Antecedent and persistent symptoms in COVID-19 and other respiratory illnesses: Insights from prospectively collected data in the BRACE trial - 17/10/24

Doi : 10.1016/j.jinf.2024.106267

Ellie McDonald ^a , Laure F. Pittet ^a,^b,^c , Simone E. Barry ^d,^e , Marc Bonten ^f,^g , John Campbell ^h , Julio Croda ^i,^j,^k , Mariana G. Croda ^k , Margareth Pretti Dalcolmo ^m , Andrew Davidson ⁿ , Fernando F. de Almeida e Val ^o , Glauce dos Santos ^m , Kaya Gardiner ^a,^p , Grace Gell ^a , Amanda Gwee ^b,^l,^q , Ann Krastev ^a , Marcus Vinícius Guimaraes Lacerda ^r,^s,^t , Michaela Lucas ^u,^v,^w,^x , David J. Lynn ^e,^y , Laurens Manning ^x,^z,^aa , Nick McPhate ^a , Kirsten P. Perrett ^b,^ab,^ac , Jeffrey J. Post ^ad,^ae , Cristina Prat-Aymerich ^f,^g , Lynne E. Quinn ^af , Peter C. Richmond ^x,^aa,^ag , Nicholas J. Wood ^ah,^ai,^aj , Nicole L. Messina ^a,^b,^{^{1
Co-last authors, equal contribution.}} , Nigel Curtis ^a,^b,^l,^⁎,^{^{1
Co-last authors, equal contribution.}}
the BRACE Trial Consortium Group^²
Members of the BRACE trial Consortium are listed in the Supplementary Appendix.
^a Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
^b Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
^c Immunology, Vaccinology, Rheumatology and Infectious Diseases Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
^d Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
^e Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
^f ECRAID, European Clinical Research Alliance on Infectious Diseases, Utrecht, the Netherlands
^g Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, the Netherlands
^h Exeter Collaboration for Academic Primary Care, University of Exeter Medical School, Exeter, United Kingdom
ⁱ Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
^j Fiocruz Mato Grosso do Sul, Fundação Oswaldo Cruz, Campo Grande, Brazil
^k Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
^l Infectious Diseases, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
^m Centro de Referência Professor Hélio Fraga, ENSP/FIOCRUZ (Fundação Oswaldo Cruz), Rio de Janeiro, Brazil
ⁿ Melbourne Children's Trial Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
^o Tropical Medicine Foundation Dr Heitor Vieira Dourado, Brazil
^p Research Operations, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
^q Antimicrobials Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
^r Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
^s Instituto Leônidas & Maria Deane, Oswaldo Cruz Foundation Ministry of Health, Manaus, Brazil
^t University of Texas Medical Branch, Galveston, TX, USA
^u Department of Immunology, Pathwest, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, Australia
^v Department of Immunology, Perth Children's Hospital, Nedlands, Western Australia, Australia
^w Department of Immunology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
^x School of Medicine, University of Western Australia, Perth, Western Australia, Australia
^y Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
^z Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
^aa Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
^ab Department of Allergy and Immunology, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
^ac Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
^ad Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia
^ae School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
^af Exeter Clinical Trials Unit, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus, Heavitreee Road, Exeter, UK
^ag Department of Immunology and General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
^ah Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
^ai National Centre for Immunisation Research and Surveillance of Vaccine Preventable Disease, Westmead, New South Wales, Australia
^aj Sydney Children's Hospital Network, Westmead, New South Wales, Australia

^⁎Correspondence to: Department of Paediatrics, University of Melbourne, Royal Children’s Hospital Melbourne, 50 Flemington Rd., Parkville, Victoria 3052, Australia.Department of Paediatrics, University of Melbourne, Royal Children’s Hospital Melbourne50 Flemington RdParkvilleVictoria3052Australia

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Summary

Background

Some individuals have a persistence of symptoms following both COVID-19 (post-acute COVID-19 syndrome; PACS) and other viral infections. This study used prospectively collected data from an international trial to compare symptoms following COVID-19 and non-COVID-19 respiratory illness, to identify factors associated with the risk of PACS, and to explore symptom patterns before and after COVID-19 and non-COVID-19 respiratory illnesses.

Methods

Data from a multicentre randomised controlled trial (BRACE trial) involving healthcare workers across four countries were analysed. Symptom data were prospectively collected over 12 months, allowing detailed characterisation of symptom patterns. Participants with COVID-19 and non-COVID-19 respiratory illness episodes were compared, focussing on symptom severity, duration (including PACS using NICE and WHO definitions), and pre-existing symptoms.

Findings

Compared to those with a non-COVID-19 illness, participants with COVID-19 had significantly more severe illness (OR 7·4, 95%CI 5·6–9·7). Symptom duration meeting PACS definitions occurred in a higher proportion of COVID-19 cases than non-COVID-19 respiratory controls using both the NICE definition (2·5% vs 0·5%, OR 6·6, 95%CI 2·4–18·3) and the WHO definition (8·8% vs 3·7%, OR 2·5, 95%CI 1·4–4·3). When considering only participants with COVID-19, age 40-59 years (aOR 2·8, 95%CI 1·3–6·2), chronic respiratory disease (aOR 5·5, 95%CI 1·3–23·1), and pre-existing symptoms (aOR 3·0, 95%CI 1·4–6·3) were associated with an increased risk of developing PACS. Symptoms associated with PACS were also reported by participants in the months preceding their COVID-19 or non-COVID-19 respiratory illnesses (32% fatigue and muscle ache, 11% intermittent cough and shortness of breath).

Interpretation

Healthcare workers with COVID-19 were more likely to have severe and longer-lasting symptoms than those with a non-COVID-19 respiratory illness, with a higher proportion meeting the WHO or NICE definitions of PACS. Age, chronic respiratory disease, and pre-existing symptoms increased the risk of developing PACS following COVID-19.

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Keywords : Post-acute COVID-19 syndrome (PACS), Persistent symptoms, Long COVID, COVID-19, Non-COVID-19 respiratory illness, Symptom severity, Symptom duration, Age, Chronic respiratory disease, Pre-existing symptoms, Healthcare workers, Symptom patterns, Prospective data, Multicentre study

Plan

Comparison of severity and duration of symptoms between participants with COVID-19 and those with a non-COVID-19 respiratory illness (Aim 1)

Factors associated with PACS following COVID-19 (Aim 2)

Matched case-control analyses comparing COVID-19 and non-COVID-19 respiratory illness (Aim 3)

Discussion

Ethics approval

Funding

Role of funding source

Authors contributions

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Vol 89 - N° 5

Article 106267- novembre 2024 Retour au numéro

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Antecedent and persistent symptoms in COVID-19 and other respiratory illnesses: Insights from prospectively collected data in the BRACE trial - 17/10/24

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