Q&A: Does vaccination prevent long COVID?
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Vaccination may not fully protect people from long COVID symptoms if they experience a breakthrough infection, according to a study published recently in Nature Medicine.
The study of nearly 34,000 vaccinated Veterans Affairs patients with breakthrough SARS-CoV-2 infections found that they had a higher risk for death (HR = 1.75; 95% CI, 1.59-1.93) and incident long COVID (HR = 1.50; 95% CI, 1.46-1.54) compared with almost 5 million contemporary controls with no documented SARS-CoV-2 infection.
The long COVID symptoms included cardiovascular, coagulation and hematologic, gastrointestinal, kidney, mental health, metabolic, musculoskeletal and neurologic disorders.
Additionally, compared with unvaccinated patients with a SARS-CoV-2 infection, patients with a breakthrough infection had a 34% lower risk for death (HR = 0.66; 95% CI, 0.58-0.74) and 15% lower risk for incident long COVID (HR = 0.85; 95% CI, 0.82-0.89).
“Altogether, the findings suggest that vaccination before infection confers only partial protection in the post-acute phase of the disease; hence, reliance on it as a sole mitigation strategy may not optimally reduce long-term health consequences of SARS-CoV-2 infection,” Ziyad Al-Aly, MD, FASN, chief of research and development at the Veterans Affairs St. Louis Health Care System, and colleagues wrote.
We spoke with Al-Aly about the study.
Healio: What impact does vaccination have on the risk for long COVID?
Al-Aly: Vaccines reduce but do not eliminate risk of long COVID. This really means that we cannot rely on vaccination alone to protect us from the long-term consequences of long COVID. Vaccines are an imperfect shield, and you don't want to go to battle with a shield that only partially works.
Healio: Are there clinical differences in long COVID depending on whether a person was vaccinated or not?
Al-Aly: Long COVID is phenotypically indistinguishable in people who are vaccinated and unvaccinated, meaning that the clinical features and the symptomatology are the same. The fingerprints of long COVID are the same.
Healio: Besides vaccination, what else can be done to reduce a person’s risk for long COVID?
Al-Aly: The best way to reduce long COVID is to reduce COVID-19 in the first place and reducing risk of exposure to COVID. I still really think that prevention of primary infection through masking and reducing risk of exposure is important. In people who are already infected once, prevention of reinfection is also important. Furthermore, we need to understand that masking and other public health measures cannot be implemented over the long term. We really need to develop prevention strategies that would be accepted by the public and could be implemented over the long term. We also urgently need to develop treatment for long COVID.
Healio: What would long COVID-specific vaccines or therapeutics look like?
Al-Aly: We don't know all the answers, but our current vaccines were not designed with long COVID in mind. They were designed to reduce risk of severe disease, and they do very well in that regard. We need to better understand the biology of long COVID so we can design interventions to prevent it and treat it.
Healio: What other aspects of long COVID do you think most need to be researched? Are any projects in the works?
Al-Aly: We need to develop a deeper understanding of long COVID, and most importantly, we need to develop treatment for long COVID. There needs to be urgency around this issue. Long COVID is a huge health crisis, and it needs to be addressed with urgency and resolve.
References:
Al-Aly Z, et al. Nature Med. 2022;doi:10.1038/s41591-022-01840-0.
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