gabrysch ^d,^e,^f, Cornelia Gottschick ^a, Barbara Bohn ^g, Hermann Brenner ^h, Christoph Buck ⁱ, Stefanie Castell ^j, Sylvia Gastell ^k, Karin Halina Greiser ^l, Volker Harth ^m, Jana-Kristin Heise ^j, Bernd Holleczek ⁿ, Rudolf Kaaks ^l, Thomas Keil ^b,^o,^p, Lilian Krist ^b, Michael Leitzmann ^q, Wolfgang Lieb ^r, Claudia Meinke-Franze ^s, Karin B. Michels ^t, Ilais Moreno Velásquez ^u, Nadia Obi ^m, Leo Panreck ^g, Annette Peters ^v,^w, Tobias Pischon ^u, Tamara Schikowski ^x, Börge Schmidt ^y, Marie Standl ^v,^z, Andreas Stang ^y, Henry Völzke ^s, Andrea Weber ^q, Hajo Zeeb ^i,^aa, André Karch ^ab
^a Institute for Medical Epidemiology, Biometrics, and Informatics, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
^b Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany
^c Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig, Germany
^d Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany
^e Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
^f Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
^g NAKO e.V., Heidelberg, Germany
^h Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany
ⁱ Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
^j Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
^k NAKO Study Centre, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
^l Division of Cancer Epidemiology, DKFZ Heidelberg, Heidelberg, Germany
^m Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
ⁿ Krebsregister Saarland, Saarbrücken, Germany
^o Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
^p State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
^q Institute of Epidemiology and Preventive Medicine, Regensburg, Germany
^r Institute of Epidemiology, Kiel University, Kiel, Germany
^s Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
^t Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Centre, University of Freiburg, Freiburg, Germany
^u Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
^v Institute of Epidemiology, Helmholtz Zentrum München - German Research Centre for Environmental Health (GmbH), Neuherberg, Germany
^w Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
^x IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
^y Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
^z German Centre for Lung Research (DZL), Munich, Germany
^aa Health Sciences Bremen, University of Bremen, Bremen, Germany
^ab Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany

^⁎Correspondence to: Institute for Medical Epidemiology, Biometrics, and Informatics, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.Institute for Medical Epidemiology, Biometrics, and Informatics, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-WittenbergMagdeburger Str. 8Halle(Saale)06112Germany

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Summary

Objectives

The risk of Post-COVID-19 condition (PCC) under hybrid immunity remains unclear.

Methods

Using data from the German National Cohort (NAKO Gesundheitsstudie), we investigated risk factors for self-reported post-infection symptoms (any PCC is defined as having at least one symptom, and high symptom burden PCC as having nine or more symptoms).

Results

Sixty percent of 109,707 participants reported at least one previous SARS-CoV-2 infection; 35% reported having had any symptoms 4–12 months after infection; among them 23% reported nine or more symptoms. Individuals, who did not develop PCC after their first infection, had a strongly reduced risk for PCC after their second infection (50%) and a temporary risk reduction, which waned over 9 months after the preceding infection. The risk of developing PCC strongly depended on the virus variant. Within variants, there was no effect of the number of preceding vaccinations, apart from a strong protection by the fourth vaccination compared to three vaccinations for the Omicron variant (odds ratio = 0.52; 95% confidence interval 0.45–0.61).

Conclusions

Previous infections without PCC and a fourth vaccination were associated with a lower risk of PCC after a new infection, indicating diminished risk under hybrid immunity. The two components of risk reduction after a preceding infection suggest different immunological mechanisms.

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Highlights

•	Individuals exhibited a lower Post-COVID-19 risk after a second infection.
•	The risk of developing Post-COVID-19 strongly depended on the virus variant.
•	A fourth vaccination offers a strong protection against Post-COVID-19 condition.

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Keywords : SARS-CoV-2, Post-COVID-19 condition, Reinfection, Hybrid immunity, Vaccination

Plan

Introduction

Methods

Study population

Definition of exposure, outcome and covariables

Data analysis

Results

Characteristics of the participants

Influence of virus variant, previous infections and vaccinations

Discussion

Ethics approval statement

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Vol 89 - N° 2

Article 106206- août 2024 Retour au numéro

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Likelihood of Post-COVID Condition in people with hybrid immunity; data from the German National Cohort (NAKO) - 16/07/24

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