Viral and host factors associated with SARS-CoV-2 disease severity in Georgia, USA

• Published in: PloS one Vol. 20; no. 4; p. e0317972
• Main Authors: Carmola, Ludy R., Roebling, Allison Dorothy, Khosravi, Dara, Langsjoen, Rose M., Bombin, Andrei, Bixler, Bri, Reid, Alex, Chen, Cara, Wang, Ethan, Lu, Yang, Zheng, Ziduo, Zhang, Rebecca, Nguyen, Phuong-Vi, Arthur, Robert A., Fitts, Eric, Gulick, Dalia Arafat, Higginbotham, Dustin, Taz, Azmain, Ahmed, Alaa, Crumpler, John Hunter, Kraft, Colleen, Lam, Wilbur A., Babiker, Ahmed, Waggoner, Jesse J., Openo, Kyle P., Johnson, Laura M., Westbrook, Adrianna, Piantadosi, Anne
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.04.2025; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Asymptomatic; Biology and life sciences; Child; Child, Preschool; COVID-19; COVID-19 - epidemiology; COVID-19 - immunology; COVID-19 - pathology; COVID-19 - prevention & control; COVID-19 - virology; COVID-19 vaccines; COVID-19 Vaccines - immunology; Development and progression; Diseases; DNA sequencing; Female; Gene sequencing; Genetic aspects; Genome, Viral; Genomes; Genomics; Georgia - epidemiology; Health aspects; Host-virus relationships; Humans; Immunosuppression; Infections; Kidney diseases; Male; Medical research; Medicine and health sciences; Medicine, Experimental; Middle Aged; Mutation; Nucleotide sequencing; Public health; SARS-CoV-2 - genetics; SARS-CoV-2 - immunology; SARS-CoV-2 - isolation & purification; Severe acute respiratory syndrome coronavirus 2; Severity of Illness Index; United States; Vaccination; Vaccination - statistics & numerical data; Viral diseases; Whole genome sequencing; Young Adult; Georgia; United States; Atlanta Georgia; United States > US
• DOI: 10.1371/journal.pone.0317972
• ISSN: 1932-6203

While SARS-CoV-2 vaccines have shown strong efficacy, the continued emergence of new viral variants raises concerns about the ongoing and future public health impact of COVID-19, especially in locations with suboptimal vaccination uptake. We investigated viral and host factors, including vaccination status, that were associated with SARS-CoV-2 disease severity in a setting with low vaccination rates. We analyzed clinical and demographic data from 1,957 individuals in the state of Georgia, USA, coupled with viral genome sequencing from 1,185 samples. We found no specific mutations associated with disease severity. Compared to those who were unvaccinated, vaccinated individuals experienced less severe SARS-CoV-2 disease, and the effect was similar for both variants. Vaccination within the prior 3-9 months was associated with decreased odds of moderate disease, severe disease, and death. Older age and underlying health conditions, especially immunosuppression and renal disease, were associated with increased disease severity. Overall, this study provides insights into the impact of vaccination status, variants/mutations, and clinical factors on disease severity in SARS-CoV-2 infection when vaccination rates are low. Understanding these associations will help refine and reinforce messaging around the crucial importance of vaccination in mitigating the severity of SARS-CoV-2 disease.