Epidemiology
Table 2 Duration of symptoms and postacute sequelae of COVID-19 (PASC) following breakthrough versus non-breakthrough COVID-19 infection Breakthrough COVID-19 infection (N=116) Non-breakthrough COVID-19 infection (N=164) P value Symptom-free days during 204-day* follow-up, mean 133.8 112.4 0.04 D ifference in symptom-free days (95% CI) 21.40 (0.95 to 41.91) Reference 0.04 CDC definition of PASC (COVID-19 symptoms lasting at least 28 days post- COVID-19 infection), n (%) 48 (41) 89 (54) 0.04 U nadjusted OR (95% CI) 0.59 (0.37 to 0.96) Reference (1.0) 0.03 A djusted OR (95% CI), Model 1† 0.52 (0.31 to 0.86) Reference (1.0) 0.01 A djusted OR (95% CI), Model 2† 0.49 (0.29 to 0.83) 0.01 WHO definition of PASC (COVID-19 symptoms lasting at least 90 days post- COVID-19 infection), n (%)‡ 10 (21) 65 (41) 0.01 U nadjusted OR (95% CI) 0.14 (0.07 to 0.30) Reference (1.0) <0.0001 A djusted OR (95% CI), Model 1† 0.11 (0.05 to 0.24) Reference (1.0) <0.0001 A djusted OR (95% CI), Model 2† 0.10 (0.04 to 0.22) Reference (1.0) <0.0001 *Primary follow-up period was 204 days, given that this was the maximum follow-up period among those with breakthrough infections †Multivariable model one is adjusted for age, sex and race. Multivariable model two is adjusted for age, sex, race, comorbidity count and use of any one of the following medications: anti-CD20 monoclonal antibodies, methotrexate, mycophenolate or glucocorticoids. ‡Denominator includes those who completed a survey at least 90 days following COVID-19 diagnosis; N=47 with breakthrough infection and 159 with non-breakthrough infection CDC, Centres for Disease Control and Prevention; WHO, World Health Organization.
Patient-reported outcomes including pain, fatigue, functional status and rheumatic disease activity following COVID-19 infection Pain and fatigue were less severe in those with breakthrough infection than in those with non-breakthrough infection (SF- MPQ: median score of 4 vs 5, p=0.04 and FSI: 48 vs 55, p=0.08, respectively) (figure 3A,B; table 4). Functional status (mHAQ) scores were similar between those with and without breakthrough COVID-19 infection (median of 0.1 in each group, p=0.88) (figure 3C). Health-related quality of life, as assessed by the SF-12, was similar among those with and without break- through infection (figure 3D). The median (IQR) PCS-12 was 43.6 (33.7, 52.6) in those with breakthrough infection compared with 41.0 (32.2, 49.5) in those with non-breakthrough infection (p=0.11), and the median (IQR) MCS-12 was 49.4 (41.4, 55.6) in those with breakthrough infection compared with 50.2 (37.9, 57.0) in those with non-breakthrough infection (p=0.86).
Figure 1 Adjusted days to symptom resolution in those with breakthrough versus non-breakthrough COVID-19 infection over 204- day follow-up period. PASC, postacute sequelae of COVID-19. (A) Cumulative incidence curves for time to symptom resolution, comparing breakthrough versus non-breakthrough infection. (B and C), mean post-symptom resolution time spans as the area under the cumulative incidence curves in those with breakthrough versus nonbreakthrough infection, respectively, across 204 days of follow-up.
Figure 2 Proportion experiencing postacute sequelae of SARS CoV- 2 among those with breakthrough and non-breakthrough COVID-19 infection. *Based on the Centers for Disease Control and Prevention Definition of PASC (COVID19 symptoms lasting at least 28 days post- COVID-19 infection) or the World Health Organization Definition of PASC (COVID-19 symptoms lasting at least 90 days post-COVID-19 infection)
Patel NJ, et al . Ann Rheum Dis 2023; 82 :565–573. doi:10.1136/ard-2022-223439
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