Outcomes of laboratory-confirmed SARS-CoV-2 infection in the Omicron-driven fourth wave compared with previous waves in the Western Cape Province, South Africa.

Autor: Davies MA; Health Intelligence, Western Cape Government: Health, Cape Town, South Africa.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.; Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa., Kassanjee R; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa., Rousseau P; National Department of Health, Pretoria, South Africa., Morden E; Health Intelligence, Western Cape Government: Health, Cape Town, South Africa.; Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa., Johnson L; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa., Solomon W; National Department of Health, Pretoria, South Africa., Hsiao NY; Division of Medical Virology, University of Cape Town, Cape Town, South Africa.; National Health Laboratory Service, Cape Town, South Africa., Hussey H; Health Intelligence, Western Cape Government: Health, Cape Town, South Africa.; Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa., Meintjes G; Groote Schuur Hospital, Western Cape Government: Health, Cape Town, South Africa.; Department of Medicine, University of Cape Town, Cape Town, South Africa.; Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa., Paleker M; Health Intelligence, Western Cape Government: Health, Cape Town, South Africa.; Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Tygerberg, South Africa., Jacobs T; Health Intelligence, Western Cape Government: Health, Cape Town, South Africa., Raubenheimer P; Groote Schuur Hospital, Western Cape Government: Health, Cape Town, South Africa.; Department of Medicine, University of Cape Town, Cape Town, South Africa., Heekes A; Health Intelligence, Western Cape Government: Health, Cape Town, South Africa.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa., Dane P; Health Intelligence, Western Cape Government: Health, Cape Town, South Africa.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa., Bam JL; Health Intelligence, Western Cape Government: Health, Cape Town, South Africa., Smith M; Health Intelligence, Western Cape Government: Health, Cape Town, South Africa.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa., Preiser W; National Health Laboratory Service, Cape Town, South Africa.; Division of Medical Virology, Stellenbosch University, Stellenbosch, South Africa., Pienaar D; Rural Health Services, Western Cape Government: Health, Cape Town, South Africa., Mendelson M; Groote Schuur Hospital, Western Cape Government: Health, Cape Town, South Africa.; Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa., Naude J; Mitchells Plain Hospital, Western Cape Government: Health, Cape Town, South Africa., Schrueder N; Tygerberg Hospital, Western Cape Government: Health, Parow, South Africa.; Department of Medicine, Stellenbosch University, Stellenbosch, South Africa., Mnguni A; Khayelitsha District Hospital, Western Cape Government: Health, Khayelitsha, South Africa., Le Roux S; Karl Bremer Hospital, Western Cape Government: Health, Bellville, South Africa.; Western Cape Government: Health, Cape Town, South Africa., Murie K; Western Cape Government: Health, Cape Town, South Africa.; Metro Health Services, Western Cape Government: Health, Cape Town, South Africa., Prozesky H; Tygerberg Hospital, Western Cape Government: Health, Parow, South Africa.; Division of Infectious Diseases, Department of Medicine, Stellenbosch University, Tygerberg, South Africa., Mahomed H; Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Tygerberg, South Africa.; Metro Health Services, Western Cape Government: Health, Cape Town, South Africa., Rossouw L; Western Cape Government: Health, Cape Town, South Africa., Wasserman S; Groote Schuur Hospital, Western Cape Government: Health, Cape Town, South Africa.; Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.; Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa., Maughan D; Groote Schuur Hospital, Western Cape Government: Health, Cape Town, South Africa.; Department of Medicine, University of Cape Town, Cape Town, South Africa., Boloko L; Groote Schuur Hospital, Western Cape Government: Health, Cape Town, South Africa.; Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa., Smith B; Karl Bremer Hospital, Western Cape Government: Health, Bellville, South Africa.; Western Cape Government: Health, Cape Town, South Africa., Taljaard J; Tygerberg Hospital, Western Cape Government: Health, Parow, South Africa.; Division of Infectious Diseases, Department of Medicine, Stellenbosch University, Tygerberg, South Africa., Symons G; Groote Schuur Hospital, Western Cape Government: Health, Cape Town, South Africa.; Department of Medicine, University of Cape Town, Cape Town, South Africa., Ntusi NAB; Groote Schuur Hospital, Western Cape Government: Health, Cape Town, South Africa.; Department of Medicine, University of Cape Town, Cape Town, South Africa., Parker A; Tygerberg Hospital, Western Cape Government: Health, Parow, South Africa.; Division of Infectious Diseases, Department of Medicine, Stellenbosch University, Tygerberg, South Africa., Wolter N; National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa., Jassat W; National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa., Cohen C; National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.; Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa., Lessells R; KwaZulu-Natal Research, Innovation & Sequencing Platform, University of KwaZulu-Natal, Durban, South Africa., Wilkinson RJ; Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.; Francis Crick Institute, London, UK.; Department of Infectious Diseases, Imperial College London, London, UK., Arendse J; Western Cape Government: Health, Cape Town, South Africa., Kariem S; Western Cape Government: Health, Cape Town, South Africa., Moodley M; Health Intelligence, Western Cape Government: Health, Cape Town, South Africa., Wolmarans M; National Department of Health, Pretoria, South Africa., Cloete K; Western Cape Government: Health, Cape Town, South Africa., Boulle A; Health Intelligence, Western Cape Government: Health, Cape Town, South Africa.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.; Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Jazyk: angličtina
Zdroj: Tropical medicine & international health : TM & IH [Trop Med Int Health] 2022 Jun; Vol. 27 (6), pp. 564-573. Date of Electronic Publication: 2022 May 10.
DOI: 10.1111/tmi.13752
Abstrakt: Objectives: The objective was to compare COVID-19 outcomes in the Omicron-driven fourth wave with prior waves in the Western Cape, assess the contribution of undiagnosed prior infection to differences in outcomes in a context of high seroprevalence due to prior infection and determine whether protection against severe disease conferred by prior infection and/or vaccination was maintained.
Methods: In this cohort study, we included public sector patients aged ≥20 years with a laboratory-confirmed COVID-19 diagnosis between 14 November and 11 December 2021 (wave four) and equivalent prior wave periods. We compared the risk between waves of the following outcomes using Cox regression: death, severe hospitalisation or death and any hospitalisation or death (all ≤14 days after diagnosis) adjusted for age, sex, comorbidities, geography, vaccination and prior infection.
Results: We included 5144 patients from wave four and 11,609 from prior waves. The risk of all outcomes was lower in wave four compared to the Delta-driven wave three (adjusted hazard ratio (aHR) [95% confidence interval (CI)] for death 0.27 [0.19; 0.38]. Risk reduction was lower when adjusting for vaccination and prior diagnosed infection (aHR: 0.41, 95% CI: 0.29; 0.59) and reduced further when accounting for unascertained prior infections (aHR: 0.72). Vaccine protection was maintained in wave four (aHR for outcome of death: 0.24; 95% CI: 0.10; 0.58).
Conclusions: In the Omicron-driven wave, severe COVID-19 outcomes were reduced mostly due to protection conferred by prior infection and/or vaccination, but intrinsically reduced virulence may account for a modest reduction in risk of severe hospitalisation or death compared to the Delta-driven wave.
(© 2022 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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