The persistence and effect of COVID-19 vaccination on the risk of clinical sequelae one year after COVID-19 infection: a territory-wide cohort study in Hong Kong

Research Square (Research Square)(2023)

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Abstract Introduction The persistence of post-acute sequelae of SARS-CoV-2 (PASC) and the protection against such risk conferred by COVID-19 vaccination on the risk of remains largely unknown. This study evaluated the progressive risk of PASC one year after infection and comparing the risk and its persistence between patients of different COVID-19 vaccination status. Method A retrospective territory-wide cohort study was conducted using electronic medical record from the Hong Kong Hospital Authority (HKHA) database. 1,166,987 patients with COVID-19 between April 1st and 2020 and October 31st, 2022 aged 18 or above, stratified into unvaccinated or in-completely vaccinated (received ≤ 1 dose), fully vaccinated (2 doses) and received booster (≥ 3 doses) of BioNtech or CoronaVac COVID-19 vaccines and non-COVID-19 controls matched by the exact birth-year and sex. Covariates between patients with COVID-19 and non-COVID-19 controls were adjusted using propensity score-based inverse probability treatment weighting. The hazard ratio of evidence based list of reported clinical sequelae, cardiovascular and all-cause mortality between participants with a confirmed COVID-19 infection and their matched controls at three-monthly interval up to one year of COVID-19 infection were estimated using Cox proportional regression model. Results A progressive reduction in risk of all-cause mortality was observed over one year between patients with COVID-19 and non-COVID-19 controls [0-30d: HR16·00 (95%CI 15·35 to 16·67); 31-90d: 3·76 (3·58 to 3·95); 91-180d: 2·17 (2·06 to 2·28); 181-270d: 1·85 (1·75 to 1·95); 271-365d: 2·01 (1·87 to 2·16)]. Patients with complete vaccination or have received booster dose incurred a lower risk of PASC including major cardiovascular diseases [dose ≤ 1: 1·69 (1·51,1·89); dose = 2: 1·04 (0·92,1·17); dose ≥ 3: 1·06 (0·95 to 1·18)], and all-cause mortality [dose ≤ 1: 3·76 (3·58 to 3·95); dose = 2: 1·39 (1·29 to 1·50); dose ≥ 3: 1·08 (0·96 to 1·22)] than un-vaccinated or patients with in-complete vaccination 30–90 days after infection. Completely vaccinated and patients with booster dose of vaccines did not incur significant higher risk of PASC from 271 and 91 days of infection onwards, respectively, whilst un-vaccinated or incompletely vaccinated patients continued to incur a greater risk of PASC including major cardiovascular diseases [1·27(1·10 to 1·46)] and all-cause mortality [2·01(1·87 to 2·16)] for up to a year. Conclusion The study findings reported a progressive reduction in risk of PASC following COVID-19 infection over a year and provided real-world evidence supporting the effectiveness of COVID-19 vaccines in reducing the risk of PASC and its persistence following infection.
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vaccination,cohort study,hong kong,clinical sequelae,territory-wide
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