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Journal Article Epublish 35 citations

PubMed: 38140174 DOI: 10.3390/vaccines11121769

A Multi-Center Study Investigating Long COVID-19 in Healthcare Workers from North-Eastern Italy: Prevalence, Risk Factors and the Impact of Pre-Existing Humoral Immunity-ORCHESTRA Project.

Vaccines (Basel) 11(12)

Authors: Luca Cegolon, Marcella Mauro, Donatella Sansone, Alice Tassinari, Fabrizio Maria Gobba, Alberto Modenese, Loretta Casolari, Filippo Liviero, Sofia Pavanello, Maria Luisa Scapellato, Francesco Taus, Angela Carta, Gianluca Spiteri, Maria Grazia Lourdes Monaco, Stefano Porru, Francesca Larese Filon

Affiliations

  • Occupational Medicine Unit, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy.
  • Occupational Medicine Unit, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy.
  • Department of Biomedical, Metabolic and Neurological Sciences, University of Modena and Reggio-Emilia, 41125 Modena, Italy.
  • Health Surveillance Service, Modena University Hospital, 41125 Modena, Italy.
  • Occupational Medicine Unit, Padua University Hospital, 35128 Padua, Italy.
  • Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy.
  • Department of Diagnostics and Public Health, Section of Medical Statistics, University of Verona, 37134 Verona, Italy.
  • Occupational Medicine Unit, Verona University Hospital, 37134 Verona, Italy.
  • Department of Diagnostics and Public Health, Section of Occupational Medicine, University of Verona, 37134 Verona, Italy.

Abstract

The impact of long-COVID-19 syndrome is rather variable, since it is influenced by several residual confounders. This study aimed to investigate the prevalence of long COVID-19 in healthcare workers (HCWs) from four university hospitals in north-eastern Italy: Trieste, Padua, Verona, and Modena-Reggio Emilia. During the period June 2022-August 2022, HCWs were surveyed for past COVID-19 infections, medical history, and any acute as well as post-COVID-19 symptoms. The prevalence of long COVID-19 was estimated at 30-60 days or 61+ days since first negative swab following first and second COVID-19 episode. Furthermore, the risk of long COVID-19 was investigated by multivariable logistic regression. Results were expressed as the adjusted odds ratio (aOR) with a 95% confidence interval (95%CI). 5432 HCWs returned a usable questionnaire: 2401 were infected with SARS-CoV-2 at least once, 230 were infected at least twice, and 8 were infected three times. The prevalence of long COVID-19 after a primary COVID-19 infection was 24.0% at 30-60 days versus 16.3% at 61+ days, and 10.5% against 5.5% after the second SARS-CoV-2 event. The most frequent symptoms after a first COVID-19 event were asthenia (30.3%), followed by myalgia (13.7%), cough (12.4%), dyspnea (10.2%), concentration deficit (8.1%), headache (7.3%), and anosmia (6.5%), in decreasing order of prevalence. The risk of long COVID-19 at 30-60 days was significantly higher in HCWs hospitalized for COVID-19 (aOR = 3.34; 95%CI: 1.62; 6.89), those infected with SARS-CoV-2 during the early pandemic waves-namely the Wuhan (aOR = 2.16; 95%CI: 1.14; 4.09) or Alpha (aOR= 2.05; 95%CI: 1.25; 3.38) transmission periods-and progressively increasing with viral shedding time (VST), especially 15+ days (aOR = 3.20; 95%CI: 2.07; 4.94). Further determinants of long COVID-19 at 30-60 days since primary COVID-19 event were female sex (aOR = 1.91; 95%CI: 1.30; 2.80), age >40 years, abnormal BMI, or administrative services (reference category). In contrast, HCWs vaccinated with two doses before their primary infection (aOR = 0.57; 95%CI: 0.34; 0.94), undergraduate students, or postgraduate medical trainees were less likely to experience long COVID-19 at 30-60 days. Apart from pandemic waves, the main determinants of long COVID-19 at 30-60 days were confirmed at 61+ days. The risk of long COVID-19 following primary infection increased with the severity of acute disease and VST, especially during the initial pandemic waves, when more virulent viral strains were circulating, and susceptibility to SARS-CoV-2 was higher since most HCWs had not been infected yet, COVID-19 vaccines were still not available, and/or vaccination coverage was still building up. The risk of long COVID-19 therefore decreased inversely with humoral immunity at the individual level. Nevertheless, the prevalence of long COVID-19 was remarkably lower after SARS-CoV-2 reinfections regardless of vaccination status, suggesting that hybrid humoral immunity did not increase protection against the syndrome compared to immunity mounted by either natural infection or vaccination separately. Since the risk of long COVID-19 is currently low with Omicron and patients who developed the syndrome following SARS-CoV-2 infection in the early pandemic waves tend to return to a state of full health with time, a cost-effective approach to screen post-COVID-19 symptoms during the Omicron time could be restricted to vulnerable individuals developing severe disease and/or with prolonged VST.

MeSH

Asthenia, Immunity, Humoral, Vaccines, Multiple Chronic Conditions, Vaccination, Signs And Symptoms, Covid-19, Prevalence, Health Personnel, Immunity, Risk Factors, Pandemics, Infections, Post-Acute Covid-19 Syndrome

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