Viral and host factors associated with SARS-CoV-2 disease severity in Georgia, USA

• Type of Material: Article
• Authors: Ludy R. Carmola, Emory University; Allison Dorothy Roebling, Emory University; Dara Khosravi, Emory University; Rose M. Langsjoen, Emory University; Andrei Bombin, Emory University; Bri Bixler, Emory University; Alex Reid, Emory University; Cara Chen, Emory University; Ethan Wang, Emory University; Yang Lu, Emory University; Ziduo Zheng, Emory University; Rebecca Zhang, Emory University; Phuong-Vi Nguyen, Emory University; Robert Arthur, Emory University; Eric Charles Fitts, Emory University; Dalia Arafat Gulick, Emory University; Dustin Higginbotham, Emory University; Azmain Taz, Emory University; Alaa Ahmed, Emory University; John Crumpler, Emory University; Colleen S Kraft, Emory University; Wilbur Lam, Emory University; Ahmed Babiker, Emory University; Jesse J. Waggoner, Emory University; Kyle Peter Openo, Emory University; Laura Michelle Johnson, Emory University; Adrianna Lynn Westbrook, Emory University; Anne L. Piantadosi, Emory University
• Language: English
• Date: 2023-10-25
• Publisher: NIH
• Publication Version: Preprint (Prior to Peer Review)
• Copyright Statement: The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1101/2023.10.25.23297530
• Title of Journal or Parent Work: medRxiv
• Start Page: 23297530
• Grant/Funding Information: The study was supported by Centers for Disease Control and Preventions contract 75D30121C10084 under BAA ERR 20-15-2997 (to A.P) and by the Emory WHSC COVID-19 Urgent Research Engagement (CURE) Center, made possible by generous philanthropic support from the O. Wayne Rollins Foundation and the William Randolph Hearst Foundation (to A.P.). L.R.C. was supported by Award Number T32AI074492 from the National Institute of Allergy and Infectious Diseases. EIP Surveillance of COVID-19 was funded through the Centers for Disease Control and Preventions Emerging Infections Program [U50CK000485]. The study was supported by the National Institute of Biomedical Imaging and Bioengineering at the National Institutes of Health under award U54 EB027690 (to W.A.L.) and the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002378 (to W.A.L.). Additional support was provided by the Georgia Clinical & Translational Science Alliance of the National Institutes of Health under Award Number UL1TR002378. The study was supported in part by the Emory Integrated Genomics Core (EIGC) and Emory Integrated Computational Core (EICC), which are subsidized by the Emory University School of Medicine and are one of the Emory Integrated Core Facilities. The study was supported by the Data Analytics and Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine.
• Keywords: post-vaccine infection; disease severity; SARS-CoV-2
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology; Health Sciences, Immunology

Abstract

While SARS-CoV-2 vaccines have shown strong efficacy, their suboptimal uptake combined with the continued emergence of new viral variants raises concerns about the ongoing and future public health impact of COVID-19. We investigated viral and host factors, including vaccination status, that were associated with SARS-CoV-2 disease severity in a setting with low vaccination rates. We analyzed clinical and demographic data from 1,957 individuals in the state of Georgia, USA, coupled with viral genome sequencing from 1,185 samples. We found no difference in disease severity between individuals infected with Delta and Omicron variants among the participants in this study, after controlling for other factors, and we found no specific mutations associated with disease severity. Compared to those who were unvaccinated, vaccinated individuals experienced less severe SARS-CoV-2 disease, and the effect was similar for both variants. Vaccination within 270 days before infection was associated with decreased odds of moderate and severe outcomes, with the strongest association observed at 91–270 days post-vaccination. Older age and underlying health conditions, especially immunosuppression and renal disease, were associated with increased disease severity. Overall, this study provides insights into the impact of vaccination status, variants/mutations, and clinical factors on disease severity in SARS-CoV-2 infection when vaccination rates are low. Understanding these associations will help refine and reinforce messaging around the crucial importance of vaccination in mitigating the severity of SARS-CoV-2 disease.