Effects of COVID-19 vaccine in elderly SARS-CoV-2 infected patients_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

CHEN Qing ¹ ,  HE Wei ^1,2 ,  WU Guihui ¹ , LU Xiaoli ¹ , SUN Jiying ¹ , DAI Li ¹ , HUANG Tao ¹ , ZOU Liping ¹ , LIANG Li ¹ , GAO Ya ¹ , HUANG Xiaoqiu ³

1. Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, Sichuan 610000, P. R. China;
2. Department of COVID-19, Public Health Clinical Center of Chengdu, Chengdu, Sichuan 610000, P. R. China;
3. Medical Records Room, Public Health Clinical Center of Chengdu, Chengdu, Sichuan 610000, P. R. China;

Corresponding?author：

HE Wei, Email: 3550897@qq.com; WU Guihui, Email: wghwgh2584@sina.com

Keywords：

SARS-CoV-2; COVID-19; aged; vaccine

DOI：

10.7507/1671-6205.202206019

Video：

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Objective The current study aimed to compare the differences in clinical characteristics and prognosis of elderly patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between patients who were vaccinated and those not and to explore the clinical significance of vaccination for the elderly.Methods A total of 92 elderly patients (≥60 years old) with SARS-CoV-2 infection who were admitted to Chengdu Public Health Clinical Center from December 10, 2020, to May 2, 2022, were included, and they were grouped according to whether vaccinated. The differences in clinical manifestations, laboratory examinations, imaging, treatment, prognosis, hospitalization time, and nucleic acid conversion time between the two groups were compared in this study. Results A total of 92 elderly patients were included, with a male-to-female ratio of 1.3:1, and a median age of 66 (62, 71) years old. There were 79 patients in the vaccinated group and 13 in the unvaccinated group. The positive rate of total SARS-CoV-2 antibody in 92 patients was 91.3%, and those of IgG and IgM of SARS-CoV-2 antibody were 89.1% and 37%, respectively. The positive rates of total SARS-CoV-2 antibody and IgG of SARS-CoV-2 antibody in the vaccinated group were higher than those in the unvaccinated group (97.5% vs. 53.8%, 96.2% vs. 46.2%) (P<0.01), and COI values of total antibody, IgM and IgG were higher than those of unvaccinated group (P<0.01). The proportions of the initial symptoms of sputum, ground-glass opacity or patchy opacity involving both lungs in chest CT in the unvaccinated group were higher than those in the vaccinated group (P<0.05). The white blood cell counts and platelet counts in the vaccinated group were higher than those in the unvaccinated group, whereas the prothrombin time and D-dimer were lower than those in the unvaccinated group (P<0.05). COI values of total antibody in the 3-doses group were higher than those in the 2-doses group, and the white blood cell counts in the 3-doses group were higher than those in the 2-doses group (all P<0.05). During hospitalization, asymptomatic infection (58.2%) and general type (53.8%) was the most common in the vaccinated and unvaccinated group, respectively. Patients in the unvaccinated group were more likely to progress to severe status than the vaccinated group during hospitalization (15.4% vs. 0%, P=0.019). The unvaccinated group received more treatments of intravenous immune globulin, non-invasive and invasive mechanical ventilation, plasma after immunization of vaccine and convalescent plasma of SARS-CoV-2 infected patients than those of the vaccinated group (P<0.05). Patients in the unvaccinated group developed a higher proportion of respiratory failure, secondary infection, acute respiratory distress syndrome, and heart failure than in the vaccinated group (P< 0.05). The median lengths of hospitalization and nucleic acid conversion in the unvaccinated group were 22 (7, 32) days and 13 (2, 20) days, which were longer than those in the vaccinated group [8 (7, 12) days, 2 (2, 7) days] (all P<0.05). Conclusions Vaccination of SARS-CoV-2 can improve the positive rate of total SARS-CoV-2 antibody and IgG of SARS-CoV-2 antibody in elderly patients with SARS-CoV-2 infection, milder disease status, and can shorten the time of hospitalization and nucleic acid conversion. These results suggest that the COVID-19 vaccine can reduce the disease and improve the prognosis in the elderly.

Citation： CHEN Qing, HE Wei, WU Guihui, LU Xiaoli, SUN Jiying, DAI Li, HUANG Tao, ZOU Liping, LIANG Li, GAO Ya, HUANG Xiaoqiu. Effects of COVID-19 vaccine in elderly SARS-CoV-2 infected patients. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(7): 484-492. doi: 10.7507/1671-6205.202206019 Copy

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1. World Health Organization. WHO Coronavirus (COVID-19) Dashboard[EB/OL]. (2022-05-22).https://covid19.who.int/.
2. Verity R, Okell LC, Dorigatti I, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis, 2020, 20(6): 669-677.
3. Wang DW, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA, 2020, 323(11): 1061-1069.
4. Shapiro JR, Sitaras I, Park HS, et al. Association of frailty, age, and biological sex with severe acute respiratory syndrome coronavirus 2 messenger rna vaccine-induced immunity in older adults. Clin Infect Dis, 2022, 75(Supplement_1): S61-S71.
5. World Health Organization. Draft landscape and tracker of COVID-19 candidate vaccines [EB/OL]. [2022-05-20]. https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines.
6. 國家衛生健康委員會疾病預防控制局. 新冠病毒疫苗接種技術指南(第一版). 中國病毒病雜志, 2021, 11(3): 161-162.
7. 中國國家衛生健康委員會. 新型冠狀病毒肺炎診療方案(試行第九版). 國際流行病學傳染病學雜志, 2022, 49(2): 73-80.
8. 關于印發新型冠狀病毒肺炎防控方案(第八版)的通知. 中華人民共和國國家衛生健康委員會公報, 2021, (5): 4-60.
9. 岳勇, 梁嫻, 毛毅, 等. 新型冠狀病毒疫苗接種對成都市境外輸入病例流行病學及臨床特征的影響分析. 中華流行病學雜志, 2021, 42(8): 1365-1370.
10. Zhou F, Yu T, Du RH, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet (London, England), 2020, 395(10229): 1054-1062.
11. 陳晴, 黃濤, 楊銘, 等. 成都市不同年齡段新型冠狀病毒肺炎患者臨床特征及預后分析. 實用心腦肺血管病雜志, 2020, 28(12): 9-15.
12. Garcia-Beltran WF, Lam EC, Astudillo MG, et al. COVID-19-neutralizing antibodies predict disease severity and survival. Cell, 2021, 184(2): 476-488.
13. Wu ZW, Hu YL, Xu M, et al. Safety, tolerability, and immunogenicity of an inactivated SARS-CoV-2 vaccine (CoronaVac) in healthy adults aged 60 years and older: a randomised, double-blind, placebo-controlled, phase 1/2 clinical trial. Lancet Infect Dis, 2021, 21(6): 803-812.
14. Polack FP, Thomas SJ, Kitchin N, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med, 2020, 383(27): 2603-2615.
15. 刁凱悅, 韓沛倫, 龐彤, 等. 新型冠狀病毒肺炎胸部高分辨率CT的表現與變化特點. 中國呼吸與危重監護雜志, 2020, 19(2): 166-171.
16. Feng CQ, Shi JR, Fan QH, et al. Protective humoral and cellular immune responses to SARS-CoV-2 persist up to 1 year after recovery. Nat Commun, 2021, 12(1): 4984.
17. Wang ZJ, Lorenzi JCC, Muecksch F, et al. Enhanced SARS-CoV-2 neutralization by dimeric IgA. Sci Transl Med, 2021, 13(577): eabf1555.
18. 徐佳麗, 胡蓓蓓, 茅秋霞, 等. 新型冠狀病毒肺炎患者的靜脈血栓栓塞癥風險評估與抗凝治療. 中國呼吸與危重監護雜志, 2021, 20(2): 101-105.
19. Voysey M, Costa Clemens SA, Madhi SA, et al. Single-dose administration and the influence of the timing of the booster dose on immunogenicity and efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine: a pooled analysis of four randomised trials. Lancet, 2021, 397(10277): 881-891.
20. Ella R, Reddy S, Jogdand H, et al. Safety and immunogenicity of an inactivated SARS-CoV-2 vaccine, BBV152: interim results from a double-blind, randomised, multicentre, phase 2 trial, and 3-month follow-up of a double-blind, randomised phase 1 trial. Lancet Infect Dis, 2021, 21(7): 950-961.
21. Haas EJ, Angulo FJ, Mclaughlin JM, et al. Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data. Lancet, 2021, 397(10287): 1819-1829.
22. Ramasamy MN, Minassian AM, Ewer KJ, et al. Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial. Lancet, 2020, 396(10267): 1979-1993.
23. Feikin DR, Higdon MM, Abu-Raddad LJ, et al. Duration of effectiveness of vaccines against SARS-CoV-2 infection and COVID-19 disease: results of a systematic review and meta-regression. Lancet, 2022, 399(10328): 924-944.

Chinese Journal of Respiratory and Critical Care Medicine

Effects of COVID-19 vaccine in elderly SARS-CoV-2 infected patients

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